Family Tree: An Excerpt from Tiffany Graham Charkosky’s Living Proof
The following is an excerpt from Living Proof, out now from Little A. To read an interview with the author, go here.
Dr. Arenberg was based out of the same hospital that had treated my mom and Uncle Jeff, which was also the same hospital where they both died. The day of my first appointment, I drove from my office across town and through Rockefeller Park, the same green space we’d passed through to visit my mom when she was sick. The hospital was in University Circle, a neighborhood packed with museums, colleges, and health-care institutions. Nearby, a public art installation made of stones traced the path of a former Indigenous trade route, marking the spot where a buried stream flowed underground. It was strange how one place could hold such a patchwork of memories.
I parked on Euclid Avenue and walked past the taller, newer hospital buildings and toward the older, pale yellow one bearing the address from Dr. Arenberg’s email. It wasn’t until I approached the entrance that I realized it was not only the same hospital system but the exact building where we’d visited my mom and my grandpa in the preceding years. It seemed quaint, nestled into a side street, like it had been designed to fit into London a hundred years earlier and now sat like an overdressed relic amid a row of parking garages and boxy medical offices.
I was nearly eight weeks pregnant, aware every day of how much I wished for everything to keep progressing as normal. Like with Ben, I was nauseated all the time. Unlike with Ben, I found it strangely comforting. As long as I kept throwing up throughout the day, I could believe the baby was still alive inside me.
As I walked toward the yellow building, a different feeling of sickness than my constant nausea spread through my limbs. I was young again, walking into this hospital with my dad. I’d asked him if my mom was dying exactly once. He’d answered, “She could outlive any of us,” which I think he thought would give me hope for a miracle but instead made me afraid that I might come home from ice-skating with my friends to find our house in flames or accidentally jump into moving traffic. Though I’d lived with awareness of my mortality for nearly two decades, walking through the door of the hospital to learn the potential limits of my life felt like reaching a point of no return—a destination with no path back home.
But the email had been very clear: This appointment was not to conduct a genetic test. It was just to discuss the testing process. Brian had offered to come with me, but I told him to save his time off. The deeper truth was that I needed to face this on my own. I needed space to understand and process and figure out how to handle the information in a way I could manage. I knew I couldn’t shield him from it forever, but I wasn’t ready to share the burden. First, I had to make sense of it myself before I could take on the weight of his reaction too. At the same time, I imagined an alternate storyline where this entire thing was a big misunderstanding.
I made it through the maze of hallways and to the correct waiting room. A tall man wearing a sweater-vest introduced himself as Lou, the genetic counselor who worked with Dr. Arenberg. “She’s the best,” he said as we walked to a small gray room with a table and four chairs. The bright white winter sky was framed by windows at the top of the walls. Boxes of tissues sat on every available surface: table, windowsill, counter. I didn’t think I’d be able to work with people who cried every day.
Dr. Arenberg entered the room a few minutes later. Her wildly curly hair was somewhere between black and gray and balanced by her glasses and smart-looking slacks. Her prominent nose and jaw reminded me of my Grandpa Mitchell. Lou took a seat beside her and folded his hands on the table. One of them had only two fingers, suggesting the origin of his interest in genetics, but I tried not to let my eyes linger on them.
“Your uncle seemed like a wonderful man,” Dr. Arenberg said, sounding friendlier than I had expected. “I’m sorry I didn’t meet him under different circumstances.”
“Me too,” I said, forcing a polite smile. Jeff took up a lot of space in every room he was in. This wasn’t only because he was physically imposing, which he was, but because he was also among the funniest people I knew in real life. He would have found a way to make me laugh in here, in spite of everything. I understood why there were tissues everywhere.
“I’m looking for families that have HNPCC, or Lynch syndrome, but don’t meet the current standards for testing.” She slid a blue sheet of paper across the table with a matrix of different cancers, ages, and percentages. At the top it read, “Hereditary Nonpolyposis Colon Cancer (HNPCC).” I felt healthy, but maybe I didn’t even know what healthy felt like. I wished I was in the wrong place, or the wrong person, that this entire chain of events was a mistake.
I was angry and frazzled, like I wanted to stomp my feet and shout, This isn’t fair! But at the same time, I wanted to prove to them I had my life together, that I was exactly the kind of person they sought to help: an upstanding member of society, a good mother, someone who deserved to keep living.
“I’m here to help you navigate this process and make decisions along the way that are best for you,” Lou said. His role as a genetic counselor wasn’t to study genetics itself, but to provide therapy to patients who were considering genetic testing. He seemed to be offering emotional support to balance out the cold, hard science that Dr. Arenberg doled out.
“We’ll start by drawing your family tree,” Dr. Arenberg said. A folder with Jeff’s name on it sat beside her. Lou pulled out the chart and placed it next to the blank paper in front of Dr. Arenberg.
“We can’t just use his?” I asked, looking toward Jeff’s papers.
She shook her head. “I like to have one for everyone. Never know what we might learn.” She started by writing Jeff’s name and drawing a box around it.
He was my mom’s younger brother, the third of four Mitchell children.
I circled Jeff’s name and age on the paper in front of me. It was suddenly clear why my grandma had lost two of her children to the same disease, both far too young. Like realizing the culprit in a mystery, I felt silly for not seeing the clues earlier. Dr. Arenberg drew lines from Jeff’s name to my grandparents and his three siblings. It was surreal, watching a stranger create a map of my relatives. She knew where the ravines and valleys were and was showing me terrain I should have known better.
She reached across the small table and placed her hand on mine.
“Even if your mom had swum daily in a pond of carcinogens, without a genetic mutation, she wouldn’t have gotten cancer so young.” She waited for me to look at her before drawing the lines from my grandpa’s name to my mom’s. “We are recommending you get genetic testing. If you choose not to test, we suggest you follow the screening protocols for people who test positive.”
“It can be hard, however, for many people to get these tests covered by insurance without having proof of the mutation,” Lou said.
“So, I would need to get colonoscopies every year and consider a hysterectomy and all of that, with or without the testing?” I asked. Suddenly, not getting tested no longer seemed like a valid option at all. Pandora’s box had been opened, and there was nothing I could do to stuff this information back inside.
“Yes, that’s what we would recommend,” Dr. Arenberg said. “There are, of course, people we meet who choose not to move forward with us. But the average age for the onset of colorectal cancer with people who have Lynch syndrome is between forty-two and sixty-one. I think your uncle has given you a great gift,” she said.
Even among a population of individuals at increased risk, my mom was an outlier. My long-held belief that I had survived a lightning strike was suddenly replaced by an overwhelming feeling that I lived in an electrical field. My family was lightning itself.
Dr. Arenberg wrote my name and drew a line to Ben’s. My son was almost three years old. He loved construction equipment and superheroes and sports. My body was heavy in the chair. I gripped the cool metal bar on the sides. The letters in his name swam on the white paper. I was no longer the child who had lost her mother. I became the mother who would be lost, leaving a hole inside my son he would never be able to fill. I couldn’t imagine causing him that kind of pain, and right then, I knew I would do whatever Dr. Arenberg told me I needed to do.
Sixteen years after losing my mom, I became one. When I was in labor, my mother-in-law, Suzie, wiped my face with a cool rag and kept Brian grounded so he could hold one of my legs each time I pushed. Brittany was there too, offering sips of ice water between contractions. Before going into labor, I had imagined only Brian and the doctor present when our son was born. But after sixteen hours of labor, when it came time to push, I begged Suzie and Brittany to stay. I never registered how much my mom loved me, or how much my grandmother loved her, until I pulled my slimy newborn onto my chest. Waves of love and fear washed over me, unlocking a universe I hadn’t known existed. In that moment, I understood these women in a way I never had before, as though time’s long arms were welcoming me across an invisible threshold.
In caring for newborn Ben, I learned that love isn’t just an emotion but a verb, a series of actions repeated day after day. His needs were as constant as the tides. At first, love felt like a primal instinct, a ferocious drive to keep him safe, connecting me more to the animal world than to the moms I met at the breastfeeding clinic I visited. Over time, though, emotions unfolded within my heart for this beautiful, perfect, helpless creature Brian and I had created. We called him “the Brad Pitt of Babies,” amazed we’d made something so wonderful.
Mothering Ben also connected me across time with my mom. I imagined her learning to love me, a puny pink blob with orange fuzz on my head. I pictured her pacing the rooms in our duplex or passing me off to my dad for a nap. Somewhere within the maze of diapers, feeding, learning to use a breast pump, getting an IUD placed, and sunrise walks with a stroller and our dog, I finally felt how much she must have loved me. Until I had Ben, I hadn’t understood how hard it must have been for her to stop being the kind of mother she wanted to be.
Facing the reality of this mutation was another practical act of maternal love. Before I sat down to work on this dreaded family tree, I saw my mom’s death in terms of what we lost: me, Danny, Brittany, our dad, our grandma, her siblings, her friends. But as I traced the lines connecting her to me, and me to Ben and the unborn baby inside me, I began to understand the depths of what she had lost. I felt the fear, sadness, and guilt that must have consumed her as she contemplated all she would soon leave behind. Sitting in this orderly room with two strangers, I felt an unknowable anger beginning to unclench its invisible claws. For the first time, I understood how far beyond her control it all had been.
About the Author
For over twenty years, Tiffany has worked at the intersection of arts and urban planning. She has helped hundreds of artists across mediums implement projects in public spaces throughout Cleveland, Ohio, first at LAND studio and most recently as Director of Arts & Culture for Cleveland Public Library.
Her creative work explores the dynamics at work within human relationships and has been featured in Gordon Square Review, MUTHA Magazine, South Dakota Review, and Avalon Literary Review. Her essay Year of the Rat was the Ohio Prose Contest winner in 2022.
Tiffany studied English and creative writing at Kenyon College and holds a masters degree in urban planning, design, and development from Cleveland State University. She lives with her husband, two sons, and two dogs in Northeast Ohio. She spends early mornings writing and weekends cheering for her sons on various sports fields across Ohio.
LIVING PROOF: How Love Defied Genetic Legacy is Tiffany’s debut. She is currently working on a novel.
Photo credit: Kim Wasielewski Photography
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