Perfect

Natalie Wexler

Tuesday, March 18, 2003, 3:00 pm: I am lying face down and naked from the waist on a doctor’s examining table. The doctor, a petite blonde in her thirties, uses an instrument called a cannula to scrape, tug, and siphon off the fat from my outer thighs, all the while having an animated conversation with two nurses. The chatter that wafts back and forth over my prone body is cozy and female: schools, kids, shopping. It could be a twenty-first-century version of a quilting bee; I, it seems, am the quilt.
    I am deeply conflicted about, indeed profoundly ashamed of, the fact that I am here; I am not the kind of person, in my own estimation, who undergoes liposuction. How did I come to be here? Maybe it was that stylish blonde doctor, a dermatologist. My appointment was for nothing more than a once-over to check for skin cancer—I swear!—but somehow the subject came up. Well, okay, maybe I brought it up. She had sent all her patients a newsletter that touted, among other cosmetic procedures, something she called “lunch hour liposuction.” Just an hour or two in her office, the newsletter said, and out walks a new you.
    “Oh, yes,” the doctor had gushed, scrutinizing the bulges at the tops of my thighs, “you’re the perfect candidate.” She assured me it was not my fault, that I could do all the dieting and exercising in the world, and it wouldn’t make any difference. “It’s genetic,” she said.
    Since then two annoyingly persistent voices have warred in my head:
    “It’s genetic, like a deformity,” one will say, “like a harelip or a club foot.”
    “Give me a break,” the other will rejoin; “nobody even notices this except you.”
    “Well, okay, maybe it’s not a deformity, but it’s bothered me all my life, and it makes it really, really hard to find pants that fit me.”
    “Oh, for Christ’s sake—you call that a hardship? What do you want to be, perfect ?”
    But the voices are silent now, or at least irrelevant; the die has been cast, the Rubicon crossed, and nearly a liter of fat—a yellowish liquid that reminds me of rendered chicken fat—has been transferred from my thighs to a clear canister slightly northeast of my head. I am helped off the table, and the nurses bandage my thighs; the small incisions where the cannula was inserted, they inform me, will leak for several days. I am to go home and rest.
    At about three thirty, one of the nurses leaves to call my husband, who will need to drive from his office in downtown Washington, D.C., about half an hour away, to pick me up. There is a strict rule that patients cannot drive themselves home—not even a patient like me, who stoically declined the Valium that was offered before the procedure. Several minutes elapse, during which I examine, tentatively, the bandages and the promise of new, svelte thighs underneath.
    The nurse returns. “We’re having some trouble reaching your husband,” she tells me. “He’s not answering his work phone, and he’s not answering the cell phone number you gave us.”
    I feel a wave of mild irritation. Jim never turns on his cell phone on the theory that everyone knows he never turns on his cell phone and, therefore, no one ever calls him on his cell phone. I have pointed out to him the circularity of this argument. But today, damn it, he knew I would be calling him, right about now, to come pick me up.
    I reach for my own cell phone; maybe there’s a message. There is. The phone must have rung while I was on the table, but—given my position at the other end of the room and the roar of the fat-draining machine—I hadn’t heard it. The voice on the message, to my surprise, is not that of my husband but of his colleague and friend, a guy named Irv.
    “Umm, I don’t want to alarm you,” Irv says, his voice tight, “but Jim’s been in an accident.” He tells me that Jim has been taken to the emergency room at George Washington University Hospital, and he thinks it would be a good idea if I could come down there. Right away.
    “Oh my God, oh no,” I hear myself say. I sway slightly, my eyes close; I reach out to the table—where minutes ago my thighs were being scraped—to steady myself. The nurses gather around me now—nurses I haven’t seen before emerging from other examining rooms as the word spreads—solicitous, asking what happened. An accident, I tell them, imagining a horrendous car crash, remembering how Jim always speeds up when he sees a yellow light. Through my numbness I feel another far-off wave of irritation. A nurse hurries off to call the GW emergency room while two others put an additional layer of bandages on my thighs so the incisions won’t leak while I’m at the hospital.
    The hospital, how am I going to get to the hospital? My car isn’t here, and even if it were, I’m not supposed to drive. For some reason the thought of a taxi doesn’t occur to me. Then my phone rings again—Irv. Jim fell in the bathroom at work, he tells me. (So, not a car crash.) Apparently he hit his head very hard—Jim works in a thirties-era government building where the bathroom surfaces are all unforgiving marble—and there was a lot of blood. Afterward he wasn’t quite . . . himself.
    I explain that I am at a doctor’s office, that Jim was actually supposed to pick me up, that I am not supposed to drive. I feel I should explain that it is nothing serious—that in fact it is something disgustingly frivolous and inane—but even at this point (especially at this point), wild horses couldn’t drag the true nature of the medical procedure out of me. And Irv doesn’t ask; he announces that he will be here as soon as he can to pick me up and take me to the hospital.
    As I wait for Irv on the sidewalk—one of those solicitous nurses at my elbow, my thighs so swaddled in bandages and tape that I feel their circumference must be twice what it was before the liposuction—the thought enters my head that I am being punished. It is not that I believe in God; certainly not in a god who fritters away his time wreaking vengeance on women who go in for cosmetic surgery. And yet somehow—in a cosmic, inexplicable sense—the conviction begins to grow that if only I hadn’t indulged my foolish yearning for perfect thighs, everything would be just fine right now.

It was an extremely hard fall, the emergency room doctor tells me in the small office into which I have waddled, thigh bandages and all, while Irv parks the car. The X-ray reveals a large clot of blood pressing on Jim’s brain—a clot that is probably the result of the fall rather than the cause of it, the doctor says. “Did he trip?” I ask. “Unlikely,” says the doctor. He explains that people who trip are apt to break the fall with their hands, blunting the impact, but the amount of blood in Jim’s case is more consistent with a free fall.
    “It’s like what you’d see if someone hit him over the head with a billy club,” he adds.
    I don’t have time to wonder if this is simply a metaphor or if it is being offered as a plausible scenario. The doctor tells me that they have to operate immediately—it is almost 6:00 pm now—that Jim has already been sedated, and that they are about to wheel him into the operating room. “We had to act fast,” he says ominously. “We were losing him.”
    But he also reassures me that the chances are good everything will be alright. The amount of blood is unusually large, but the hematoma is epidural rather than subdural (a distinction that will become increasingly familiar in days to come, that I will repeat like a mantra), meaning that once the clot drains and the pressure on the brain recedes, everything should return to normal. A ray of relief penetrates the fog of shock that has enveloped me since I retrieved Irv’s message on my cell phone; I cling to the doctor’s reassurance, trying to ignore the part that consigns the ultimate outcome to chance.
    The doctor tells me I can see Jim, but it will have to be quick. He directs me to a room where my husband lies unconscious on a gurney, his bare feet poking out from beneath a sheet, medical personnel readying him for surgery. His head is bandaged, the blood has been cleaned up, but his right eyelid is yellow and purple and grotesquely swollen, as though someone has punched him mercilessly.
    “Oh my God, his eye!”
    The looks from the green-suited hospital workers tell me that his eye is the least of his problems. “That’ll go away,” one of them mutters.
    I begin, quietly, to cry.

At about three, while I was watching the dermatologist’s canister fill up with fat from my thighs, Jim was discovered by a man who worked in the building. Though he was bleeding profusely from the head—indeed he was largely covered in blood—Jim was standing and conscious in the hallway outside the men’s room. Clearly disoriented, he was unable to tell the man his own name. (And yet, a bit later, he was able to give Irv my cell phone number with no difficulty, just as he was able to recall his internist’s phone number, but not the internist’s name. The brain works, or fails to work, in mysterious ways.)
    On the men’s room floor was a pool of blood in which Jim may have lain unconscious for some time before managing to get up and make his way out to the hall. The man who found Jim—who, luckily, had some training in emergency medicine—brought him to the office library, called for an ambulance, and determined Jim’s identity from his government ID. All the while Jim remained conscious but strangely unconcerned about his predicament; in fact he kept insisting he was fine, that there was no need for him to go to the hospital.
    Jim could provide no explanation of what had happened; he didn’t remember, didn’t seem to realize at that point that anything had happened. And the bathroom yielded no clue: no slippery puddle of water from an overflowing sink or toilet, no sign of a struggle. Just that pool of blood and, some distance away, Jim’s glasses, which apparently flew off his face when he fell.

Now, in my own bathroom, many small pools of blood form—ridiculous, mocking echoes of the pool in which Jim lay for God knows how long. I have come home for just an hour or so, having been instructed to return to the hospital at 9:00 pm, when Jim should be coming out of surgery. I have told the kids—my twelve-year-old daughter and fifteen-year-old son—what happened, more or less, emphasizing that everything will be alright. They have taken the news with an odd calm; if they are upset they do not let me know. The one person I haven’t told, whom I must tell soon, is Jim’s mother, well into her eighties and in a hospital herself with a broken hip. She fell three days ago, and I know Jim had planned to visit her this evening.
    But for the moment, I am entirely absorbed in the effort to stop the rivulets of blood—or rather, a pinkish fluid that looks like a pale imitation of blood— spurting from my thighs; I have taken off the layers of bandages that were taped to me at the doctor’s office only to discover that the narrow tape and the sanitary pads with which I am attempting to replace them are grossly inadequate to the task. The tape refuses to stick to the pads or to my thighs but uselessly adheres in a tangle to my fingers. Meanwhile the bloody liquid is leaking from those deceptively small incisions onto my legs, my clothes, the bathroom floor, the towels. As the minutes tick by, my efforts grow more frantic but no more effective. I am reminded of those medieval portraits of Saint Sebastian in which sprays of red liquid arc outward from his martyr’s wounds.
    I curse myself, my stupidity—a martyr, yes, but in my case a martyr to my own vanity—and tears of frustration, fear, and self-accusation course down my cheeks. This might be the worst moment of my entire life. Just then the phone rings. It is my mother-in-law.
    “Do you know where Jim is?” she asks, the slightest note of petulance in her voice.

March 19: Last night at the hospital, the surgeon assured me that the operation was a success. But despite that good news—and the ingestion of some over-thecounter sleeping pills—I haven’t managed more than two hours of sleep. I now regret having declined the Valium that was offered to me at the dermatologist’s office; at least I could have pocketed it and saved it for later.
    I have spent the night thinking about the unthinkable. Jim will survive; I am reasonably confident of that. But will he be the same person? I suddenly miss him, ache for him with an intensity that astonishes me. After sixteen years of marriage, the only intense feeling I am used to having about him lately is annoyance. It hasn’t been an unhappy marriage, far from it; I’ve certainly never met another man I would rather be married to. But if there is a baseline of contentment, the things that flare up, that break the surface and leave an impression, are the conflicts: he always worries about being early, and I always worry about being late; the briefcase flung onto the kitchen table annoys me, and the dust on the ridges of the kitchen cabinets annoys him; he likes to keep his options open until the last minute, while I can’t stand living with uncertainty; and each of us tends to feel, at times, that the other isn’t really listening. There have been times when I have thrown up my hands, at least figuratively, at something he has said or done and declared to myself that I will never understand him. There have even been times, I will admit, when I have wondered if there isn’t some other man out there, some potentially perfect husband I have never met.
    It all seems ridiculously trivial now, as the enormity of what I might be losing hits me. I realize that in all the world, there is no one else like Jim. Even with all his imperfections, every molecule of his being is infinitely precious to me. Who else sings (in a voice that renders nearly any tune unrecognizable) both “Di Provenza, il mar” from La Traviata and also growls “I feel good” in the style of James Brown? Who else can recite from memory large chunks of both the dialogue from A Night at the Opera and—in the original Yiddish—a number of choice phrases from the works of Sholom Aleichem? And even if there is, by some strange chance, someone else out there who can do these things, he still wouldn’t be Jim. I yearn for him to walk into the house and call out—the way he always does, for reasons that are unclear, since Spanish is not one of his languages—“Hola!” I vow that if Jim recovers, I will cling to this appreciation; I will never again take him for granted; I will appreciate the hell out of him. I will cherish even his imperfections.
    When dawn breaks I manage to rebandage my thighs securely enough to drive the kids where they need to go without serious mishap. I then head immediately to the nearest drugstore, where I purchase what is probably a lifetime supply of heavy-duty bandages and medical tape. At last I arrive at the hospital, where I find Jim still groggy, drifting in and out of sleep. His right eye looks better, but now the left one is becoming swollen and discolored—the result, I learn, not of any onetwo punch, but of blood from the head injury collecting around his eyes. He recognizes me and says hello, but in an offhand, matter-of-fact way, as though I had just returned from a trip to the supermarket. His emotional flatness is at the opposite end of the spectrum from my intensity.
    A staff neurologist comes into the ICU to ask Jim a series of questions—a procedure that will be repeated frequently in days to come by a rotating cast of doctors. He answers most of them with a reasonable degree of accuracy (I am greatly relieved to find he has no trouble remembering my name), but when she asks if he knows what city we are in, he answers, after only a little hesitation, “New Orleans.”
    The doctor looks at me quizzically. “Have you been to New Orleans recently?”
    I shrug. “About fifteen years ago.”
    “Well . . . this kind of disorientation is perfectly normal at this point. He’s doing very well, actually.” I must look dubious, because the doctor adds, kindly and reassuringly, “If you have any questions, any questions at all, you can have me paged.”
    Then she tells me her name, which I promptly forget. But it doesn’t matter— my questions can’t be answered right now by her or by anyone else. There is nothing to do, really, but sit by Jim’s bed and wait, greet the occasional visitor, answer the occasional phone call, and—when Jim is awake—have the same conversation with him over and over:
    “I have to go to the bathroom.”
    “No, it’s okay, you have a catheter in.”
    “I have a catheter?”
    “Yes, you had an operation.”
    “I had an operation?”
    “Yes, you had an accident.”
    “I had an accident?”
    During the lulls in the action, there is always the TV. Cruise missiles fall on Baghdad through an eerie greenish light. War, I note with a detachment that I recognize as strange, appears to be breaking out.
March 20: Now that I have bought all these bandages and tape, my thighs have almost stopped leaking. But the anesthetic has definitely worn off: sleeping on my side, as is my habit, is out of the question. I resolve this morning that whatever else I do, I will obtain the painkillers prescribed by the dermatologist. The good news is that, when I desperately rummaged through the medicine cabinets last night, I managed to find some Valium, which helped to quiet my roiling brain and bought me a modicum of sleep.
    When I see Jim later, I note with a stab of disappointment that he appears pretty much the same: groggy, dozing intermittently. Given the doctors’ and nurses’ reassurances, I had expected some improvement. In fact, as the day wears on and Jim’s Atavan wears off, I realize that there has been some improvement, but it is double-edged. As he becomes more alert and more aware of his surroundings, he becomes what the nurses call “agitated.” What this means, as I soon discover, is that he keeps trying to get out of bed. His brain is still unable to process the information that something is wrong with him, and he cannot understand why he has to lie still, why there is an IV stuck into his hand, electrodes on his chest, and a stiff plastic collar around his neck.
    His efforts to pry off his various attachments and get out of bed went on all night, which explains why there is a rolled-up sheet looped around his chest, securing him to the bed, and why his ankles and wrists are also tied down. He constantly tries to sit up, to lift his arms and legs. Over and over again he asks me—as he asks anyone who comes into the room, doctors, nurses, or wellmeaning friends or acquaintances—to help him free himself.
    “Can you help me undo this?” Jim will ask, indicating the wrist or leg restraint as though it is some stubborn shoelace knot.
    “No, I can’t,” I say.
    “Of course you can,” he replies, as though I’m the one who’s being unreasonable. “You just undo this thing here.”
    From his skewed perspective, of course, I am the one who is being unreasonable: there is nothing wrong with him, he feels fine, so why should he be confined to a hospital bed with all this uncomfortable paraphernalia? Part of me longs to comply, to set him free; I can’t stand to see him tied down this way, his familiar furry chest banded by that sheet.
    What makes a brain injury so hard to take is that the victim looks pretty much the same as he did before (aside, of course, from the half-shaved head and the raised gash encrusted with dried blood and held together with industrial-strength staples, all too visible now that the bandage has been removed). But you can’t talk to him, you can’t reason with him the way you used to; you no longer share a common frame of reference. Your reality is no longer his.
    Oh there are glimmers of the old Jim. When his internist dropped by the day after the accident and remarked dryly, “Well, you had quite a day yesterday,” Jim replied—even more dryly—“So I gather.” But for the better part of this afternoon, Jim is under the impression that we are at the Chevy Chase Pavilion—a small upscale shopping mall near our house—waiting for a movie to begin. (That the Chevy Chase Pavilion does not actually contain a movie theater seems a minor quibble, which I don’t bother to raise.) Jim’s agitation has died down now. He mostly dozes but rouses himself every once in a while—interrupting my halfhearted attempts to decipher the various maps of Iraq being shown on CNN—to ask, “Is it time to go to the movie yet?” The first few times, I explain to him that there is no movie, that he is in a hospital, but my explanation just sets off the same old round of questions and answers—“I’m in a hospital?”—and triggers the same old agitation. After a while, to make things easier on both of us, I play along: “No, it’s not time to go to the movie yet, just relax.” But my conscience bothers me, and when the next passing neurologist stops by with the usual barrage of questions, I ask him if what I am doing is alright.
    The doctor looks dubious. “I think it would be better to try to get him reoriented.”
    So the next time Jim asks if it is time to go to the movie, I dutifully reply that we are, in fact, in a hospital.
    There is only a slight pause before he asks, “But there’s a movie, right?”
    The nurses tell me that Jim will be moved out of the ICU as soon as a room opens up on the neurology wing. I accept this news with mixed feelings: it seems to indicate that things have improved. But is this the best we can hope for? Will he spend the rest of his life under the delusion that he is at the Chevy Chase Pavilion, waiting for the movie to begin?

March 21: I realized last night, too late, that I had completely forgotten about getting those painkillers. What I need is a painkiller that goes well beyond anesthetizing my aching thighs (which, still swollen from the “procedure,” bulge only a little less than they did before). It is hard to say what is worse: being at the hospital with a person who looks and sometimes even sounds like Jim but isn’t really Jim, or being here at home, surrounded by his clothes and books and shampoo and all the other things that scream his absence. All I have to do is look at his toothbrush and the tears begin. But so far—since that first glimpse of Jim being readied for surgery, anyway—I have done all my crying privately.
    Today, I think, surely today he will be better, more himself, more aware of what has happened. But when I arrive at the neurology wing—even before I see Jim— the nurse at the station outside his door lets me know he kept the staff busy all night with his efforts to get out of bed. They have given him Atavan to calm him down, but they don’t want to give him too much, for fear the drug-induced grogginess will slow his recovery.
    “He’s still pretty disoriented,” says the nurse, a large, hearty black woman wearing a Muslim head scarf.
    “How can you tell?” I ask.
    “Well,” she says, leaning closer, “I asked him if we were at war, and he said no.”
    I comfort myself with the thought that, of course, as of the time Jim fell in the men’s room, we were not in fact at war. But it soon becomes clear that the nurse is right; though Jim asks the occasional sensible question, most of the time he is single-mindedly focused on freeing himself from his restraints and getting out of bed. And because he has become more alert and energetic, his efforts have taken on a greater intensity. Now, when I explain to him that he can’t get up, that he has had an accident and is in the hospital, he doesn’t just close his eyes and briefly accept it; he gets angry. He doesn’t yell or scream—he’s never been the yellingand-screaming type, and his basic temperament has remained intact. Instead— using the quiet, urgent, insistent voice so familiar to me from any number of serious arguments—he says, “Look, I need to go home. I feel perfectly fine, and there’s no reason for me to stay here.”
    At one point during a brief period of calm, I tell him that tomorrow is March twenty-second. “Do you know what that means?” I coax, as one might prompt a child.
    He pauses, considering. “My birthday?” he ventures.
    “That’s right.” I feel encouraged. The kids expect to see him on his birthday, though I haven’t made any promises. They haven’t seen him since the day after the accident, when he was still basically in a stupor; I don’t want them to see him when he is agitated, don’t want him to beg them to untie his restraints, don’t want them to have to refuse.
    I take the questioning a step further. “And do you know how old you’re going to be?”
    He thinks about it for a minute and then says no—although it doesn’t seem to bother him particularly that he doesn’t know. It occurs to me that I could tell him anything; why not let him believe that he is turning, say, thirty-nine? But then I remember what the doctor said yesterday about my playing along with the Chevy Chase Pavilion scenario.
    “Fifty-three,” I tell him. “You’re going to be fifty-three.”
    At last, at about two thirty, I go home, leaving Jim in the care of his private day nurse, a gentle-voiced African woman. He is sleeping peacefully now, and I am worn out from my repeated efforts to keep him from getting out of bed. Besides, a stack of mail is piling up at home, containing God knows what: utility or mortgage bills. I imagine the heat being shut off, foreclosure on the house.
    At about four thirty the phone rings. “Nat,” I hear Jim say in a voice that is both bewildered and outraged, “I’m in the hospital !”
    “I know. I was there today, remember?”
    “But I’ve got to get out, you’ve got to help me get out of here.”
    I take a deep breath, mustering all my strength to make an argument that might at last part the clouds for him. I tell him that he has had a serious head injury—“Did I slip on the ice or something?” he asks—and that the injury itself is affecting his perception of the situation. “I know you feel fine,” I say, “but the thing is, you’re not able to see the whole picture at the moment. The best thing, if you want to come home, is just to do what the doctors say: rest and be patient. I know it’s hard, but that’s what you have to do.”
    “Okay, okay,” he keeps saying, as if all this is finally sinking in. He suddenly sounds exhausted, perhaps from the effort to comprehend what I have been telling him. “Anything else going on?” he asks, much the way he would if he were calling home from the office in the middle of the afternoon. “No,” I tell him, “we’re just hanging out here.” I ask if he would like me to come back to the hospital tonight. “No,” he says wearily. “Not tonight. Maybe tomorrow.”
    Of course tomorrow, I tell him, and say goodbye. I close my eyes, smile to myself: we had a real conversation. His very weariness and the dismay in his voice have elated me. He understands. At last he understands.
    I decide that, after all, I will go off to a reading tonight by one of my favorite authors, an excursion I had planned months ago with a friend. At times my mind wanders to Jim, and at others—thanks to my accumulated sleep deficit—my eyes begin to close, but for much of the reading, I am able to attend to what is being said. It is a wonderful luxury, spending an hour or so contemplating something other than my own situation.
    As soon as I get home, I call the nurses’ station just to check in. “Well,” says the nurse, a professional chuckle in her voice, “he’s still keeping us on our toes, trying to get out of bed every five minutes.” Dismay sweeps over me: that phone call made no difference. He has already forgotten our conversation. Hearing the disappointment in my voice, the nurse assures me that there’s nothing to worry about, that this isn’t in the least abnormal, that these things take time. Her words wash past me. I am tired of being reassured, of being patient, of keeping my hopes up.

March 22: Again I realized too late that I forgot to get the painkillers; I am learning to sleep on my back.
    Jim’s best friend is coming down from New York today, and the kids and I have assembled a small collection of birthday presents to bring to the hospital. Theirs is a fake composite photograph they have been working on all week, which purports to show Jim singing on stage with James Brown. One of my gifts is a series of sailing lessons, something Jim has often talked of wanting; now it seems ridiculously, hopelessly inappropriate, like giving a pair of high-end running shoes to someone confined to a wheelchair. I am not at all sure there will be a birthday celebration.
    Today is probably the first day since the accident that I arrive at the hospital without much in the way of expectations; when I called this morning, the nurse told me Jim had had a “good” night (which apparently meant that he had been given a lot of Atavan) but added that he had still been trying to get out of bed. So I am completely unprepared for what I find: Jim sitting calmly in bed, greeting me with his customary “Hola!”
    “What did I do to myself?” he says, sounding exactly—and exhilaratingly—like his old self.
    Jim has no idea why I am moved almost to tears to hear him ask this; he has no idea, in fact, about a lot of things. He has no memory whatsoever of the previous three-and-a-half days; he simply woke up this morning and found himself, to his great surprise, in a hospital. I am wounded to find that he has no idea I have been here to visit him before. “How could you think I wouldn’t?” I ask. The last thing he remembers is being at his desk on Tuesday afternoon, before the accident; he doesn’t remember going to the men’s room.
    While I am filling him in on recent events—he is fascinated and will continue to be fascinated in days to come, asking me to go over and over what happened, like a child begging to hear tales of his babyhood—I see Irv in the hospital corridor, walking toward us, looking grim.
    “He’s better!” I call to Irv. And as I see the smile that suddenly illuminates his face, I realize that I must look like that too: transformed, radiant.

Months later the only lingering effect of what Jim has taken to calling his “brain transplant” is the partial loss of his sense of smell. While I understand his frustration at this, when I consider what might have happened, I feel we are extraordinarily lucky. The doctors warned of irritability, memory loss, personality change, but these afflictions, if they showed up at all, were only temporary. (Yes, sometimes Jim claims to have no recollection of something I know I have told him two or three times, but I remind myself that used to happen before the brain transplant.) As for the cause of the fall, various tests have ruled out a seizure. The most likely hypothesis is that Jim experienced “micturitional syncope”: fainting after emptying an extremely full bladder. When we ask what the chances are of this happening again, all we get is the medical equivalent of a shrug. We proceed on the assumption that it won’t.
     That is not to say we haven’t been changed by the experience, at least in subtle ways. Jim has had a brush with his own mortality; he has a greater awareness of aging, of time being finite. And I have had a glimpse of the abyss, of what either Jim or I will almost inevitably confront someday: life without the other.
    Of course now that he is not delusional and restrained in a hospital bed, it is a little harder for me to sustain that intense appreciation of Jim and his various imperfections. Old conflicts and tensions have a stubborn way of reasserting themselves. Just recently I showed Jim the journal I kept while he was in the hospital. He handed it back to me, visibly moved, and asked if I still felt that way.
    “Well,” I replied, “I think it might be time for another head injury.” A joke, of course, but one containing the inevitable grain of truth.
    As for my thighs, the ugly bulges have all but vanished. And does that make me a happier person? Although I still consider the liposuction a shameful secret, I would be lying if I didn’t admit that, in fact, it does make me happier. After thirty years or more of seeing myself, however irrationally, as deformed and freakish, I now have the satisfaction of zipping up a pair of pants in a department store dressing room and discovering that my body at last conforms to an average human type, the hips and waist in the expected proportion to one another. Call it vanity, call it brainwashing by the media and the fashion industry, call it what you will: I can’t deny how I feel.
    If you asked me what was more important, my husband’s health or my new thighs, I would not hesitate to choose the former. But the irony is that it is the former I have come to take for granted again and the latter that actually gives me little twinges of satisfaction on a daily basis. Perhaps it is because we simply can’t conduct ourselves according to the formula urged by greeting cards and gurus, living every day as though it is our last—or in this case the last with our loved one: if we did we would go nuts. Maybe, in order to get through life, we have to keep our focus primarily on the superficial.
    And yet the superficial and the too-meaningful-to-contemplate sometimes connect. When I returned to the dermatologist for a final assessment, after the swelling had gone down, we agreed that there was still a slight bulge at the top of each thigh. She offered to perform a touch-up liposuction, free of charge. “Just so it will be,” she said, “perfect.”
    I thanked her, but in the end I decided not to take her up on it. I don’t want to tempt fate or whatever it was that struck last March. And besides if I haven’t learned to cherish imperfection, at least I have learned that there is no such thing as life without it.

Natalie Wexler has had essays appear in Forward, the Washington Post Magazine, and other periodicals, and her fiction has been published in the Baltimore Review and Outlook. She lives in Washington, D.C., where she is an associate editor of The Documentary History of the Supreme Court of the United States, 1789–1800 and a workshop instructor at The Writer’s Center in Bethesda, Maryland.

“Perfect” appears in our Summer 2005 issue.