Marjorie Williams knew Washington from top to bottom. Beloved for her sharp analysis, elegant prose and exceptional ability to intuit character, Williams wrote political profiles for the Washington Post and Vanity Fair that came to be considered the final word on the capital's most powerful figures. During the last years of her life, she wrote about her own mortality as she battled liver cancer, using this harrowing experience to illuminate larger points about the nature of power and the randomness of life. Those writings are chronicled in a book called “The Woman at the Washington Zoo” written by Williams and her husband, Slate editor Timothy Noah. Here's an excerpt from the book:
The beast first showed its face benignly, in the late-June warmth of a California swimming pool, and it would take me more than a year to know it for what it was. Willie and I were lolling happily in the sunny shallow end of my in-laws’ pool when he — then only seven — said, “Mommy, you’re getting thinner.”
It was true, I realized with some pleasure. Those intractable ten or fifteen pounds that had settled in over the course of two pregnancies: hadn’t they seemed, lately, to be melting away? I had never gained enough weight to think about trying very hard to lose it, except for sporadic, failed commitments to the health club. But I’d carried — for so many years I hardly noticed it — an unpleasant sensation of being more cushiony than I wanted to be. And now, without trying, I’d lost at least five pounds, perhaps even eight.
I suppose I fell into the smug assumption that I had magically restored the lucky metabolism of my twenties and thirties, when it had been easy for me to carry between 110 and 120 pounds on a frame of 5’ 6”. In the months before Willie’s observation I’d been working harder, and more happily, than I’d done in years — burning more fuel through later nights and busier days. I’d also been smoking, an old habit I’d fallen into again, two years earlier, bouncing back and forth between quitting and then succumbing, working up to something like eight cigarettes a day.
Of course Willie noticed it first, I now think: Children major in the study of their mothers, and Willie has the elder child’s umbilical awareness of me. But how is it that I didn’t even question a weight loss striking enough for a child to speak up about? I was too happy enjoying this unexpected gift to question it even briefly: The American woman’s yearning for thinness is so deeply a part of me that it never crossed my mind that a weight loss could herald something other than good fortune.
As it happened, I took up running about a month later, in concert with quitting smoking for good. Although I’ve been athletic in the past — team sports and tennis through high school and college — I’d always loathed running, hated the smugness and visible good feeling of people who did it. But now, for some reason, I was able to push past those first awful weeks of getting winded ten minutes into the run, past the shin splints, until somehow I crested the hill, on whose other side running became easy, or at least pleasurable: a necessary part of my day. Within months I loved it, and found myself keeping a journal, recording my mileage and speed, the weather and the odd happening on one of my familiar trails. I had three basic routes I ran near my house, and by the end of the summer I was running about four miles a day, at least five days a week. I was trying to move up from twenty miles a week to twenty-five.
And with all that exercise, I found I could eat pretty much anything I wanted without worrying about my weight. So more weight melted away, and the steady weight loss that might have warned me something was going badly wrong disguised itself instead as the reward for all those pounding steps I was taking through the chill of early fall, the sting of winter, the beauty of spring’s beginning. I went from around 126 pounds, in the spring of 2000, to about 109 a year later.
Somewhere in there my period became irregular — first it was late, then it stopped altogether. Well, I’d heard of this: Women who exercise heavily sometimes do become amenorrheic. I discussed it with my gynecologist in January, and he agreed it was no real cause for alarm. He checked my hormone levels and found I definitely hadn’t hit perimenopause, but what I most remember about that visit is the amazed approval with which he commented on the good shape I was in.
Around that time — I can’t pinpoint exactly when — I began to have hot flashes, almost unnoticeable at first, gradually increasing in intensity. Well, I said to myself, I must be perimenopausal after all; a gynecologist friend told me that hormone levels can fluctuate so much that the test my doctor had done wasn’t necessarily the last word on the subject.
Then one day in April I was lying on my back, talking idly on the telephone (strangely, I don’t remember to whom), and running my hand up and down my now deliciously scrawny stomach. And just like that I felt it: a mass, about the size of a small apricot, on the lower right side of my abdomen. My mind swung sharply into focus: Have I ever felt this thing before, this lump? Well, who knows, maybe this is a part of my anatomy I was just never aware of before — I always had a little layer of fat between my skin and the mysteries of the innards. Maybe there was some part of the intestine that felt that way, and I had just never been thin enough to palpate it before.
You know how you’ve always wondered about it: Would you notice if you had a sudden lump? Would you be sensible enough to do something about it? How would your mind react? For all of us, those wonderings have a luxuriantly melodramatic quality. Because surely that isn’t really how it works, you don’t just stumble on the fact that you have a lethal cancer while you’re gabbing on the phone like a teenager. Surely you can’t have a death sentence just lying there, so close to the surface, without being in some other way aware of it.
I thought about calling my doctor, but then remembered that I had a full check-up scheduled in about three weeks anyway: I would bring it up then. In the intervening weeks I often reached down to find this odd bump: sometimes it wasn’t there, and at other times it was. Once, I even thought it had moved — could I possibly be feeling it three inches up and two inches to the left, nearly underneath my belly button? Surely not. This must be just another sign that I was imagining things. In fact, the mass hadn’t moved. That lumpy area I felt briefly under my belly button was an entirely different metastatic tumor, one of the five big ones that had by now invaded my abdomen and pelvis. And still I thought that my biggest problem was a bronchitis I picked up toward the end of April and just couldn’t shake.
Checkup day came. I had been seeing the same doctor for at least a decade, a small, faintly prissy, dry-humored man who was part of a booming practice in a good part of town. I’d chosen him casually, foolishly, at a time in my life when having a general practitioner didn’t seem like a very important decision: He was the doctor of my then-boyfriend’s boss (a boss the boyfriend — later my husband — didn’t even like). For most of the past decade, almost all my health care had taken me to the office of my obstetrician, the man who delivered my two babies. To him I felt infinitely bonded. And he had tested my health so vigilantly, as befit a mother who had her first baby at thirty-five, that I hadn’t really seen the need, for years, for a general check-up.
So this doctor I was seeing now had never had to see me through anything serious. But he had always handled what little I brought to him with sympathy and dispatch; I had a mild liking for him.
To begin the checkup, he ushered me into his office, fully clothed, to talk; my file in front of him, he showed that he’d boned up pretty well on me before my arrival. He could have passed a pop quiz about my job, number of children, and so forth. I told him about all of it: the stopped periods, the hot flashes, the fact that I could intermittently feel a mass in my belly. But I also told him what seemed most true to me: that overall I felt healthier than I’d been in years. I was running, I wasn’t smoking, I’d stopped having the chronic sinus infections that had plagued me for years.
Right off the bat, Dr. Generalist advised me to press the matter of hot flashes, and of the vanished period, with my gynecologist. No Hormones Handled Here. Then he ushered me into his examining room next door, with the standard instruction to dress in a flimsy robe while he stepped out of the room. He inspected me in all the typical ways, then told me to get back in my clothes and step back into his office. I had to remind him that I had reported a strange lump in my abdomen. So he had me lie back down, and felt all around that area. No mass. He got me to feel there too; it was one of those times when I couldn’t feel it.
“I would think,” he said, “that what you’re feeling is stool that’s moving through your bowel. What you’re feeling is a loop of intestine or something where the stool is stuck for a while. That’s why sometimes it’s there and sometimes it’s not. The bad things don’t come and go; the bad things only come and stay.”
He could send me off for a lot of expensive tests, he said, but there really wasn’t any point in going to that trouble and expense because I was so obviously a perfectly healthy patient. He would call when my labs came back.
He called me, a week or so later, to report that all my lab tests looked great, with one minor exception: My calcium level was high — not the “good calcium” he had pressed on me, in pill form, as standard practice for a woman reaching middle age, but the “bad calcium” that circulates in the blood. It was just an anomaly, not alarming; I should come back in three months and repeat the count. At the time, I was in Seattle with my husband, on a business trip, and the doctor’s report came in the form of a message on my voice mail. I never even called him back to discuss those results; he was so casual about them, and he repeated all the same information in a letter mailed to me the following week: Healthy healthy healthy.
Looking back, I know I was uneasy even after I got this clean bill of health. Sometimes I felt what seemed like a flicker of movement in my belly, and got the oddest feeling that I might be pregnant. At one point, I even bought a home pregnancy test and furtively took it in a stall in the ladies’ room in the little mall that housed the pharmacy. I felt ridiculous, at forty-three, sneaking off to take a pregnancy test like an anxious highschooler; and I felt ridiculous to myself, even to be suspecting pregnancy — especially since I hadn’t had a period for at least six months. That I even did it is a measure of how loudly my unconscious was screaming that something was seriously amiss in my body. But the doctor’s reassurances were enough to turn off those klaxons just at the time when they should have been sounding most loudly. Every now and then, the mass in my abdomen actually stuck out when I lay on my back; once, I looked down to see my stomach distinctly tilted — high on the right side, much lower on the left. I was at some pains never to point this out to my husband.
Finally, on the last Friday night in June 2001, I had a huge hot flash while my husband was tickling my back, in bed. Suddenly I was drenched; I could feel that his fingers could no longer slide easily along the skin of my back. He turned to me, astonished: “What is this?” he asked. “You’re covered in sweat.”
It was as if someone had finally given me permission to notice fully what was happening inside me. I made an appointment with my gynecologist — the earliest one I could get was the next week, on Thursday, July 5 — and began deliberately noticing how overwhelming the hot flashes had gotten. For a while now, I realized, I had been clinging to the left side of the mattress at night, hoping to avoid any contact with my husband’s warm flesh. Now that I paid close attention, I realized they were coming fifteen or twenty times a day, sweeping over and through me and leaving me sheathed in a layer of sweat. They came when I ran, making my joyous morning run a tedious slog that must be gotten through; they came when I sat still. They exceeded anything that had been described to me as the gradual coming of menopause. This was more like walking into a wall. On both Monday and Tuesday of that week, I remember, I stopped about two miles into my morning run; simply stopped, despite the freshness of the morning and the beauty of the path I usually cut through the gardened streets of Takoma Park. Any runner knows the feeling of having to push past the body’s observation that it might be more fun to walk slowly home and pop open a beer (just keep putting one foot in front of the other), but this was something different, like an override system I could no longer ignore. It said: stop. It said, this is a body that can no longer afford to run.
My gynecologist’s office is way, way out in the long exurban belt stretching westward from DC, where his practice was previously located. I had long since meant to find a new gynecologist, but I was lazy and also bonded to him because he had delivered both my kids, and so I continued to make the long trek to his alienating, boxy building — one of those addresses in five digits, ending in the word “highway”—in the middle of a fastdeveloping nowhere.
He was running late that afternoon, so it was probably after five when he finally called me into his office. We traded the chit-chat of nearfriends, the usual gossip about people we both knew; we talked about what gynecologist I should start seeing in the district. Finally, we got down to it. I told him about the hot flashes, and about the lump I was feeling in my abdomen. “Yup, you’re in menopause,” he said somewhat brusquely.
“We can start giving you hormones. But first let’s check out that lump you say you’re feeling.”
We went back into the examining room where he keeps his ultrasound equipment. He’d given me dozens of quick exams with it over my childbearing years. I hopped up on the table and he slapped on some of the chilly goo they apply to your belly, to make the ultrasound mouse slide over your skin, and almost immediately he stopped: “There,” he said.
“Yeah, there’s something here.” He looked at it a bit more, very briefly, then started snapping off his gloves. His face looked as neutral as he could possibly make it, which alarmed me instantly. “Just so you know,” he said quickly, “it’s probably fibroids. I’m not thinking cancer, but I am thinking surgery. So get dressed and come on back to my office, and I’ll explain.”
We sat back down on either side of his desk. But before we talked, he called out to his receptionist, who was just packing up for the evening. “Before you go,” he said, “I need you to book her an ultrasound and a CT scan. Tomorrow, if possible.”
I told Pat he was scaring me: What was all this speed about, if he wasn’t thinking cancer?
“Well,” he said, “I’m pretty sure it’s not — I’ll explain why in a minute — but I hate to have something like this hanging over a weekend. I want to know for sure what we’re dealing with.”
He went on to explain that he’d seen what looked like a fairly large growth on my ovary, but that it didn’t look like ovarian cancer: Its consistency was different. (Here, he drew me a picture on the back of a piece of scrap paper.) He explained that fibroids can sometimes be removed with surgery but that very often they grew back, even worse than before. His own typical recommendation, for a woman who was done having babies, he said, was a hysterectomy.
“Does this have anything to do with my hot flashes?” I asked.
“No, not a thing, in all probability. You just happen to be starting menopause too.”
Finally I felt on the verge of tears. When I left, I sat in the car to collect myself, boggling at the thought of losing my uterus at the age of forty three.
I didn’t even call my husband on my cell phone. I just wanted to calm down and get home and then seek the sanctuary of his sympathy.
The next morning, Pat’s office called to say they had scored a formal ultrasound examination at three in the afternoon, in a DC radiology practice I’d visited from time to time before. When I got there, Pat’s nurse told me, they would give me an appointment — probably early the next week — to come back for a CT-scan.
I told my husband I didn’t need him to come to the sonogram: It would probably only give a clearer picture of what Pat’s ultrasound had already told us, I assumed. There’s nothing painful or difficult about a sonogram, and I didn’t want to haul Tim out of work twice; I knew I’d want him with me for the CT scan later.
That was a bad decision.
I remember waiting endlessly at the desk for the receptionist to finish a peckish, convoluted phone conversation with the manager of the garage downstairs, about why she’d been billed wrong for that month’s parking. She talked on and on (“Yes, I know that’s what I owe for each month, but I already paid you for both June and July”), with zero self-consciousness about keeping a patient standing there at the desk. There was a sign on her desk that instructed one to sign in and then take a seat, but of course I needed to talk to her about scheduling a CT scan. She kept flicking her hand at me and trying to shoo me toward a chair, then pointing at the sign. I just waited.
Finally I told her why I was standing there: Um, Cat-scan ... the Doctor’s
office told me ... as soon as possible....”
“What are you?” she said. A puzzled silence. “I mean, what kind are you?”
“Well, um, they’re looking at something in my pelvis —”
“Oh, body,” she said, her scowl regathering. “We are really, really booked on bodies.” She started to flip through her appointment book. I stood there, trying to radiate as palatable a combination of charm and distress as I could manage. “Well, I’ll talk to the doctor,” she finally mumbled.
“Ask me again when your sonogram’s done. We might be able to do Monday morning, 11 o’clock.”
When my father was under treatment for cancer, which put him in and out of various hospitals for five years, I used to roll my eyes at the way he ingratiated himself with all the staff. You could walk into intensive care and he’d be there, his face wan against the pillow, but with his usual charming, modest smile ready for everyone. He would introduce his nurse, and tell you where she was born and how her sister wrote romance novels, and that her brother was on a track and field scholarship at the State University of New York.
Part and parcel, I thought, of his lifelong campaign to be loved by everyone he met. He had always put more energy into captivating strangers than anyone else I knew. But I learned right away, when I went for this very first test, how wrong I’d been. As a patient, you come to feel that you need everyone — from the chairman of the oncology service at a major cancer center down to the least-paid clerk in the admissions department — to like you. Some of them may have the power to save your life. Others have the power to make you comfortable in the middle of the night, or to steer away from you the nurse-in-training who is still just learning to insert IVs, or to squeeze you in for a test you might otherwise wait days for.
I was discovering this truth on my back, while the ultrasound technician guided her wand through the chilly gel she had squeezed onto my belly. She was a friendly young woman with a Spanish accent of some kind, and her job was to get an accurate picture of what was going on in my pelvis while divulging the least information possible to the anxious patient. My job was to find out as much as I could, as quickly as I could. So there I am: “Gosh, Friday afternoon … have you had a long week? … How long have you been working in ultrasound. … Oh! Is that my ovary there, really? Ah, so you’re taking pictures now … uh-huh. … Gee, that must be the growth my gynecologist was talking about.”
Under this onslaught of niceness, the technician begins to think aloud a bit. Yes, she is seeing a growth. But usually fibroids, which grow from the outside of the uterus, move in concert with it: Poke the uterus and the growth will move too. This growth seemed to be independent of the uterus.
Excerpted from “The Woman at the Washington Zoo: Writings on Politics, Family, and Fate by Marjorie Williams and Timothy Noah.” Copyright © 2005 by Marjorie Williams and Timothy Noah. Published by Public Affairs Books. All rights reserved. No part of this excerpt can be used without permission of the publisher.