A Lose/Lose Situation

My husband slams the table, surprising the doctor and I both. “You’re lying to us!”

To her credit, the oncologist doesn’t flinch as he leans towards her. “I know this must come as a big shock.”

“We came here to help her depression and now you’re telling me she’s got a tumor in her head? Her head doesn’t even hurt!”

I’m the her, and I suppose I should be advocating for myself, but I’m so shocked that I don’t particularly want to speak. There can’t be a tumor in my head. I came to the doctor because my therapist said I should seek medication. Why would a doctor say that to me?

Terrence is still yelling. “What proof do you have that anything you’re saying is true?”

Very calmly, the oncologist points to the fMRI printout she’d placed in front of us when she’d began this conversation.  “The tumor is here. It’s been growing very slowly for few years.”

“Do another test! How can you be sure?”

“We will do more tests.” The oncologist has been very patient, but her lips are pursed. She’s nervous about something—that’s probably not good. I should probably say something. It is my head, after all. “However, I… I need to have a meeting with you both, and I’ve brought in my colleague, Dr. Shifokor, to help explain all of our options here.”

Terrence looks like he’s going to yell again, so I find my voice before he can. “What… uh… kind of doctor is… Doctor…?”

“Shifokor.” The oncologist steeples her fingers. “He is a psychiatrist, one of the specialists we have here at the hospital.”

“Finally!” Terrence crossed his arms. “This is what we came for. Real psychiatric help. No more of these useless tests.” Neither the oncologist nor I mention that not two seconds earlier, he had been shouting about getting me more neurological tests.

I want to ask why I would need a psychiatrist if all that’s wrong with me is the brain tumor, but I can’t find the words. Everything is happening so quickly. Fleetingly, I wonder if I should call my therapist.

“Would you like me to bring him in now?” The oncologist tries to catch my gaze.

“Yes!”

“I asked her, Mr. Saraton.” The oncologist seems to be losing her patience with Terrence, which I can’t really blame her for.  Compared to her, he must seem like a child. We’ve been married three years, but since we eloped right out of high school, most people assume we’re newlyweds. I can’t blame him though. My husband is a great strength to me—I tend to doormat, and he stands up for me when it’s needed. However, in situations like this, in which I go completely numb, he can come off a little brash.

It takes me a minute to figure out how to answer the question. I hope she doesn’t think I’m an idiot, although she’s probably seen so many people try to deal with this sort of news that my reaction isn’t abnormal. “Yes… I would like to, uh, I would, yes.”

The oncologist nods, a half smile dancing at her lips. It’s supposed to be sympathetic, I think, but it’s not really working. It’s strange. I’m acutely aware of the fact that I’m not dealing with the reality at hand. Maybe it’ll kick in later, when I’m at home and it’s just me and Terrence. Maybe something like this never kicks in. Or maybe I’m just not feeling the strain yet because of the depression that brought me here in the first place. The oncologist picks up her office phone and I can’t help but notice it has a cord. I definitely shouldn’t be concentrating on those kinds of details—there are much more pressing matters at hand I know—but it’s the first time I’ve seen a corded phone in what, ten years? Probably more? “Dr. Shifokor? Could you please come to my office for a consultation?”

While we wait, the oncologist shows me some pamphlets. She tells me that she understands news like this can be confusing and it can be really helpful to find a community to latch on to. She also gives me some literature to give to my friends and relatives as well, telling me that it can be really frustrating when friends and relatives don’t know how to react and this might help them help me. I’m glad she’s giving these to me, but I can’t imagine my friends and family actually reading them. I can only imagine how my mom will react—she’ll cry, wrap me in her arms and squeeze for an uncomfortable amount of time.

My eyes skim the words on the pamphlets, letting the voice of the oncologist wash over my ears. I hope Terrence is listening, because I’m sure not. The creak of the door opening shakes me away from the pamphlet and a short man with tanned skin and smile lines around his eyes walks in. He shakes my hand first, then my husband’s. “Hello, I’m Dr. Shifokor, the head of the psychiatric department here at South Shore. You must be…”

It takes me a moment to realize what he wants me to say. “Oh, uh, Eva. Eva Saraton. And this is my husband Terrence.”

Dr. Shifokor glances at Terrence and nods in acknowledgment before turning back to me. He sits down next to me so I have to swivel away from my boyfriend to look at him. “So, I know this is all fast for you, but after reviewing your file, we thought it best to have this discussion as soon as possible.” He grabs the clipboard off the oncologist’s desk and flips through the papers absently. “According to your fMRI, you’ve got a tumor that may be interfering with activity in your subgenual cingulate cortex.”

“Uh huh.” I’ve got no idea where that is, but I feel like I should, so I don’t want to ask.

“It’s alright if you don’t know where that is, I had to look up how to pronounce it before I walked in.” Wow, he’s really good at this. “It seems to be slow growing, and we’ll perform a few more tests to be sure, but because of its… placement, we wanted to have this consultation with you first.”

“Its placement?”

“It’s near the section of your brain that affects guilt, empathy, attachment to others.” He says all of this so smoothly I can’t help but wonder how long he has been practicing. “If it gets much bigger, it might grow too near your amygdala and limbic system. There’s a lot of important stuff in there, which is why we had to have this conversation so quickly.”

“Alright.” A thought occurs to me, shaking me out of the numb reverie I’ve been in since the oncologist first said the word tumor. “Wait, did you say feelings of, like, guilt? Could that be—” I turn and look at my husband, who smiles encouragingly. “Could that be part of my… my depression thing, going on?”

“Dr. Shifokor nods emphatically. “Actually, upon reviewing your case, we believe it may be the primary cause for your depression. Our best guess is the tumor began to grow a little over a decade ago, which lines up with your psychiatric records for depression treatment.”

“So getting rid of the tumor would… would cure me?”

“That’s not exactly how it would work. For starters, it is still unclear whether or not we could remove the tumor in the first place. We’d need to shrink it first, most likely with radiation or other drug therapies before we’d even try. However…” He pauses for a second, and he looks a little more uncertain, as if this is territory he’s never had to cover before. In general, I feel, it’s never good when medical professionals look uncertain, especially when they’re looking at your charts. “Well, that’s the problem. We’ve been reviewing your… your childhood psychiatric records and… well… they paint an interesting picture.”

I wince. I was a little nightmare when I was younger—I had severe anger issues that therapy couldn’t touch that lasted until I hit puberty. I still feel guilty for what I did to my parents—I was such a manipulative, aggressive little prick and they still loved me anyway. “Yeah, I uh… I was a pretty bad kid, but I got better.” Sort of. I traded anger issues for moderate to severe depression—I suppose that’s better in that it hurts less people, right?

Dr. Shifokor purses his lips. “Well, upon review… it would appear that you showed signs of psychopathy as a child.”

It takes me a second to really take in his words. I’ve been called a lot of things—a pushover, a softie, a doormat, pathetically empathetic—but never psychopathic.

Terrence agrees, apparently. “Eva? No way. There’s no way. She cares about everyone. She can’t play Minecraft because she feels bad about killing the animals. She’s the person least likely to be a psychopath in the whole world.”

His faith in me is outstanding, but Dr. Shifokor’s grave eyes force me to listen to him. “The tumor started growing around the same time you started to hold back some of your violent urges due to age. The guilt the tumor induced was misinterpreted by the adults in your life as you developing a stronger moral code. It’s all here, in the notes of your old therapist. They were actually considering diagnosing you with antisocial personality disorder—that’s what psychopathy or sociopathy in children is often called, since they can’t be officially diagnosed as psychopaths—but then you started to make real turn arounds when around the age of ten and they figure you just grew out of it.”

I pull my knees up into my lap. I’ve tried to ignore that part of my history, that violence and disconnect from my family. “What are you saying? All my empathy comes from this… this tumor in my head?”

Dr. Shifokor bites his lip. “Well… I’m not sure if what you’re feeling really is empathy. What’s described in your therapist’s notes is… well, it’s more like you feel such extreme guilt for everything you do that you try everything you can to escape it. Your therapists when you were a child told you that guilt was what happens when people are hurt because of you, so you just… always assumed that the guilt you felt was because you were hurting people and it drove you into the depression you’ve suffered from for the last decade.”

That’s a lot of information to take in all at once. “Are you… I mean, is this just a… a guess?”

“I suppose so, in that much of what I do is a guess. I would say it is an educated guess though. I’ve discussed this with every psychologist and psychiatrist in my department, and this makes sense.”

“Oh.”

For once, when I turn to Terrence, he is silent. I guess I have to say something. What is the adult thing to say in this situation? Is there any situation like this?

“What do we do next?”

“Well, there lies the problem. The tumor is growing, but it’s growing so slowly that it hasn’t caused any major problems. If you hadn’t come to the hospital and happened to get an fMRI, you might have lived an entire life without ever knowing it was in there. The symptoms it is causing—the depression—we might be able to help with a drug therapy combo. Unfortunately, it also could start to grow at a faster rate—your symptoms have gotten much worse lately, which could indicate growth.”

“Could you… take it out, then?”

“Maybe. We might be able to. The only issue would be… you might lose your empathy. If you were, indeed, born a psychopath, your brain is differently composed than a… an average brain. You might lose your ability to connect with other people and understand what they’re feeling. You might go back to being just as manipulative and aggressive as you were when you were a child.”

Wow. He really did not pull any punches. The room holds silent for a few minutes while I try and fail to take all that information in.

“We don’t expect you to make any decisions now,” the oncologist says, placing her hand towards but not on top of mine, which I appreciate.

“Thank you,” I say, and I look at my husband, and he looks back helplessly.

Three weeks later, I find myself the head of a surprisingly formal meeting in my brother’s living room. He’s seven years older than me, so he remembers all too well how I used to be. My mom dressed up for the occasion, which is strange—it’s really just a weird family discussion. My brother’s husband flits in and out of the room, nervously bringing us drinks and trying to keep my father from crying. It isn’t working. At least Terrence seems steady, although I fear he’s just holding it together for me.

“Alright.” I clap. I don’t really want to lead, but it is my head after all. “So. We, uh, me and Terrence, uh, wanted to get you guys together to talk about, uh, what you guys think I should do. About my tumor. And, uh. My. Psychopathy.”

My brother rolls his eyes at me, and it feels normal. Weirdly comforting. “So what should we do, make a pros and cons list?”

He’s kidding, but that’s not actually a bad idea. “I figured we’d just kinda chat about it… see what you think…”

“Well,” says my mother, also clapping her hands, “I think you should get whatever treatment is there. There’s a ticking time bomb in your head—we’d be stupid to not try and get it out.”

“But the doctors don’t know if it’ll even impair her,” my father argues, wiping tears onto his sweatshirt sleeve. “She could live so many years just like she does now. She could be…”

He stops right before he says ‘happy,’ leaving an opening for my brother to mumble “Severely depressed.”

“Simon!”

“It’s true!”

“But we can treat the depression,” Dad continues. “They said we might be able to treat it though, with a drug cocktails and therapy and stuff. We could treat it and she would be able to live like she always has.”

“Or she could die of an untreated brain tumor.”

“We wouldn’t even know she had a brain tumor if not for the fMRI! Imagine how much stuff would be wrong with me if you scanned my brain and body!”

“The tumor is already messing with her brain. Besides,” Mom says, looking at me encouragingly. It’s like she doesn’t remember all the years I made her life so difficult as a kid. “She’ll remember what it was like to have empathy, so she won’t be like normal psychopaths, right?”

“Either that or it’ll make it so much more difficult for her because she used to have empathy and she won’t anymore. Imagine how frustrating that would be.”

“She wouldn’t just forget. She would remember. And besides, psychopathy isn’t a death sentence.” My mother looks unduly proud of herself. “I’ve been reading online. A lot of people diagnosed with psychopathy live full lives—they just have to like, check in a lot more with the people in their lives. I don’t want my daughter living with a bomb in her head.”

“And I don’t want my daughter to get alienated and have all her relationships stripped from her.”

“We don’t even know if she would react that way. She was never diagnosed with psychopathy as a kid anyway.”

“You can’t diagnose kids with psychopathy.”

“You know what I meant, Douglas.”

“It’s not your decision, Karen.”

“It’s hers,” Terrence says loudly, looking at me. And it is, which is unfortunate. This would be a lot easier if someone else could make this decision for me. There’s just no… no certainty. I can’t guarantee I will die of a brain tumor, I can’t guarantee I won’t become a manipulative liar, I can’t guarantee anything about any of the futures. A lot of my mind is telling me that if I keep the tumor it’s a win/win—either I can keep making the people I love happy or I die. Either way I don’t have to hurt them by being a way I don’t know if I’ll be able to help. What would my life be if I wasn’t such a… a doormat, willing to do anything for anyone and ignore myself. After all, what is living if it is not a culmination of all the good you can do for others? That’s the principal I’ve been living for all of these depressed years. But choosing to die, which is what they’d see if I refused treatment, would also hurt them. It’s a lose/lose, as things so often are. Do I improve my quality of life while making theirs a bittersweet hell or do I risk an inevitable sorry for them for a few more years of normalcy?

I look at the family I have in front of me, a jury of love, people who are so willing to argue and fight for me. And I figure out what I want to do.

The oncologist nods solemnly when I tell her my choice.