Bedside Manners Read online

  Picking myself up off the floor, I ask, Who is your mother?

  It’s all right if you are, she said. I know these things happen sometimes between a doctor and a patient . . .

  A chill ran through me, and it was the chill that answered my question. No way, I said. No, no, no.

  Mother said you two were getting married on Valentine’s Day. The whole family gathered at the Dominican Chapel — priest, food, music. When you didn’t show, she just said maybe there was an emergency or something. She said you were a very busy doctor.

  I shrank into my shadow on the wall. A wave of self-doubt splashed over me. Had I, in my personal remorse and isolation, radiated some gamy pheromone that misled her? Let slip a word that became a beacon to a woman looking for entry into a different world?

  I played back the recording tape in my mind to hear what I’d said—innocent enough, I thought—but faced with the fallacy of memory and such a muscular delusion to contend with, even to suggest an imperfect life may have revealed too much. I shouldn’t have done that. I expected condemnation to land upon me in the next sentence I would hear from this woman I did not know.

  It’s all right, she said. Same thing happened five years ago with her psychiatrist in Chico. I guess she just put all her dreams on you.

  I was too bewildered to speak. Too bewildered to know if this conversation with a young woman who must have briefly thought she was the daughter of my bride-to-be had done what it was supposed to, or if it wanted something more. Was the story over?

  It was.

  Don’t worry, she said. We’ll take care of it.

  HOSPITAL DU JOUR

  George Roberts Hargraves had a black leather briefcase with a golden buckle. He told us he knew Steven Spielberg and Billy Graham. He knew the mayor of Los Angeles, personally. The nurses, house staff, and the attending surgeon were all impressed.

  Mr. Hargraves complained of diarrhea and a pain in his gut. The emergency room doctors couldn’t make up their minds if something was wrong or not. Friday nights are train wrecks in the ER. But on the floors, readied for the weekend, it’s almost empty. They did the easy thing. They admitted him.

  And called for a gastroenterologist. I recommended an X-ray, a colonoscopy, and a CT scan. Mr. Hargraves informed us he’d call Senator Feinstein and tell her he’d be out of commission for a while.

  A few days passed. George Roberts Hargraves was looking well fed and rosy. All the tests were back and they were normal. The surgeon said it was time for discharge, but Mr. Hargraves refused to leave. That’s when Social Services stepped in.

  The social worker came, took one look at the chart, and went straight to his room. It was all there on the first page: no home address, no insurance, no next of kin. Doctors never read that page. Social workers do, but they don’t come into the picture until it’s almost time to go home. Mr. Hargraves asked her to please close the door.

  They had a nice conversation. He’d worked on a movie set in Los Angeles where he picked up the lingo. The briefcase with the golden buckle was stolen. Between soup kitchens and handouts he usually gets by . . .

  . . . but if the wind blows, and his hands and feet go brittle in the cold, the welfare check will be gone by the third week of the month. He’ll wait for Friday night, then come across town to the emergency room. He knows the best hospitals, with the best kitchens, and who reads the first page, and when . . .

  RITUAL

  I don’t miss it a bit, she said.

  How do you do that? I asked. I know people who plunge into deep depression after losing part of their body. One patient I know even gave it a name: Colon remorse, she said. It took her two years to recover.

  Not me, she said. It wasn’t working. It’s out. I’m better. End of story.

  She had come to me five years before, at twenty-three, already suffering from what might best be described as old-age constipation. Her days were marked by draughts and drabs from bottles of laxatives, bulking agents, and enemas, and it all had become intolerable.

  Have you taken laxatives all your life? I had asked.

  No.

  When you were a child, did your parents . . .

  Oh, my parents, now there’s another story. Mother was in my face. Meticulous attention was paid to bowel movements — color, shape, consistency, how often. She invented an entire vocabulary to describe them. Some stools were called roses, others bombs. The slender, short ones were bullets. Then there were strands, streams, ribbons, water skitters, envelopes, pellets, upstarts, tra-la-las, and matzo balls. Gas was a tickle-tease or a blossom. Most important of all, a bodily product had to arrive every morning on schedule, a sum, which observed and contemplated, was noted with the same level of exhilaration as a new baby at a family reunion. Discussions at the dinner table focused on the latest product, and because nothing satisfied like a good movement, laxatives were pushed, overtly, covertly, and obsessively, upon her children.

  My patient was remarkably thin but looked as if her body was meant to be that way. She was a little stooped, which made her head cast naturally forward and down so that when it turned side to side, as it often did in conversation, it followed the parabola of a swimmer’s head, surfacing to breathe. Her hair was short and black, swept back on the sides, forward on top in a do reminiscent of James Dean. When she smiled, the corners of her mouth turned down instead of up, revealing an orderly row of fine teeth—the kind of expression that could have been taken as either laughter or pain. She had a small tattoo on her right shoulder— a gull or a blackened flower, I could never be sure. She told me the conversations were still going on with her mother.

  Talking with my mother is like electroshock therapy, she said. She hardly finishes saying hello before the interrogation begins: Now, dear, how is that bowel thing doing? You simply must keep up. I heard about this new Swiss herb that is supposed to be wonderful. I will send you some. Don’t thank me. It’s just another way a mother wants to help her daughter.

  I told her if the two of them were waist-deep in quick-sand, they’d drown quicker because they wouldn’t be able to stop shaking each other about the neck.

  She’s my mother, she said.

  For five years we struggled with her constipation. The standard stuff didn’t work at all. So we got creative . . . new stuff, old stuff. I brought out blackstrap molasses. In the end, nothing worked, and we had to admit that the colon was flogged out and lifeless. I told her there was no guarantee surgery would solve the problem, but at least it might keep her out of the hospital awhile. She was up for it.

  It would be a hard sell. Few surgeons can bring themselves to take on a case like this. As an internist you learn to play the surgeons by their personalities: some stick to the academic canon, would like to be chief of surgery somewhere, someday, and won’t do any operation that is not supported by documented pathology. Others realize life and disease are not always scientific and will spring for the occasional case that requires a more intuitive solution. I knew whom to ask and how to phrase the question.

  Ten years later I ran into her on the street. She looked the same, no signs of aging. She asked about my poetry, the French horn, if my family was happy. She had had a hysterectomy the year before. I didn’t ask why. She said she wasn’t planning to have children. The madness had to stop somewhere, and it may as well be right here. I thought of organs rising out of her body, offered without regret in some sort of ritualistic sacrifice. I prayed she didn’t run out of tissue before the gods were appeased.

  For a while I would see her in coffeehouses, writing on small bits of paper—memoirs, I imagined, points of view she might store in a box under her bed, the little sufferings and pleasures she would tell no one, and who could guess, for she looked the same as she always looked, as if nothing at all had been taken from her.

  HOME REMEDY

  She’s a bitch, he said. The word shot from his mouth like bitter spittle and splattered the air. And just in case I hadn’t got it the first time, he said it again: She’s
really a bitch.

  Dr. Maltiban was my senior by twenty years. He had a long and distinguished career as an ophthalmologist, but unlike most surgeons, he followed his patients closely after surgery was over. He got to know his people and their families very well, and had a strong, almost spiritual, following.

  I’d never seen him so worked up. I was doubly astonished because he seemed to be such good personal friends with Sylvia and her family. Yes, he had a temper; yes, he was opinionated, bombastic, and bluntly honest. He was known to ruffle a few feathers. He was a surgeon. But this was over the top.

  I had recently inherited primary-care duties for the Lundgren family. Already I had some exposure to Sylvia’s patterns. There had been the Keflex issue, the antibiotic I prescribed for her mother’s presumed bronchitis —presumed, I say, because the mother was home in bed, ninety-two years old, completely out of touch with the world for the last ten years, unable to eat on her own, fed by a tube through her nose, held suspended like a passenger arrested in the act of boarding the train. Most families would have let her die. She’s my mother, Sylvia said. I can’t stand by and not do everything for her. So she insisted upon maximum care— and then kept a very close watch to make sure it happened.

  Every detail, from the configuration of the foam mattress to the supervision of wound dressings, from ensuring periodic chest X-rays to overseeing the concentration of calcium in her tube formula, was, for her, a ritualistic, passionate, full-time obsession. Had it not been for Sylvia’s efforts, I had to confess, her mother would have been dead years ago. Blessed death, some might say; she earned it.

  The Keflex issue went like this: Sylvia would begin by asking what should be done about her mother’s cough and the slight rise in her temperature that she’d noticed that morning and which, she had learned, contrary to standard medical teachings, meant advancing bronchitis.

  If I did not suggest an antibiotic right away she would remind me that her mother required one the last time, that Nana was not accustomed to having fevers of any sort, and that any alteration of her temperature meant trouble. Notwithstanding this illumination, it was a stretch to think she was about to come down with bronchitis. But for Sylvia it was a foregone conclusion. And eventually I would hear myself saying something like, Well, it might be all right to start something.

  Which antibiotic, Doctor? What is your judgment? You’re the doctor.

  I admitted to myself it was, at best, a guessing game. If we guessed wrong, as we did roughly one-third of the time, the fevers would continue until we guessed right or they went away because they didn’t mean infection in the first place. Meanwhile, Nana, suffering along without much evidence of suffering, continued in her own way until the status quo was restored, quo being a giggling, pleasant, ancient slip of a lady with bedsores.

  How about Keflex? I said. That’s worked pretty well in the past.

  Do you think so, Doctor? Nailing me to my Keflex cross.

  Well, it’s a good choice, I said, standing by.

  Do you really think so?

  And I’m thinking, Okay, now I’m a fixed target with blinking lights.

  Don’t you remember last time? she said. It took Biaxin to get a response.

  I boiled. Well, if that’s what you wanted, why didn’t you ask for it in the first place? I thought the sentence silently to myself, then, against better judgment, let it escape into the room.

  Oh no, Doctor. You are in charge. I respect your decision. Whatever you say.

  I was sheepish. Too much rile. Too much energy to the small things. It wasn’t supposed to be this fussy.

  Biaxin, I said.

  Are you sure?

  I called the pharmacy. They know me like a neighbor through thin walls. It’s me, I said.

  Biaxin? he asked.

  Okay, so she has this way of pissing people off. Especially El Magnifico Maltiban, who, I could imagine, had little tolerance for the controlling woman, not so well hidden behind the guise of acquiescence. But I’m the family doctor. Pissed off doesn’t work.

  I talked to Lars, her husband. I know, I know, he said. Whatcha gonna do? I decided that was Scandinavian shorthand for an unsolvable American situation.

  Lars brought an apology and a thanks in the form of a bottle. Scandinavian Lingonberry Schnapps. Lovely. Divine. A real painkiller.

  And then there was the issue of the feeding tube. It was forever getting clogged—kinked or scuzzed over with bowel jam, resisting all efforts to Roto-Rooter it out.

  To do this thing right took an Interventional Radiology team, which meant it had to be done in a rather sophisticated X-ray unit with experienced hands. Had to be the right size tube: not a #13, please—it clogs too quickly.

  Those ER docs down at Penngrove—forgive me, Doctor, Sylvia had said. They don’t know what they’re doing. I winced. No disrespect, she added, but we always have to do it here in IR.

  I called the ambulance, the IR unit, the insurance company, the home-care team . . . Sylvia could work her way through any amount of paperwork, including the unusually efficient roadblock engineered by the insurance companies to stymie the effort. She would work her way through or pester us until we did. So conditioned were we that we started the cascade of calls on the first ring of the phone. My secretary got good at this. Too good. I let her take over—one thing fewer to think about. And as I sit here this day, I’m quite sure there have been tube replacements I know nothing about.

  Lingonbery Schnapps was piling up. I gave some to my secretary. She’d earned it.

  Then I got this call from the medical supply company. The guy was beyond consolation. It was the hospital bed. Clouds of paperwork came to mind, rising out of my desktop like a slow-developing typhoon.

  Nana needed a special bed to avoid bedsores, we all agreed. But the insurance company was unwilling to fund this unless we went to bat with bases loaded. We did that. Reasons were researched and documented why only this and not that bed would do. Over and done. Next chapter. But here was this guy screaming at the other end of the line.

  Do you realize we went all the way out there to deliver this @#%$^^ hospital bed and she . . . she @#%$^^ refused it! I could feel his saliva on the back of my neck.

  Why? I dared to ask.

  She said it wasn’t the right one . . .

  I kept quiet. I visualized Maltiban blowing his top. The image seemed strangely humorous to me.

  . . . and she absolutely refuses to try it out.

  I know this may be tough, I said. But just give her what she wants.

  The man had more sense than to disagree with that.

  Lars came to see me. A diminutive man up against Sylvia, a constant smile on his pixielike, northwoods face. I hadn’t seen him for some time and it looked to me as if he had lost weight. His smile was frozen, as though he were stiffing it through pain, or worry.

  Been having a little bleeding, he said.

  How long?

  Oh, quite a while. Maybe a year . . . or so.

  My God, I thought. Why didn’t you tell me? No need to express alarm, I sighed to myself. Maybe we’ll be lucky.

  We weren’t. Big cancer in the cecum, that hiding place in the cupola of the colon with such a lethal spirit.

  Surgery. Then chemo. And Lars just melted . . .

  Sylvia wept. I never thought I’d lose him, she said. Oh, Doctor, you should have seen the funeral. Two hundred fifty people. Everybody loved that man. He was a great man . . .

  This, over the phone, with Julia Paparatovsky across the desk from me. Julia, by all accounts a schizophrenic, a street person occasionally masquerading as a competent member of society, with whom I’d just spent thirty minutes of a fifteen-minute appointment trying to administer to her lack of money, her helplessness before psychiatrists, the ugliness of her face now that the Bell’s palsy made her look like a beggar.

  As I hung up the phone, Julia turned the eyes of a slighted child to me: You spoke to her in such comforting and reassuring tones, she said. Why don’t y
ou ever talk to me like that?

  My face flushed. You don’t understand, I blurted. She just lost her husband . . . But I had forgotten who I was talking to.

  I’ve lost people, too, she said.

  Right. And I was annoyed at Julia for her narrow, solipsistic vision. My natural impulse would be to explain, to justify . . . but I let it pass. Yet in that impulse I came face-to-face with a strong will to protect and defend my patient. The mirror of Julia’s anguish had shown me more affection for Sylvia and her lonely calling than I knew I had.

  Could it be that all this time that I had stayed by Sylvia and Nana not primarily out of duty, as I had thought, but out of some deep connection to their passion? Unlikely as it seemed, given all the phone calls and paperwork and differences of style and opinion, I must have recognized something admirable in her enactment of devotion, something that tied me to it, symbolically, calling forth those desires every child has to return love to the mother.

  And Julia had made me question one thing more— namely, what the hell was I whining about? Whining is so annoying because it is never accurate, hiding, under the flare of complaint, a deeper truth. Sylvia was doing a fabulous job. I just didn’t like it because she showed me up being right all the time. One thing for sure, if I got sick, I’d be damn lucky to have someone like her around.

  I made quick work of Julia and moved through the rest of my afternoon, a motion that felt a little too much like cutting my way through a forest, some trees falling to this side, some to the other, my rhythms automatic, my thoughts on other places. Julia had neither the inclination nor the capacity to understand Sylvia’s predicament, nor had I, once . . .

  . . . as now Sylvia spirals inward toward her mother, concentrating even more on every mote of detail, rising before her like continents of danger, isolating her vision to the cracks and chinks of her grand project, the home remedy that belabors her as she belabors it, the weight of loss already felt, watching for the slightest sign of deterioration.