The Mutations Page 4

  “Relax, Ramón,” a voice was saying.

  “I iu aie,” he corrected them. “It’s Mr. Martínez,” he tried to say, with his tongue, for the very last time.

  “Give him some midazolam,” said another voice, an echo.

  The curtain of night fell over his eyes. Again, the waiting was over.

  6

  In her sessions with her own analyst and supervisor, Teresa returned time and again to the question of transference and countertransference with Eduardo. According to Teresa’s interpretation, her patient was transferring the psychological role of his mother onto his therapist. By caring for him so obsessively during his illness, his mother, a single parent, had revealed that the object of her desire wasn’t her sickly son, but rather the hidden, threatening Father beyond, of whom everyone spoke, though they rarely uttered his name. Cancer had taken on the unconscious role of the Father. That terrible identity remained repressed deep in the recesses of Eduardo’s psyche. The object of his mother’s desire was the Other in him; she wanted, unwittingly, for her son to have cancer. It was an unspeakable horror. That was why his unconscious worked so hard to repress it. And that symbolic father’s phallus, its external symptom, was the cleanliness, the hygiene Eduardo’s mother worshipped. Now, when she attempted to break her own rules and come close to him without a surgical mask, to treat him like a normal son, Eduardo sensed the oedipal threat of incest. Betrayal. Letting go of those phallic sanitary measures meant nothing less than killing leukemia, the Father, once and for all.

  This psychoanalytic interpretation led Teresa to conclude that her maternal feelings toward Eduardo, which she had often explored with her analyst, were a product of countertransference, and should therefore be put to use for his psychological cure. Teresa wanted Eduardo to overcome his identification of cancer with the Father, so he could insert a figure into that role that would be conducive to his leading a healthy emotional life, as much on a familial as on a sexual level.

  “The problem,” said Teresa, leaning back on the couch, “is that I don’t see how I can convince the patient that my desire—I mean, I’m talking about the transference, his mother’s desire—isn’t for him to be sick and have to obey a set of paranoid rules to avoid contagion or a recurrence. I can tell him that, but not on the unconscious level. At least, not right now.”

  Teresa paused, waiting for her analyst to reply.

  “Beyond the countertransference, do you think there’s something preventing you?”

  “It’s not that I’m afraid of wanting to channel my feelings into him because I don’t have any children of my own. I’ve already worked on that. I’ve talked about it for hours, and I can deal with it. What makes me feel like I’m at a dead end with this patient is that I’m clearly part of the system that keeps him tied to leukemia. He knows I work with cancer patients and run support groups, and that I’ve written about my own experience with breast cancer. How am I, a psychoanalyst specializing in cancer patients, supposed to convince him that he doesn’t have cancer? That’s one issue. And the other is, how am I supposed to get him to understand all this when the fact is that I find it fulfilling to see him, I’m fond of him, our sessions cheer me up, and on top of that, his mother is paying me every week? How am I supposed to convince him that I don’t want him to stay sick?”

  “When it’s time to end his analysis, you’ll set that part of the process in motion.”

  “But when?” Teresa protested. “In another ten years, when he’s done with college, whereas right now he has the chance to meet people his own age with similar interests? The university is a hive of social activity, and instead of taking advantage of it, he’s dealing with an emotional roller coaster—disgust and libido, fear and curiosity. He needs a more immediate solution.”

  “Well, you may think the solution is to pause his analysis now, and send him to CBT or group therapy, though I guess anything in a group would be impossible for him, but anyway, a cognitive behavioral therapy that would ideally allow him to enjoy life as soon as possible. But I see a projected desire in this rush for him to enjoy things. You’re the one who’s in a hurry for something to happen. You’ve never said he shows any interest in going to parties, going out with his buddies, or anything like that. I think your feelings about this are similar to his mother’s. You need to be careful, the countertransference could sabotage all your progress with him.”

  “But what progress? I understand that my concern is maternal and whatever you like, and of course I’m not going to ruin the transference by showing him that. But what worries me is that my strong association with cancer on a symbolic level, as a survivor and a specialized therapist, won’t let him get past the idea that what his mother wants is for him to be sick. Just think, when he leaves my office on Saturdays, he sometimes runs into my twelve o’clock patient, a woman in chemo who’s lost her hair and walks with a cane. How’s he going to overcome cancer like that? As long as he keeps seeing me, he’ll still be immersed in it.”

  “Do you still want to be immersed in it?”

  “Yes, I do. But him? I’d like to refer him to someone else, but if I do that, he’ll have to explain everything again—the leukemia, the transplant—he’ll have to relive it all, and that’s not what I want for him. It would be a major setback.”

  There was a pause, during which Teresa imagined the consequences of referring Eduardo to a different analyst, perhaps a young man with whom he could establish a paternal bond. She didn’t open her mouth. She knew where her analyst was headed: she wanted Teresa to face the possibility that the unconscious structure she attributed to Eduardo was in fact her own, and that she herself was convinced that everyone else wanted her to keep living with cancer.

  “I think my patients want to identify with me as a survivor, and that’s the most valuable thing I can offer them.”

  “A survivor?”

  “I know,” said Teresa, frustrated that she hadn’t seen her analyst’s next move coming. “That word. But it’s important not to lose sight of the fact that, even if it doesn’t define our identities, cancer changed the direction of our lives. It’s a constant presence in my life, and I honestly think I’ve come to terms with that, but Eduardo’s case is very different. I mean, I don’t think my interpretation of his case is a transference of mine. He’s dealing with his phobias, his OCD, his anxiety, the threat of the Real, the grip of leukemia on his ego. It would be great if he could experience something new, maybe with marijuana, and have his mind opened by something that came from outside. I can’t offer him that. I’m not going to break the transference and mess everything up, but maybe if someone at the university … I don’t know. It would be really positive for him.”

  Teresa paused when she noticed that her analyst had adopted her usual closing gesture. Neither broke the silence. Teresa wasn’t keen on variable-length sessions, but her analyst favored the practice, and had ended their talk with expert skill, preventing Teresa from continuing to speculate about Eduardo’s case rather than delving into her own conflicted relationship with cancer, the Other that had never ceased to make its unseen claims on her.

  After a moment of increasing tension, the analyst stood and wished Teresa goodbye with a friendly smile.

  7

  Ramón woke up in a tangle of tubes and cables. His consciousness attended to his senses one by one, beginning with his hearing—a strange gurgling in his throat, a machine’s high-pitched, intermittent beeping; then his sense of touch—the pressure of the bandages strapping his head to his neck brace; and his sight—the pale light, some gray curtains, his hands crumpled on the bed like dead birds. There were no smells, since the air entered his body not through his nostrils, but through a tracheotomy connected to a breathing tube. Nor were there any flavors, since his taste receptors were gone.

  While his brain was gradually rousing itself, his heart pumped a mixture of his own blood and other people’s, from bags donated by an airline pilot and a hyperrealist painter. His lungs filtered adulte
rated air from an oxygen tank, his liver burned its reserves to make up for the fast, his kidneys were busy breaking down the anesthetic, and his pancreas was taking a siesta.

  Ramón tried to blink and opened his eyes two hours later. Carmela was by his side.

  “How are you feeling?” she asked in a whisper.

  What time is it? thought Ramón.

  “The surgeon said there weren’t any complications, and they didn’t have to go in as far as the larynx. And the good news is, you’ll be breathing normally in a few months. We’re very relieved. Mateo and Pau are out there with Ernesto and Alicia. They send you their love, and they’ll be back to visit tomorrow. Elodia was here all day, too, but I sent her home.”

  Ramón paid close attention to the form, but not to the content of Carmela’s words. He was mesmerized by her rapidly moving lips, her expansive vowels, the plosives and occlusions, the sweet harmony of the way they combined. As her teeth moved incessantly up and down, Ramón caught a glimpse of her moist tongue, fluttering and tireless, changing places at every moment to release a succession of different sounds.

  He felt a faint pang of nostalgia. Where might his tongue be now? In a Ziploc bag? In a freezer? In a furnace? He had given written permission for samples to be extracted and analyzed in the laboratories of the National Cancer Institute. Apparently, his tumor was unheard-of, and would help researchers to establish clinical precedents. At least it would be of use for something. Beyond that, according to the General Health Law in Matters of the Sanitary Disposal of Human Organs, Tissue, and Corpses, his tongue would have to be cremated, but they wouldn’t return it to him in an urn, as if from a funeral home. Where were his tongue’s ashes going to end up? Two weeks earlier, it would have seemed like an idle question, but now he regretted not having insisted that its remains be returned to him, however meager they turned out to be. By the time he was well enough to express his wishes in writing, he was sure it would be too late.

  Carmela settled in next to him on a recliner and told him to sleep well. He did not. Doctors and nurses kept coming and going, checking his chart, his blood pressure, his catheter, his feeding tube, and his breathing valve. But they didn’t interact with him. Instead, they woke him up and prodded and poked him, with neither permission nor apology. They gave him mechanical instructions—“Lift your arm,” “Breathe out,” “Breathe in,” “Open your mouth.” They issued warnings—“This might hurt a bit,” “Just a little prick,” “It’ll sting.” They asked questions—“How are you feeling this morning?” “Is the catheter bothering you?” “Have we had a bowel movement yet?”—but relied upon Carmela, or one of Ramón’s other and more clinical representatives—the thermometer, the urinary bag, or the stainless-steel kidney basin where he spat the saliva that pooled in his mouth—to provide the answers.

  * * *

  This same stainless-steel kidney basin featured in a misdemeanor on the afternoon of December 31, when Ramón and Mateo were left in the room alone. Carmela and Paulina had gone out to get sandwiches and soda for their New Year’s Eve dinner. While Mateo played video games on his laptop with his headphones on, Ramón dozed off watching a fifties melodrama on TV. When he awoke from his siesta, the movie was over and had been replaced by Laura en América, a Peruvian tabloid talk show where guests tried to resolve their family strife in public. Mateo was still stretched out on the couch with his back to his father’s bed, shooting his virtual rifle to the rhythm of the heavy metal blaring into his ears. A short woman appeared on the screen.

  “He swore to me he’d quit going to the club with his sister, but there he was, drunk, with his arms around her, feeling her up! He’s a scumbag, Señorita Laura!”

  “Are you telling me your husband cheated on you with his own sister?” the show’s host asked in outrage, like the chorus of a Sophoclean tragedy.

  “That’s right, Señorita Laura.”

  “Incest!” screeched the host, as the betrayed wife began smacking her sister-in-law and rival.

  Ramón was outraged that such degrading spectacles appeared on TV, dulling the mind and inciting morbid curiosity and barbaric behavior. He looked for the remote control to change the channel, but it had been left on the trolley, out of his reach. He needed his son’s help, but Mateo was absorbed in his laptop, deaf to any outside noise, and blind to his father’s wild gesticulations.

  “Bring out the husband!” cried Señorita Laura. When the individual appeared onstage, his wife and his sister-lover pounced on him. Two apathetic security guards intervened to stop them. As soon as the culprit took his seat, the presenter said:

  “Not even wild animals do what you get up to, understand? Not even wild beasts in Africa!”

  The crowd applauded.

  Imagining the cries and insults he would have hurled at his son didn’t make Ramón feel any better. He began to hammer on the bedrail with the basin, inside which a considerable amount of bloody saliva was swishing around, in the vain hope that the clanging would attract his son’s attention. Ramón could have summoned a nurse at the mere push of a button, but it seemed absurd to have to do so when his eighteen-year-old son, still a dim-witted mama’s boy, was sitting only a few feet away.

  “And whose fault is all this? Who raised this pair of perverts? Bring out the mother!”

  Under the influence of the talk show’s Peruvian rage, Ramón gave in to the urge to toss the stainless-steel basin onto the floor, aiming at the side of the couch to give Mateo a fright. The basin looked like an obese boomerang as it spun through the air, spraying flecks of bloody sputum in all directions. It struck not the floor but Mateo’s head, right on the crown, splattering most of its slimy contents onto his open laptop. Mateo sprang up from his seat and turned to his father in fright.

  Ramón was genuinely surprised that his arm, in complete contempt of his conscious intentions, had managed to launch the flying basin on such a trajectory. After all, he was right-handed, and he’d had to use his left arm, since the other was immobilized by an intravenous tube. Forgive me, he said silently, sincerely. I didn’t mean to, I assure you.

  “What kind of a mother lets her teenage children see each other naked?” Señorita Laura demanded to know.

  “What the hell?” asked Mateo, more concerned for his bloodied laptop than his convalescent father.

  Since he had no way of correcting the misunderstanding, Ramón decided to use it to his advantage and pretend he was afflicted by a stabbing pain in the stomach. Mateo called the nurses’ station and asked them to come over because his father was feeling unwell. Señorita Laura and the paid shills in the audience were still shouting their heads off on TV, but for the moment, Ramón decided not to take any further action.

  A nurse arrived. She made sure that the feeding tube was in place, then asked for some help from a doctor, who had the good sense to turn off the TV as the incestuous sister hurled a torrent of curses at her cowardly brother.

  “Did he throw up?” the doctor asked when he saw the floor spattered with bloody sputum.

  “No,” said Mateo. “We dropped the spit bowl.”

  “They’ll be here to clean up in a minute,” the nurse said kindly.

  The doctor palpated the patient’s abdomen and came to the conclusion that the pain might have been caused by a minor intestinal spasm. Meanwhile, Mateo shut himself in the bathroom with his laptop and set about wiping it meticulously with toilet paper.

  When they were left alone, Mateo apologized to his father for not being more considerate. Ramón, also embarrassed by the incident, forgave him with a smile and excused himself, thinking that, under the circumstances, it wasn’t such a bad thing for his act of aggression to go unpunished.

  His bout of anger awakened the hunger that had lain dormant during the previous weeks. Ramón’s abdominal fat reserves were almost spent, and the protein shakes delivered through his feeding tube were lower in calories than the pork and beans, fried steaks, and pozoles that had taken center stage in his usual feasts. Never again wou
ld he taste a succulent rotisserie chicken, the complex spices of mole sauce, the delicate sweetness of a flan. The loss was great, and irreparable. It was impossible to evoke those flavors; not even their memory would give him solace. The objects of his nostalgia were without qualities, deep and sorrowful chasms in his mind.

  Carmela and Paulina returned laden with cartons of takeout, complaining about the lines at the shopping center and the traffic clogging the streets.

  “How have you been?” asked Carmela.

  “Great,” Mateo replied. “We were watching TV.”

  “Oh, really?” Carmela said suspiciously.

  It was also to Ramón’s advantage to hide the afternoon’s embarrassing episode. He seconded his son’s version of events with a serious look.

  “Great. Well, we brought some potato salad and cod sandwiches. Let’s see if they’re any good.”

  Cod: another delicacy lost to him.

  At midnight, Ramón toasted the New Year with a sip of cold water.

  8

  No matter how sweet, gentle, or gleeful they may have been at birth, oncologists always end up in the grip of melancholy. No other specialist, not even the forensic pathologist, maintains such an intimate relationship with misfortune. The soul of the oncologist retreats so as not to wither. When a terminal patient begs for a morsel of hope, the doctor cannot feed him lies. Duty demands not kindness, but professionalism.

  What kind of a calling is oncology? What kind of satisfaction or reward does this specialty entail? What paths lead to this grim career as a spokesperson of misfortune, a dispenser of dire cures and deadly prescriptions? When studying the oncologist’s face, it must be remembered that inside lies a motive, a cause, an unconscious trauma, a masochistic heroism, a macabre curiosity; perhaps a desire to emulate his father, to kill or to please him, or just to land a residency in a fancy private hospital. The oncologist’s office is a psychological crime scene; behind the diplomas adorning its walls lurk motives that flee the light.