Reviewed by Carolyn Roy-Bornstein
In 1997, Kathleen Watt was an assistant art director at a magazine by day and an extra chorister at the Metropolitan Opera by night, sharing opera’s magical world with the likes of Placido Dominguez and Dame Gwyneth Jones, when she discovers that an aggressive bone cancer has invaded her maxillary sinus cavity, an area of the midface that houses her “resonators.” Like the body of a Stradivarius violin, this resonance area accounts for 30% of an opera singer’s vocal power; thus her tumor is “breathtakingly tailored to obliterate my profession and my raison d’etre, never mind my face.”
This dry wit and humor of Rearranged: An Opera Singer’s Facial Cancer and Life Transposed is part of what makes this grueling tale so compelling a read as Watt endures more than thirty surgical procedures over the course of the next ten years, first to eliminate the cancer itself, then to reconstruct her facial anatomy in the hopes of reviving her singing career. Through multiple bone grafting techniques, scapula becomes palate, skull becomes eye socket, ear cartilage eyelid. She equates CATs scan of her head with the all-important “head shots” — glamourous portraits, air-brushed to perfection — that all singers must carry to auditions. “The singing life often seems to be about appearances,” Watt notes.
Watt is a skilled writer, deftly crafting scenes as the “unreliable narrator” who is plagued with post-operative narcotic delusions and haunted by ICU psychosis. Though these scenes could have been edited down to a representative few, they poignantly portray the isolation and loneliness of one whose perceptions and interpretations of her environment are not shared by her caregivers.
Determined to return to the life of opera, Watt begins recording herself through her many procedures to track her vocal progress. At first, she seems to be “recovering myself, bar by bar.” She notes her articulation improving “at a steady largo.” But as grafts become infected, flaps unsuccessful, and surgeries delayed, her hopes dim. She realizes, “I would never roll another R — that pesky fundamental of operatic diction” and “My return to professional singing was fading to a wistful what if.”
Along with the loss of her career, her changed physical appearance also takes its toll. She seems at her lowest when she realizes she has beaten cancer but has become severely disfigured in the process. “All that can be done has been done and we’re now disease-free. We’re ugly. But no longer dying. Just ugly.” She goes on, “…from the Golden Age of Greece to the Golden Age of Hollywood, beauty is virtue by equivalence. From Leonardo’s Vitruvian to the Cosmo Cover Girl to social media — physical beauty, in the shape of its time, signifies to all what is “good” and devoutly to be wished for.”
My favorite parts of Rearranged are where Watt uses her full command of music, art, and literature to describe common illness experiences. When she is leaving the hospital after many weeks in the ICU then step-down unit, she is surprised at being met with the utter mundanity of life. “I thought of Dutch master Pieter Breughel’s Landscape with Fall of Icarus — a sweeping sixteenth century genre painting, dominated by a sturdy peasant plowing a high field. We look past him out to sea, over cliffs and sailing ships, to a pale horizon. Below the plowman, a shepherd. On the rocks amidst his flocks, props himself lazily upon his staff. At water’s edge, an angler sits beside his bait pail. The only sign of the fallen “Icarus” of the title are his tiny legs, white and flailing, disappearing beneath the waves. No one even notices.”
Reading this memoir as a physician, I was struck by the many important lessons Watt would like to teach our profession. The main take-away for me is one I know well as a writer and narrative medicine facilitator, but which Watt suffused with her own personal wisdom. Words matter. They have power. Mere hours after one operation, Watt’s surgeon tells her, “You made it.” “His words flowed over me like sunshine.” Watt gives him a thumbs up sign which the doctor returns. “That economical gesture was enough to embolden me for the rest of my recovery, to own it, to commit to it, and do as much for myself as he had done for me. He legitimized my contribution, invited me to join the team, to take responsibility, for which he would give me credit.” Words matter indeed.
Though Watt’s wry sense of humor is no doubt what helps her through her harrowing odyssey, it may in the long run be what seems to have gotten in the way of her dealing deeply with certain aspects of her ordeal. She mentions her alcoholism in a list of “demons wrestled” but we see no such wrestling on the page. Likewise, she seems, at times, astonishingly unaware of the toll her illness has taken on her partner, try as she might to keep her feelings of grief hidden from her. She miscalculates the loss of her wife’s career. “How did I not know that my health issues — I myself — had probably stolen her future?”
This is an important book, both for its lessons for us physicians on listening well to our patients and cultivating close decision-making partnerships, as well as for the world at large on what it looks like to be brave. On how to be human.
Carolyn Roy-Bornstein is a retired pediatrician and the writer-in-residence at a large family medicine residency program. Her work has appeared in The Washington Post, The New York Times, The Boston Globe, JAMA, Poets & Writers, The Writer magazine, and other venues. Her most recent book is “Writing Through Burnout: How to Thrive While Working in Healthcare.”
