Only sisters, p.1
Only Sisters, page 1
ALSO BY LILIAN NATTEL
Girl at the Edge of Sky
Web of Angels
The Singing Fire
The River Midnight
PUBLISHED BY RANDOM HOUSE CANADA
Copyright © 2022 Moonlily Manuscripts Inc.
All rights reserved under International and Pan-American Copyright Conventions. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer, who may quote brief passages in a review. Published in 2022 by Random House Canada, a division of Penguin Random House Canada Limited, Toronto. Distributed in Canada by Penguin Random House Canada Limited, Toronto.
www.penguinrandomhouse.ca
Random House Canada and colophon are registered trademarks.
LIBRARY AND ARCHIVES CANADA CATALOGUING IN PUBLICATION
Title: Only sisters / Lilian Nattel.
Names: Nattel, Lilian, 1956- author.
Identifiers: Canadiana (print) 20220212821 | Canadiana (ebook) 2022021283X | ISBN 9780735277069 (softcover) | ISBN 9780735277076 (EPUB)
Classification: LCC PS8577.A757 O55 2022 | DDC C813/.54—dc23
Text design: Kelly Hill
Cover design: Kelly Hill
Image credits: (Robin) sylviacphotography/Getty Images
a_prh_6.0_140577850_c0_r0
For Donna Rhindress, BFF,
who has the gift of always looking truth in the eye
And in memory of Frances Greenbaum
CONTENTS
Cover
Also by Lilian Nattel
Title Page
Copyright
Dedication
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Acknowledgements
About the Author
CHAPTER 1
I agreed to become my sister during a polar vortex. It was her fifty-ninth birthday, and we were ten thousand kilometres apart. I was sitting on my bed, and though the city was encased in ice, I had the window open. With the superpower of a menopausal woman, I could melt mountains of snow. The computer was on my lap, a frigid breeze tapping my hot cheeks, while my sister kept breaking up on the screen. It was midnight in my time zone, an hour before dawn in hers. She was a nurse working in rural West Africa, where the seasons were wet or dry but never cold. Her nose was sunburned and peeling. There was a vase of spiky crimson flowers nearby. A fan whirred, stirring her hair.
My sister was named after the movie star Vivien Leigh, whose beauty and grace our mother adored. I was named Joan after no one in particular, and as a child, that worried me. I also worried about pollution, nuclear war, being too ugly to be loved, everyone in my family dying, the callus on my finger (I thought it was a symptom of yaws, a rare tropical disease), getting a B in math, going blind and how to use tampons. (I still worry about going blind. Also, climate change. Flying. And whether I’m ugly.) I wore thick glasses when I was young. Except for that, my sister and I looked very much alike, though she grew up to be a beautiful woman. Even our parents couldn’t tell our voices apart on the phone. In temperament, we were as different as water and wine. While I stayed home, my sister travelled the world. She was nonchalant about sharing her bed, picking up and dropping men at whim. I’d had one serious relationship. She delivered babies, bringing life into the world. My patients were dying. She needed to be free, but I needed to be good.
She’d messaged me earlier in the day, while I was on my way to see a patient. I was late because the cold had killed my car battery, and I’d had to wait for a boost. Hurrying along the twelfth-floor corridor of a waterfront condo, I heard my phone whistle. On the lock screen: Vivien Connor: Skype call tonight at 10 your time?
It was always Skype—I didn’t use social media or messaging apps other than what came with my phone. I wrote back, Sure, as if we talked all the time, and stuck the phone back in my jacket pocket. That winter I had a new jacket, waterproof with a removable lining. There was another coat I’d tried on, a black wool that made me feel as chic as a Parisian who only had to lift her chin to stop a taxi, but I visit patients in all weather and so I’d put it back on the rack. As a physician, I could afford both coats, and I’m not stingy, but it seemed unkind to buy two coats when so many people struggle to pay for one. Doing the right thing was a compulsion—my colleagues called me Saint Joan, and they didn’t mean it as a compliment.
I’m a physician in palliative care. On the surface, it’s like any other form of medicine. Once the cause of a person’s symptoms is determined, treatment is prescribed, based on experience and instinct as well as medical training. But there the similarity ends. We don’t cure—we heal by easing pain and disability, improving quality of life. Palliative treatment doesn’t change the course of a life-limiting illness. It has an unavoidable destination, the same as every person’s life. Most physicians can’t bear the helplessness of that. Palliative care doctors must bear it and we are expected to do so with professional dispassion. This means hiding my own grief, even though I hold every loss in my heart like a secret child.
I saw Vivien’s message just before my first appointment with Eddie Wong. The nurse assigned to his care had warned me that his Yorkshire terrier would jump all over me until it was petted, so as soon as I introduced myself, I bent down to give the dog a vigorous rub along its back and a scratch between the ears. That didn’t get me even a small smile from the old man. I would have to work harder for that.
Eddie’s apartment, which I subsequently visited many times, had a similar layout to the one I’d sold before moving back home to take care of my mother. Open-plan kitchen and living-dining room, a hallway leading to bedroom, bathroom, den. On the wall were several paintings of the lake view as well as other landscapes—cottage country, the Toronto skyline. A line of portraits hung on the wall next to the dining table, as if they were guests waiting for an invitation to be seated. The living room furniture was sturdy and old. Across from the couch, there was a vintage stereo, a 1960s conceit, large speakers and a turntable built into a wooden cabinet, concealed by sliding doors.
“It still works,” Eddie said when he saw me looking.
While he lay down on the couch, I pulled a chair close and hung my jacket on the back of it, then sat. The jacket was navy, like my messenger bag and my pants, my shirt light grey. The bag was spacious—it held a laptop, stethoscope and blood pressure cuff, as well as personal essentials. I unzipped it and extracted my laptop so I could take notes while we talked. I have an unobtrusive laptop—small screen, quiet keyboard—and I’ve found that as long as I touch-type while keeping my gaze mostly on my patient, it doesn’t interfere with the flow of conversation. I like to ease the way with a bit of weather talk or a compliment about something in a new patient’s home. Through the window, I could see a fog of steam, like God’s breath, hovering over the icy surface of Lake Ontario.
“Do you think the lake will freeze?” I asked.
“It did the year my oldest brother was born,” Eddie said.
Afterwards, I googled has Lake Ontario ever frozen, and he was right. I put that in my patient notes. I’m known for the thoroughness of my notes. In our practice, we record vitals and medications, but also moods, hopes, resentments, relatives’ attitudes and a description of the home environment. These inform us of what’s possible and desirable for our patients, so that we can do everything medically feasible to make the rest of their lives worth living and their deaths peaceful. It’s what’s best about my job—seeing patients light up when they realize that their existence has purpose, their essence still a viable proposition.
But Eddie didn’t believe in beating around the bush.
“My niece was skeptical when I told her that you were coming to see me at home,” he said. His niece—a dental assistant—had planned to be here, but, like me, she’d had car trouble and was running late. “Doctors don’t make house calls anymore. Except when their patient is dying. That tells you something about our world, Dr. Connor.” He laughed; he had breath for laughter because the metastases in his lungs were still just scattered cells. He wasn’t wearing his dentures and when he laughed his face crinkled around his mouth. There was a wedding photograph on an end table. A young Eddie, shorter than his bride, but barrel-chested.
“Do you think you’re dying?”
“I’ve got Stage 4 cancer.” His voice was still deep.
“And you may have it for a while yet.”
“No offence, Dr. Connor, but you can cut the crap.”
“Call me Joan.” From his file, I knew that Eddie was a widower with no children and lived on his own. He had issues with nausea, but he was dealing with the colostomy bag. His blood pressure was higher than I’d ha
I asked, “What’s your understanding of your disease?” The answer would tell me how much his oncologist had been able to communicate and how much reality my new patient was able to tolerate.
“The cancer is in my gut, lymph nodes, liver and lungs. I’m going to die from the liver before the lungs get too bad. So…I’ll be able to keep breathing?”
“I think so.”
“I don’t want to die on a ventilator.”
“I’ll make sure everyone knows that. We’ve got a DNR, but your nurse will bring you a DNI form to sign so it’s in your record, and she’ll go over everything that can be done to make you comfortable. I have to say, Eddie, it isn’t often that patients talk with me about their end-of-life preferences at our first visit.”
“When you’re dying, you shouldn’t wait until it’s too late.”
“You’re sick, but active dying is a process. There’s nothing I see to indicate that it’s begun.”
“A process. Like turning garbage meat into sausage.” His tone was resentful, defiant, adolescent. My elderly patients often say they feel the same inside, that it shocks them to see wrinkles and liver spots in the mirror.
“Not garbage meat. You can’t shock me, Eddie. I used to work as an emergency room physician. The ER isn’t a nice place.”
He pushed himself up to a semi-sitting position. He had the usual turkey neck of the old. A solid chin and a wide nose, cheeks thin but not gaunt, wisps of white hair above his ears. Deep-set eyes and glasses of an older style, square with black frames. “What made you go into this business, instead?”
I weighed how much to share. “Sometimes heroic efforts cause people needless suffering, and I hated that.” My tone was more intense than I intended, and I softened it. “Palliative care is a different kind of medicine. We can have an hour or even longer for this appointment. There’s no rush. What we’re doing here is about the patient, not the meat.”
The little dog jumped up on the sofa and lay down beside him. “Time has beaten me,” Eddie said. “Even my wife wouldn’t recognize me.” He pointed to the row of portraits. “That’s her, Lucy, the one on the far left nearest the window. In the red dress.”
“She looks determined.”
“She was.”
“Who painted her?”
“I did.”
“So you’re an artist, Eddie.”
“I wouldn’t go that far.” On his coffee table, there was a pile of books—Masterpieces of Classical Chinese Art, Painting People, Kurelek: Collected Works—and a magnifying glass on top of the pile. “I was a cutter in a shirt factory. The only reason I have a place like this is that a Hong Kong girl liked me and made her father bring me into his business. We got married, and I became his partner. Anyone can pick up a brush. Maybe even a doctor.”
“Painting isn’t that easy,” I said.
He smiled for the first time, a stretch of lips, not revealing his unadorned gums.
“My father painted on weekends,” I said, “and more often after he retired. It relaxed him.” Like his Scotch, but with no ill effects on the liver.
Eddie shook his head. “No, no, I don’t believe that. How could it be relaxing? Sitting on the toilet is relaxing. I miss it now with the bag…But art makes you see truth and that is no shit. When I first saw the paintings at the Louvre…Have you been there?”
“No.” I hadn’t gone anywhere in twenty years—I was afraid to fly and worried too much about what might happen at home in my absence. “What was it like?”
“For our honeymoon, my wife wanted Paris, so we went to Paris. She said, ‘Eddie, you can’t go to Paris and not see the Louvre. It will astonish you.’ She was an educated woman, and I don’t mean just because she went to college. You see that rock on top of the cabinet? When she found it, she picked it up and kept it. I asked her why. It’s just a rock. She said, ‘Eddie, it’s volcanic rock.’ We were in Colorado. It was our fifth anniversary? I’m not sure. She said, ‘This came out of the centre of the earth. Imagine how far it’s come.’ Do you ever think about that?”
“I don’t believe I have,” I said.
“Before I started painting, I didn’t either. Do you think my wife’s up there somewhere, waiting for me?”
“The only opinion that matters is yours.”
“If you’re going to keep me company through this, don’t you think you should at least tell me where you believe I’m going, Dr. Connor?”
“Would you like me to connect you with a chaplain?” I stopped because he was already pulling away inside himself, his gaze falling to his hands, his face slack. “I’m not trying to be evasive,” I said, and he looked up at me again. “I want you to be able to trust me when I say I know something, so I can give you good care. And just because I’m around death and dying doesn’t make me an expert on the afterlife.”
“But you come closer than most people.”
“That’s true.” The doctor who trained me in palliative care was religious; my sister was an unshakable atheist; my own beliefs shifted from day to day. “I can tell you what I’ve witnessed. That in the last few days before they die, people often talk to something or someone no one else can see. They talk about going home. It makes them happy.”
“At least that’s something to look forward to.” The terrier batted his hand for attention. He scratched between its ears.
“Anything else you look forward to, Eddie?”
“Not really. I can’t even paint anymore.”
“Why not?”
“To stay on my feet in front of the easel, I have to hang on to my walker. I can’t hold a brush at the same time. I’m too old to learn how to paint with my teeth.”
“You’d have to put your teeth in first.”
He smiled broadly, showing me his gums, and I laughed.
“What about a table easel?”
“I thought of it,” he said. “But even if I had something like that and could sit, I’m too tired to paint.”
“That must be frustrating.”
He nodded.
“What makes for a better day?”
“When I can eat. I still like eating. My nieces are good cooks and they bring me food. There’s an off-leash park near here where Claude can run around. If I could sit there in the spring. Will I still be here in the spring?”
“We can’t make predictions. I can just say what your body is telling us right now. I have your latest scans, and I’ll also examine you. Claude…named after Monet?”
Another smile.
“So, it sounds to me like we have three goals: eating well, getting to the park and being able to paint.”
“You got a miracle in that bag? Or you want to call in the chaplain for that too?”
“Here’s another idea. Your oncologist talked to you about FOLFOX.”
“It’s good if you don’t need your fingers.”
He was right—one of the nastier side effects of oxaliplatin (the ox of FOLFOX) is peripheral neuropathy, unpleasant sensations or numbness in fingertips and feet. “Is that why you refused treatment?”
“There are other pleasures I can do without too.”
“FOLFOX on its own should be easier to tolerate than the combined chemo you had before. I wouldn’t recommend it if I thought the hardship outweighed the benefit.” I paused, giving him space to say more, but he just stroked the terrier’s back with his old man’s hand, so I continued. “People often talk about treatment giving them more time. What would more time mean for you?”
“What it could mean?” He shrugged. “After seventy-five, it goes in a flash. A little more or less doesn’t matter.”
