A Singular Woman (43 page)

In Honolulu, Ann pressed on gamely. According to her correspondence, Barry helped her with insurance forms and letters in the immediate aftermath of her surgery. After a short time, she moved into an apartment in the same building as her mother and attempted to get back to her life. Her hair fell out, but otherwise she seemed to tolerate the treatment. She attended concerts and seminars at the university, having acquired a collection of colorful turbans and scarves. “She seemed as cheerful as ever,” said Michael Dove, the anthropologist Ann had known in Java and Pakistan and who was now at the East-West Center. “She even looked the same as ever, except, I think, she'd lost her hair and was wearing a scarf.” She insisted on going to a traditional Hawaiian feast known as a luau with her old friend Pete Vayda and his wife, when they arrived in Hawaii on vacation. She went on walks at Ala Moana Beach Park with the Solyoms—and with Maya when she visited. Georgia McCauley, her friend from Jakarta who was now back in Hawaii, saw her weekly. Madelyn's sister Arlene Payne telephoned regularly from North Carolina and sent books—mostly French authors, at Ann's request, notably Proust and Sartre.

Ann also continued to work. When Alice Dewey dropped by the apartment, she would find Ann at the computer. Gillie Brown sent the progress reports on the project in Jakarta for Ann to edit. Ann dispensed wise advice to Brown. Despite her youth and inexperience, Brown had been thrust by Ann's departure into the role of team leader. She was ambitious to make headway and impatient with the rigid code of female behavior inculcated by the Suharto government. In her first meeting with the state minister for the role of women, Brown received what she would later remember as a lecture on the importance of lipstick—which she was not wearing. As the daughter of a Welsh farmer, she knew that farmers looked after their cows well for a reason: Cows brought in income. It seemed to Brown that Suharto attended to the welfare of Indonesia's women like a farmer tended his herd. That was why the health and education statistics for women in Indonesia looked so good. When she would complain to Ann that nothing in Indonesia was changing, Ann would laugh. “If you can see progress on gender issues over a ten-year period, you're doing well,” Ann would say. Ann's advice to the younger woman on dealing with people was unfailingly practical. “She'd always laugh first and say, ‘Why don't you do it this way . . . ?'” Brown recalled. With older Indonesian women of high status, Ann suggested Brown try backing off. She could see, in a way that Brown did not, that change would eventually come. “Don't just get frustrated and unhappy,” Ann seemed to be saying. Focus on where you can make a difference. Accept that progress takes time.

Quietly, Ann also emboldened Brown to examine the ground rules in her own life. Brown was a married mother of three and the “supplementary income earner” in the family—the role to which married women in Indonesia were consigned by law, Brown told me. Coming from a conservative area in West Wales, Brown felt she had pushed the barriers to their limits. To have claimed even more independence—to have wanted things for herself, such as a career and an identity independent of that of her family—would have felt selfish. Ann inspired Brown, through their telephone and e-mail discussions of the limits on the lives of Indonesian women and through her comments on Brown's reports, to reconsider her own life. “I think Ann was, in the subtlest of ways, trying to say, ‘Well, actually, you have these constraints in your own life . . .'” Brown told me. “I think there was a mutual respect in trying to live our lives differently. She was sort of saying, ‘There's more: There's you.'”

Ann's compensation for her job in Jakarta had included health insurance, which covered most of the costs of her medical treatment. She had even had a physical in order to qualify—an examination she said had required six separate office visits in Jakarta. Once she was back in Hawaii, the hospital billed her insurance company directly, leaving Ann to pay only the deductible and any uncovered expenses, which, she said, came to several hundred dollars a month. To cover those charges as well as living expenses, she filed a separate claim under her employer's disability insurance policy. That policy, however, contained a clause allowing the company to deny any claim related to a preexisting medical condition. If, during the three months before starting work, a patient had seen a doctor or been treated for the condition that caused the disability for which they later wanted coverage, the insurance company would not compensate the patient for lost pay.

In late April, a representative of the insurance company, CIGNA, notified Ann that the company had begun evaluating her disability claim. (According to CIGNA, the disability policy was underwritten by Life Insurance Company of North America, a subsidiary of CIGNA.) In the meantime, the representative suggested that Ann find out if she was eligible for benefits under the Social Security system. Ann had already been told by Social Security Administration officials in Honolulu that she was not eligible: She had not earned enough credits in the previous ten years to be eligible for Social Security disability income, and she was ineligible for benefits under the Supplemental Security Income program for disabled people with limited resources because she owned an asset worth more than $2,000, an Individual Retirement Account. In response to the letter from CIGNA, Ann sent back copies of letters from the Social Security Administration and a half-dozen other documents that CIGNA had requested, along with a four-page letter that included a detailed chronology of her illness. “During the three months before joining DAI, the only doctor I consulted was Dr. Barbara Shortle, a New York gynecologist,” Ann wrote in the letter. “Dr. Shortle gave me a routine annual examination in May 1994, including pap smear and pelvic exam. She sent me to a laboratory for a mammogram and pelvic ultrasound. On the advice of the radiologist of the laboratory, I also had a breast ultrasound. None of these tests indicated that I had cancer. The pelvic examination indicated that I had an enlarged uterus, but this is a condition which I had had for about five years previously.”

Ann's letter did not mention the one procedure, the dilation and curettage, she had omitted to have.

By late June, CIGNA had made no decision on Ann's disability claim. The company was waiting to hear from Shortle, a representative told Ann. Ann faxed a letter to Shortle, whom she had not seen since her appointment thirteen months earlier. She explained that she was being treated for ovarian cancer in Hawaii and that her disability claim had been held up for months while CIGNA investigated whether her cancer was a preexisting condition. She said she had given Shortle's name to CIGNA, which, in turn, had faxed Shortle a request for information. Two weeks later, CIGNA sent another letter to Ann, addressed this time to “Mr.” Dunham. Among other things, the letter said, “If we do not receive either the requested information or some communication from you within 30 days from the date of this letter, we will assume you are no longer claiming benefits under your Long Term Disability Plan.”

In one of several drafts of a response to CIGNA, Ann coolly leveled a pointed objection.

In mid-August, CIGNA denied Ann's claim on the basis of her visit to the New York gynecologist two and a half months before she started work in Jakarta. Shortle's office notes had indicated that she had formed a working hypothesis of uterine cancer, though Ann said Shortle never discussed that hypothesis with her. When I spoke with Shortle, she said it was quite possible that she had not told Ann of her suspicions. “Whenever you do a D and C on any woman who has bleeding on and off, you're always doing it to rule out uterine cancer,” she said. But, she said, the procedure can be therapeutic as well as diagnostic. She might not, at that point, tell a patient her thinking.

Ann requested a review of the denial and informed CIGNA that she was turning over the case to “my son and attorney, Barack Obama.” Years later, during the presidential campaign and even after his election, Obama would allude to his mother's experience, albeit in an abbreviated form, when making the case for health care reform. Though he often suggested that she was denied health coverage because of a preexisting condition, it appears from her correspondence that she was only denied disability coverage.

Ann, characteristically, had hoped for the best. If all went well, the chemotherapy would be completed by the end of August, after which it would take two months for the side effects to abate. “Then, assuming that I go into remission and there is no recurrence of the disease, I should be able to return to work in November,” she had written to CIGNA in May. Because she would need monitoring and regular blood tests, it would be difficult to take a long-term overseas assignment again. “Instead, I plan to do short-term assignments for DAI which will allow me to return to Hawaii for checkups in between,” she wrote.

When friends called on the telephone, Ann often sidestepped the subject of her illness. In a series of conversations with Madelyn's youngest brother, Jon Payne, they sparred jokingly for the title of black sheep of the family, wondering why they had allowed themselves to fall so far out of touch. To Made Suarjana, calling from Bali, Ann insisted she was fine. He began to notice, however, that her voice sounded different. Slamet Riyadi, a colleague from Bank Rakyat Indonesia, was uncomfortable even asking about her health. Instead, he told her he would pray for her. Dick Patten came away from one telephone conversation believing that Ann had beaten the cancer. Julia Suryakusuma received a letter from Ann, which she allowed herself to understand, only later, had been intended to let her know that her friend was dying. When Rens Heringa called from Los Angeles on a visit from the Netherlands, Ann implored her to fly to Hawaii, but Heringa could not. Ann made it clear to Heringa that she knew she would never get better. Why was she forcing herself to continue with chemotherapy? Heringa wondered. Ann refused to give up hope. “Even when she knew she was seriously ill, it was probably not a matter of denial but really believing she was not ready to die,” Suryakusuma said.

Ann Hawkins, whom Ann had first met fifteen years earlier in the mountains above Semarang on the north coast of Java, understood that Ann was extremely ill. With some people, Ann seemed to keep the conversation light so she could think about happier things, Hawkins told me. But she spoke honestly with Hawkins. “She didn't really talk about her life,” Hawkins remembered. “Except that I always had the sense that Ann felt very privileged. She felt, yeah, of course her life was cut short. But at the same time she had an extraordinary life. . . . And I think she knew that. I think she
showed
it, in how she treated other people. She felt such abundance—that's the word—in not only her own life but life all around.”

Hawkins extended her arms out in front of her, palms turned upward.

“I see Ann sort of like this, with her hands out, giving,” she said. It was a gesture, she said, of generosity, perceptiveness, and compassion.

In early September, Ann said good-bye to her friend Georgia McCauley, whom she had known since her days at the Ford Foundation with McCauley's husband, David. In their weekly visits over the previous months, the two women had talked often about their children, rarely about Ann's illness. Now the McCauleys were moving. “It was difficult, because we both sort of knew that we wouldn't be seeing each other,” Georgia McCauley remembered. Ann indicated that she believed Barack would be fine: He was happy, and Ann thought Michelle would be a good partner. “She was just worried about Maya,” McCauley remembered. “‘Will you take care of Maya? Keep an eye out for Maya.'

“She was saying something pretty profound,” McCauley told me. “But it was sort of like the end of a conversation, as you're leaving. Nobody wants to face the obvious.”

Ann had told McCauley many times that she did not want her children to see her in the state she was in. But in the weeks that followed, McCauley said, “I often wondered, maybe I should have called Barry and bugged him. I asked Maya to talk to him. I said, ‘You all need to realize that it's going to happen fairly soon.' But I didn't know him well enough. I just thought it was kind of presumptuous for me to tell him what to do. I know they spoke. It's a difficult issue to deal with.”

In mid-September, Ann and Madelyn flew to New York City for a series of appointments at Memorial Sloan-Kettering Cancer Center, widely considered the most respected cancer center in the country. An oncologist at Sloan-Kettering had agreed to give Ann a second opinion. Maya, working full-time as a student teacher while in graduate school, met her mother and grandmother at LaGuardia Airport. Ann emerged from the terminal in a wheelchair, looking dazed and startled. Madelyn, a month away from her seventy-third birthday, was suffering from severe back pain. They were carrying with them Ann's medical records, X-rays, and tumor slides. They settled into the Barbizon Hotel on the East Side of Manhattan, near the hospital. Barack, back from his book tour and one week away from announcing his candidacy for the Illinois State Senate, arrived from Chicago with Michelle. At the first of two appointments at Sloan-Kettering, Ann was given a physical examination; she turned over the records to the doctor and the tumor slides for reevaluation by the pathology department. Then she returned to the hotel to wait.