In Sickness and

by,  Mako Yoshikawa

A bright, chilly February morning. I was coming downstairs after a call with my mother when Rob, my fiancé, happened to glance up. Catching sight of my expression, he shut his laptop, made room for me on the sofa, and coaxed the story out.

It was nothing he hadn’t heard. Another bad spell for my 73-year-old mother. The pain keeping her in bed until noon; my stepfather, Jimmy, snapping at her.

Rob grimaced. That fucking illness, he said.

What I didn’t get, I said, was what happened to Jimmy. For years his and my mother’s marriage had seemed like a fairytale, her reward after all she suffered in her first marriage, with my father. Where had that fairytale gone? Why had Jimmy turned mean, just when she needed him most?

It’s the illness, Rob said.

I felt a flash of irritation. He sounded so sure. How did he know? 

But the truth was he did, or might. His mother had suffered from and eventually died of rheumatoid arthritis, the same illness that my mother has. Rob is an outgoing filmmaker from Texas; an optimist about love, he’d already been hitched twice. A Japanese-American writer, I’d had too many flings and relationships to count, but in my mid-forties, had never married. When I met him four years earlier, the bond he and I had felt special, and I wanted to believe it was just about us. Our mothers having the same illness was happenstance. It hadn’t brought us together.

The likelihood of RA, though, is just 0.6 percent among adults, and Rob had been as close to his mother as I was to mine. If just a coincidence, it was an uncanny one. 

“That illness. When I think about my parents—” Rob shook his head. “It was a circus,” he said, almost in wonder. 

RA is often confused with its more common cousin, osteoarthritis, which strikes only loadbearing joints and results from wear and tear. An autoimmune disease, RA affects joints but also the nervous system, blood cells, and organs. Symptoms include deep fatigue; nausea; weakness; muscle aches; low-grade fever; severe damage of the eyes, lungs, kidneys and heart; erosion, deformity, and immobility of the joints; and chronic, acute pain throughout the body. 

RA in itself isn’t fatal, but it can imperil the patient’s life. Doctors first warned my mother, Hiroko, about her crumbling neck cartilage almost two decades ago. That’s how Rob’s mother, Bess, died. In her last few years, the top of her spine began pressing into her brain; one night the bone pierced her medulla and she stopped breathing. 

Hiroko was 39 when the pain started in her toes; my two sisters and I were children. Bess was 36; she had two young sons and was pregnant with Rob. 

Bess’s illness took hold fast. Jaime, a family physician, bathed and dressed her, clipped her toenails, and in her last years cut up her food and fed her, bite by bite. Letters and journals he left behind suggest that he never strayed, not an insignificant achievement considering that Bess almost certainly couldn’t have sex after her mid-40s, when he was just 40.

When she died, Jaime was 71. A year later, Gudrun, an old family friend with breast cancer and a prognosis of five years, asked him to help research treatment options. They made up their minds quickly: she’d leave her abusive husband and marry Jaime. When I heard this story, I was in awe—to take on the care of another sick woman! Jaime was a saint—until Rob explained. In her mid-fifties, Gudrun was determined to have fun while she could, and with the kind of cancer she had, she could; energetic and able-bodied, she’d carry Jaime rather than the other way around. Which she did, Rob said. They traveled and danced and laughed to the end. He sounded wistful, so I kept quiet. But later, alone, I tried to imagine the courage it would take to marry a dying woman after just burying a wife. If not a saint, his father was a hero. 

Rob has an extensive collection of video clips of his mother, and the day after our conversation, I watched them all. The clip I couldn’t stop replaying takes place in a hospital. Bess, in her mid-sixties, a woman with a swollen face and bright, curious eyes like Rob’s, has just had a stint inserted in her heart. Lying in bed with a nasal tube worming across her face, she smiles weakly at Rob behind the camera.

Soon Jaime—his face is long and intelligent, lined but still handsome—strides into view with a tray. Bess doesn’t want soup, so he begins feeding her fruit salad. The first piece is big and the degeneration of her jawbone means that she can’t chew fast. But almost right away Jaime is forking out a pear slice; he holds it an inch from her mouth, waiting for her to finish.

“That’s too fast, Jaime,” Bess says, jaws grinding. “I don’t eat like you do.”

“Just open up,” he says. 

She takes the pear in her mouth. 

From behind the camera Rob gives a little laugh; I can hear his shock in its breathiness. “And here comes the little airplane,” he says. “Dad, give her time to chew.”

Jaime turns toward Rob and mugs. “Here, we make it colorful for the television.” He spears a slice of peach, a glistening orange, and holds it in front of Bess.

“Not so fast,” she says.

“Shh, don’t talk with your mouth full,” he says.

She eyes the peach; it’s so close her eyes cross. “Jaime, it’s too big. Cut that piece.”

He shakes his head.

Bess opens her mouth and the fork slides in and out. Before she can swallow, a pineapple chunk is floating by her nose.

Rob laughs his little laugh again. He says, less utterance than exhalation, “God.”

Her lips pursed, Bess gazes at the pineapple. “It’s too big,” she says again, for the first time sounding querulous. 

“Okay, Bessie,” Jaime says. His voice is gentler yet he continues to stand, the pineapple hovering by her mouth, as the camera runs.

When I told Rob that evening that watching the video was complicated, he nodded.  

He said the way his father treated his mother enraged him. But Rob couldn’t blame him. From an early age, Rob, his mother’s favorite, had tried to spend as much time with her as possible, pushing her around in her wheelchair, making family dinners under her direction, and sitting with her in her dark stuffy room for hours. At the same time, in spite of or perhaps because of how much he loved her, he sought escape—through long solitary walks in the desert when he was a boy, drugs when he got older. 

Eventually he, like his brothers before him, left Texas. In the years that followed, Bess’s condition deteriorated sharply. By the last decade, her care was a fulltime job. Rob hunched his shoulders. “Dad suffered, too,” he said.

The hard-earned wisdom of Rob’s words was evident. The question was why I hadn’t understood what he had. How did I miss that my mother’s illness afflicted Jimmy?

From the start I’d considered Jimmy indomitable, a man undaunted by RA. When he met my mother on a blind date, he was 49, a divorced New Yorker and a wealthy international executive; like her, he was newly divorced with three daughters. Hiroko was 46, and exhausted and frail; since the divorce she’d been working as a translator in a Wall Street firm, and the commute and full days wore her down. When Jimmy, within weeks, brought up marriage, she said she could imagine nothing better but she owed him the truth: according to the doctors, she’d end up in a wheelchair. Maybe before I turn 50, maybe after. At this Jimmy was silent; as she told me later, she thought that was that. But he came back to see her, and a few weeks later announced he’d found a solution, a so-called miracle drug known as Embrel. Brand new and not yet FDA-approved, it’d be expensive and had serious side effects, but after much research he thought it worth the risk; of course he’d foot the bill. If that didn’t help, they’d find something else that would. In the meantime they should get married.  

And for twenty years Embrel worked wonders, giving Hiroko whole days that were almost completely pain-free. Jimmy spirited her off to Switzerland and then England; with every passing year they seemed more in love. 

My faith in Jimmy was absolute, so much so that when my mother called, more than three years ago and almost two and a half decades after their first date, to tell me that he was fed up with her health problems and no longer cared about her, I scoffed. Not until I visited them a month later and saw for myself that Jimmy had turned testy, either ignoring her or making cutting remarks, did I believe what she said. 

I was livid, and barely civil to Jimmy for the two weeks of my stay. When I visited them six months later and he was back to his old self, I felt relieved, but couldn’t forgive him. Though polite, I kept my distance.

*

The day after viewing Rob’s video, I was alone at home, and restless. I reached Jimmy in the early evening, England time. I explained, the words tumbling out, about Rob’s father and the video. I said I was sorry. I could see now how difficult it’d been for him with Mom.

At first Jimmy didn’t respond. I pictured him sitting back in his big chair in his study, his bushy eyebrows pulling together, one hand on his dog’s head. He thanked me but said it wasn’t so bad. “There’s a tangible satisfaction to knowing you’re of use.”

I said I knew it was worse than he was letting on. She needed so much help now. With me and my sisters so far away, he was on his own.

At last he said, “My wish is that Hiroko retains some of the qualities that drew me to her.”

I asked what he meant and he talked about how bright and funny she was, but also completely humble. “On bad days,” he said, “when she can barely move or speak, those traits get occluded by her illness.”

I shut my eyes: they were the words of a man no longer in love. Yet as he went on—there were still good days, when she worked and laughed—I realized he was speaking without bitterness, and with something, even, like hope.

“I do my best to enjoy the good times,” he said. “There has to be some relief. The danger is giving up on someone.”

I was nodding. Then, before I could remember that I’d called out of concern for his and my mother’s relationship rather than my own, I found myself blurting out that I was worried about marrying Rob. If I got sick, he might flee. 

Jimmy didn’t laugh. “Oh Mako,” he said, and I knew his eyebrows had come down. “When you marry someone, you take vows, you hope and you trust.”

“But anything could happen. What if—” I stopped, overcome by the possibilities. 

Jimmy said that the likelihood of my contracting RA was almost nil. Yet if that’s what I was worrying about, he’d lay odds I’d chosen the best possible person. It’s not easy loving and taking care of someone who’s always sick, but if anyone could do it, it was Rob. “There’s no one more steadfast.”

It came to me then that I knew that. My real question was one Jimmy couldn’t answer: was I ready to commit fully to Rob? Could I stand next to him in front of family and friends and honestly swear I’d withstand the grim grinding stress of a chronic illness? It was unthinkable to be like Bess and Hiroko, dependent and trapped, or like Jamie and Jimmy, beleaguered and trapped. I wasn’t sure I had the strength to give or receive the care that my mother—and Rob’s mother, too, before her—needed.

But Jimmy had spoken of hope and trust. Maybe the oath about in sickness was less a promise than an assertion of a belief: even if the unimaginable happens, some love will last. Perhaps taking vows was a pledge of faith in the love Rob and I shared now.

Jimmy’s voice broke into my thoughts. “Rob has strength of character, too,” he said. “One needs that, to endure.” 

He sounded matter of fact but I felt stricken anew. “It’s been rough for you.”

He said that wasn’t so. Overall he’d been fortunate. England was beautiful and he had his enjoyments—his work, his dog, poetry, chess. “I’m not unhappy,” he said.

I said not unhappy was a far cry from happy. After a pause, he said he sometimes wished there were other things.

I’d come too far to turn back. “Like what?” 

Another silence. “Neither Hiroko nor I is terribly demonstrative,” Jimmy said at last. “I know it’s often all she can do to make it through the day. But sometimes, some greater sense of being cherished would be nice.” 

It was then my eyes brimmed over. 

He added, more firmly, “And I’m sure that Hiroko on her side feels the same.”

Later that evening, I told Rob about my talk with Jimmy. Ever the optimist, he said Jimmy’s words proved he still loved Hiroko, yet I was less sure. Perhaps the pressure over the decades had been too much even for Jimmy. Perhaps no love could last in those conditions. Maybe RA would always win.

But just after my phone call with Jimmy, a memory, unbidden, had come to me. When he and Hiroko got together, his daughters and my sisters and I were teenagers. Tough girls, hardened by our parents’ unhappy marriages, we bonded over our shock and embarrassment at Jimmy and Hiroko’s behavior. To be so old and so moony! When they cooed at each other and kissed, we snickered, made jokes, and ostentatiously averted our gaze. At their wedding, when Jimmy’s voice broke in the middle of his vows, we hid from each other the sudden welling in our eyes.