The Sad Truth About Happiness Read online

  Lucy had become someone I hardly recognized—inactive and passive. I was afraid that her decision to marry Ryan might be a mistake that could only be undone with great difficulty and pain, that she would be unable to resist blaming Ryan later, and maybe the baby, for taking her from her old life in Rome and replacing it with one that was predictable, conventional, and perhaps loveless. I felt certain, though, that Ryan would not change his mind about marrying Lucy. He adored her. He smiled whenever anyone mentioned the baby, a smile that smoothed his brow, crinkled the corners of his brown eyes, and dug deep brackets in his freckled cheeks.

  There is a kind of very nice man who tends to marry short-tempered or self-absorbed, even neurotic, women, maybe because such women provide their lives with some critical measure of conflict and friction, or because this sort of man realizes that he has enough virtue for two. Or it may be that the cheerful expansiveness of such a man makes him unable to believe that the selfishness manifested by the woman he loves is either inherent or incurable. Ryan is this kind of good-souled man, which is why, it seemed to me, he was prepared to put up with Lucy’s gloomy inertia.

  Janet’s husband, John, is another example. John is one of the most sociable people I know. He adores the dynamic, looping intricacies of a good conversation. He dives into talk like a swimmer, leaning in toward the others in an irresistibly attentive and energetic way. He never falls prey to the common male vices of feeling impelled to do most of the talking, or to ensure that his views prevail. John has an astonishing ability to remain his convivial, deft, concentrated self even while working a room. When he throws a party or book launch at his store, he bounces around on his small feet (he is a very large man), managing to spend an equitable amount of time with everyone without appearing rushed or unctuous or superficial or overly adroit. John owns one of the few remaining independent bookstores in the city, and it thrives, not in a major way but consistently. His store is called Niche Books, and the name describes both the small, specialized markets he serves and the interior of the store, which is painted in browns and golds and wine colors, and has wooden cabinets and shelves, most of which John built himself, many nooks and alcoves, and window seats with red-and-black-checked cushion covers. Janet worked there full-time before the twins arrived. She worked part-time after that, and quit altogether when Marie was born. She was also, I finally learned, taking a single, eight-sided yellow Pacicalm every morning and she now appeared to be happier than anyone I knew or have ever known—a change that I found not entirely settling.

  “My moods were chemical, Maggie,” she told me one day when Marie was four months old. I was visiting her on a Saturday afternoon. The twins were playing around our feet and Marie was sleeping in my arms.

  “I felt things slip sideways after I was pregnant with the twins,” Janet continued. “I couldn’t bear it. I felt as though a gaping black hole was opening up in front of me. But it wasn’t until after I had Marie that I knew something was seriously wrong with me. I became more and more convinced that it would be better for the children and for John if I wasn’t around anymore. I began to be obsessed with the idea that I had to find a way to disappear, to take myself out of their lives, for their sakes. I found myself scouting out single mothers at the park and at the community center to see if there was anyone who might be a good replacement for me if I could just devise a way to introduce her into our lives before I left. But John realized that something was wrong. He caught me crying in our bedroom and in the kitchen—the stupidest places—and he noticed that I was losing weight. I wasn’t eating; I was living on coffee and nerves. He suspected that something was wrong with me physically, and he insisted that I go to see our doctor. I didn’t intend to tell her anything, but I had been through a bad day when she saw me. I was at the lowest point ever. I think I weighed less than a hundred pounds. I was a wraith. My hands were shaking, for god’s sake. She asked me a few questions. Had I been sleeping? Eating? Thinking about harming myself? It spilled out. All of it. I couldn’t have managed much longer. I was coping on the surface, but underneath I was miserable, terrified, sick with anxiety. I didn’t feel like a good mother or a good wife or even a good person. Taking care of myself didn’t seem to be worth the effort. Some days I couldn’t even lift my arm to comb my hair. The doctor said that this depression, or whatever it is, has probably been affecting me all of my life, at least since my early teens. These things are hormonal. The changes of having children make it far worse for some women. But now I’m fixed. It was that simple. One pill a day, every morning. It’s marvelous. I wasn’t meant to be unhappy. My chemistry was a little out of whack, that’s all.”

  I have never been in the habit of worrying about myself. I was pleased with my new job at St. Matthew’s, which I had discovered I was good at. It was a sea change from being a receptionist, which I had stuck to—amazingly, looking back—for eight years. I had held the job summers when I was going to university and I went back when they needed someone in a hurry right after I graduated. Then somehow I had stayed on for years. The firm had a hard time keeping receptionists. All of the women—I have never met a male receptionist—who had been in the position before me had either married one of the lawyers or clients and quit, or taken the first opportunity that came their way to move “up” into secretarial work, and so the firm was willing—eager—to overpay me.

  I was bored from the first day. Remembering people’s names, taking coats, and bringing cups of coffee—that strong, cindery law-firm coffee—taking messages, listening with half an ear to the couriers chatter about their drug trips, parties, near-misses in traffic, bruised shins and hearts, and puny paychecks. But, whenever I looked at other jobs, like editing, or even, one time, a position as a trainee insurance underwriter, I found that they either required long hours, or paid terribly, or both. I was able to stand it for so long because I spent most of the time in a kind of trance. I could read novels when things were quiet, which was a good deal of the time, so I spent those years working my way through the nineteenth- and twentieth-century women writers—novelists, poets, essayists, everything. For some reason, mostly men had been taught when I did my English degree. I got an entire second education. I read Mary Shelley, the Brontës, Virginia Woolf, Margaret Drabble, Margaret Atwood, Alice Munro, Doris Lessing, Joyce Carol Oates, Edna O’Brien, Nadine Gordimer, Jane Smiley, Amy Clampitt, Carol Shields, Barbara Kingsolver, A. S. Byatt, Annie Proulx, Muriel Spark. I was a dreamy, inattentive receptionist, running on automatic, making the appropriate sounds and acting out the expected role. The better part of my mind was always somewhere else entirely.

  Aunt Rae’s money when it came—twenty-five thousand dollars each for me and my sisters—was large and unexpected enough to pull my head out of my books, an odd and sudden sensation, like a champagne cork jumping clear of the bottle—I could almost hear the pop. I knew it was time to make a change. I ordered brochures from a half-dozen universities and spent several weeks at my desk reading them between hanging coats and connecting calls. I actually got as far as sending in the forms to apply for admission to the graduate English program. That was when Luba found a lump in her breast, and I made the switch to radiation technology. I had the prerequisites, and the course seemed doable and more obviously practical than a higher degree in the arts.

  One of the requirements for the students in the program was to have a mammogram ourselves. I was one of the few who did not find it painful. The job of the technician is to arrange the breast and as much of the surrounding tissue as possible on a metal plate. Another plate is screwed down on top of the first, with the tissue pressed out as evenly as possible in between. Then a low-level x-ray beam is sent through the tissue to produce a picture in the form of a flat-film negative. The negative creates a two-dimensional representation of the breast—its lobes, ducts, blood vessels, and soft or fibrous tissues. Soft tissue, such as fat, shows up on the film as gray. Lobes, fibrous areas, ducts, and tumors, if they are present, show up as whiter areas, crystals of snow
in a field of gray granite.

  I had never had a mammogram before. Most women don’t start having them until they are about forty, depending on their risk factors. One of the other students, a young Chinese-Canadian woman, with a sensitive round face and delicate hands, switched immediately afterward to the pharmacology program. She could not, she said, imagine inflicting such a humiliating, tormenting procedure on anyone. But to me the procedure felt like being stretched and pulled, no worse than that.

  Everyone’s response to pain is different. There is no way to be sure that any two people feel pain in the same way. So much depends on our idiosyncrasies, how finely attuned our nerve endings are, how tightly or loosely our pain receptors are wired in to our brain and spine and fears. Our responses are entwined with our history and emotions, and are unmeasurable in any case. Even if we did all experience the same stimulus in the same way, there would be no way of knowing it. It is impossible to tease out the physical from the complex overlay of our motivations, anxieties, and tolerances. Pain has a limited and far from perfect vocabulary. I read once about an African language that must have arisen in a country with a great deal of experience with suffering. This language had a word for a malaise as specific as a painful pinching in the armpit. English is much less precise. Not much useful is conveyed by the words “sharp,” “searing,” “throbbing,” or “dull.”

  Quite a lot of pain arises out of simple fear. I sometimes reassure the more nervous patients who come in for routine screening by reminding them that, although a mammogram can be uncomfortable and frightening, they are far more likely than not to receive a notice in the mail a few weeks later saying that nothing unusual was found. What I don’t say, but believe, is that even women who are going to receive very bad news are better off knowing and planning for the worst.

  I have also learned that no two sets of breasts are identical. Although of course they mostly follow the same basic template, they come in an expansive range. I have been surprised by how often breasts remind me, oddly, but perhaps appropriately, of food. They can be as lumpy as potatoes, as firm as mangos, as soft as butter, as fine and consistent as white flour, as withered as windfall apples, as dimpled as cottage cheese, as stiff as meringues, as round and dusky as plums, as flat as naan bread, as pliable as dough, as golden as lemons, as dusky as late fall grapes sprinkled with frost and yeast. They come in all colors and sizes. Some breasts are enormous. I remember one woman who raised her sweatshirt and nursed her newborn son for a few minutes to settle him before we started on her mammogram. He was exceedingly small, a preemie perhaps, and as red as a crab. He sprawled out like a minute red spider clinging to the vast expanse of her yellow, pillowy breast. Some women have a scant thimble of breast tissue, or a saucer, teacup, or baseball cap full. Some have breasts with skin so transparent the veins show through, like a roadmap from the heart to the surface. There is an endless array of nipples: red, orange, peach, brown, black, blue, yellow, cream, nipples smooth as a kindergartner’s knees, nipples surrounded by tendrils of short, fine hair or ringed in dark fur, nipples the size of dollar coins or larger, nipples as small as a thumbprint, nipples pointed in every direction: forward, downward, upward, sideways, even crossed like lazy eyes. Some women have inverted nipples, which always remind me of seersucker. I have seen several pierced nipples, which I find unsettling—an odd and counterintuitive impulse, to poke holes in ourselves. One of the other technicians had a woman come in who had three breasts, two in the normal places and a third, much smaller, below the others. In one of my textbooks there was a picture of a man with twin rows of rudimentary nipples on his torso, like the buttons on a double-breasted suit. And, of course, many women have been left with only one breast.

  Most women are relatively matter-of-fact about having a mammogram, especially once it becomes routine. But some of them have an intense and complicated relationship with their breasts. They are shy about them, or humble beyond all reason. They worry that their breasts are too small, too large, uneven, lopsided, stretched out, too low, too high, too far apart, a strange shape, or tipped with the wrong sort of nipples. A few women actually apologize to me before opening their gown, their hands hovering in the air, shielding their breasts from impending scrutiny. A lot of fuss over sweat glands, which is what breasts are, essentially. Enlarged, specialized sweat glands. Breasts have become loaded with meaning, far more than they can bear. We are fascinated by them; we interpret them like a text, men and women both, in much the same way that we read faces, for signs of sexual availability, modesty, or confidence, and we label them: beautiful, sexy, maternal, comfortable, thrilling. A woman’s breasts provide balance and ballast. They ornament her, attract a mate, enhance her sex life, and feed her children.

  And they can kill her, which is the reason the women come one by one with their breasts two by two into the clinic where I work. The machine that I operate provides a shower of low-level x-rays, invisible rays of energy that travel though the breast and leave a record on the film of any dense, irregular areas. Trouble spots show up as small white specks gathered together like a distant constellation in the breast’s gray expanse.

  I take infinite care. It is important to me to get it right the first time, to avoid having to call a patient back in. I check and check again to make certain I have produced an accurate picture, one that the radiologist will be able to read readily. Whenever I see any sign of thickening, hardening, or other transformation, my breath catches at the back of my throat and I experience an instant, sympathetic ache inside my ribs. These whiter areas—they look like starbursts in a night sky—will cause the radiologist to frown into the shadowy film, striving to read their meaning, interpret their message. The radiologist may start to consider, even run through the words that may become necessary. How to tell a woman—it is almost always a woman—that her life might just have changed from an orderly unfolding, opening and spreading like the unfurling of a perfectly made origami bird, to something crabbed and closed, clenched tight against the dreadful draining of hope?

  It has recently occurred to me, in part because of my somewhat unusual circumstances, that hope is a fundamental part of the human condition, a characteristic inherent in our species. In school as a young girl, I was taught that we are tool users and that we have opposable thumbs—these were the traits that set us apart from the other animals. It has become clear to me that this is not sufficient to define what makes us human, and I have come to think that hope may be the missing and defining element of our natures. Because we have the ability to contemplate the future and compare it to the images our imaginations conjure, and because of our stubborn un-uprootable expectation that the machinery of providence will continue to function, we have hope.

  It seems to me not entirely impossible that we might be found to have somewhere in our chests or brains, or in one of the twists of our damp, shiny bowels, an as yet undiscovered gland whose role it is to produce faith in life’s outcomes—a rich, oily substance that suffuses our cells and subsumes fear. Although hope often defies common sense, paradoxically, the ability to sustain hope in the face of affliction and tragedy, the ability to place a fundamental level of trust in the world and its offerings seems to be the very hallmark of mental health. Something to love, something to do, something to hope for. Someone, I can’t remember who, once said these are the essentials of happiness.

  Hope cares nothing, I have noticed, for facts. It is unrealistic, impractical, frivolous, unserious, idealistic, a kind of magician’s trick. After it has been folded, spindled, and mutilated, sliced, diced, and scorched, it bursts forth fresh and whole and beautiful, like the spring’s first green shoots or a baby’s first lusty, longing cries.

  A man beside me on my flight back from Italy that time I went to visit Lucy crossed himself hurriedly as the plane took off, in hopes, no doubt, of coming down again safely. I felt the same hope, and it must have sprung from the same place and need, although I kept my hands neatly folded in my lap. My hands have no practice in invokin
g the gods to provide me with favorable outcomes.

  Some of the people I see are very sick, sick beyond the power of words to describe, but few are truly lost to absolute despair. Although they may have spent thousands of hours feeling sorrow, anger, helplessness, and fear, hope seldom seems to leave them entirely. If there are hours when only the most ghostly memory or shadow of hope remains, in time it rushes back like the surging salty tide, sweeping, brave, doughty, optimistic, ridiculous, grand. People from whom hope has retreated—I see them sometimes in the waiting room at the hospital: the husband sitting in one of the orange plastic chairs clenching and unclenching his large, empty, powerless hands; a patient’s sixteen-year-old daughter with a pierced, pouting, blood-dark lower lip, and with thick and sullen eyebrows drawn low over flat, anxious eyes; the preoccupied mother in her late fifties whose vibrant daughter is my patient, who reads to her three small, edgy grandchildren as she waits—these people look as untethered as a kite whose string has snapped, as abandoned as a failed farm left unprotected from the scouring wind. Hope has departed abruptly, without notice, and without any promise of ever coming back.

  “Never allow your patients to lose hope, even when they are obviously dying,” one of my instructors taught us. He reminded us in the next breath not to encourage people who are sick or dying to place their scant store of hope in false treatments or impossible cures or miracles, and instead urged us to remember to encourage hope for other, perhaps attainable, goals. To have time to spend with the people we love. To have the strength to attend to things undone. To have the ability to forgive, and to set aside all bitterness. Not to suffer unduly. Not to die alone.

  Mostly, of course, what my patients hope for is life itself. An elderly neighbor of my parents died early last February. In the sweet, soft days of early March, I was surprised to see crocuses sprout all over her front yard, their bright heads bowed as if in prayer to the pagan gods of spring. They were scattered throughout the grass in small haphazard knots and random clusters, rather than tucked away neatly in the flowerbeds or marshaled into straight rows. At first I imagined that my parents’ neighbor had planted the bulbs last fall as a kind of joke or cheerful welcome to passersby in the spring since she must have known that she could not possibly expect to be there herself to greet them. It was only recently that it occurred to me that she must have planted them for herself, hoping against all hope to be there to see them on that cold, bright, sunny morning when the first pastel shoots rose up in the grass, as vibrant and brave as flags after a terrible storm.