Bedside Manners Read online

  She looked at me as if I were crazy.

  I told her it was my job not to overtreat patients, and I needed to ask whatever crazy questions might get us to the truth.

  She shrugged.

  Three months later she was back, her stepmom and dad with her. In desperation, I had given her antibiotics to treat an undocumented infection with the ulcer bacteria. When that did no good, I initiated a trial of a prostaglandin provider to strengthen the lining of the gut, which only gave her diarrhea. She wanted to talk about that surgery I had mentioned for reflux esophagitis.

  Whoa! I said.

  I wanted to hear her symptoms all over again. The look she gave me said she thought I was suffering from a brain spasm. I asked again.

  She said she didn’t feel good. It just wasn’t right down there.

  I said she would have to do better than that. But the closer we got to details, the more she changed the subject or deflected questions, rolling her eyes as if to appear put out by the absurdity of the inquisition.

  I persisted.

  Her symptom was this bubbling back of a small portion of her food, the part just ingested. An argument ensued with her stepmother as to how significant a problem that was. The daughter shut off discussion by saying, You’re mean, and how do you know anyway, since you’re never there?

  We’ve had a pretty bad year, said the mother.

  I was looking the daughter straight in the eye. We have to be careful here. Illness like this can sometimes be used as ammunition to get at people.

  I’m not doing anything.

  The mother shifted in her chair, but did not speak.

  I’m not saying you are, or that this didn’t start out as a real problem and maybe it still is. But sometimes illness works to improve our lives in strange ways, ways we might not know unless we’d seen it happen, ways that if we stumble on, we find out we like and might want to keep around.

  Like what?

  Like getting attention.

  I’ve got plenty of attention.

  But look, here’s your stepmother whom you’ve described as mean, driving you one hundred miles to come and see me, concerned about your welfare, doing extraordinary things for you. Illness can be an equalizer of unequal conditions.

  She’s not concerned about me.

  An image of a dance came to mind, a fast tempo and a beat so seductive the participants lose control, a dance that keeps going even if it means collapse and destruction.

  I paused to let the tension drift and fall. My message had been delivered. Impact, who knows? If any effect was rendered by my observations, we would not see evidence of it here in the camp of the enemy.

  Listen, I said. Surgery is a serious deal, especially for the young. You never want to do surgery for the wrong reasons. You start that ball rolling, and you can wake up at thirty-five with a bunch of organs missing.

  But what are you going to do about me?

  The hardest thing there is to do. Nothing. Actually, it’s a little more than that. Support. Observation. I think in a couple of years when you leave home this thing will go away. Sometimes the best I can do for people is to keep them from getting hurt long enough to let natural processes take over. Think about it.

  I take it as a good sign that I haven’t seen her. I hope that the malady has been split into its parts, and in parts, can do no harm. I could be wrong. She may have another doctor by now, may have started her litany of surgeries, may have hard feelings for a doctor who cut into her tight world, cut in as an uninvited partner at a private dance, an interloper whose only recommendation was to slow down the music.

  PROTECTION

  Somebody’s trying to kill me, he said.

  I hadn’t seen Stanley for years — change of jobs, maybe his insurance — there were no road signs to tell me why.

  Times like this I try to take up the weaving at the spot we left in the nap years ago. But this reentry was going to be tangled.

  What are you talking about? I asked.

  There had been a death at work, someone young, physically fit—a drowning, maybe, a disappearance—details were vague. Death is never vague, I thought. There’s more to it.

  The woman who disappeared was a key figure in some kind of investigation, some alleged wrongdoing. It was sounding like a story for Elliot Ness.

  People started getting phone calls, threats. There was a fight at work— someone showed up with seven stitches, a few puffy hematomas fading to yellow in the tense weeks that followed. The place started looking seedy. Somehow he was in this, or thought he was. He started getting telephone calls in the middle of the night.

  It’s my arthritis, he said. It feels like someone took a cattle prod to my joints and forgot to turn it off. I looked. There were the telltale signs of inflammation: tumor, rubor, calor, dolor— swelling, redness, heat, pain. The knee joint was out like a burl on a redwood tree. Nasty, I said. What are you doing for this?

  We talked about management of rheumatoid arthritis, the drugs that reduce pain and swelling and side effects: gastritis, bleeding, et cetera. I assumed that under this much stress he would be susceptible to side effects. I was feeling at home in the discussion of pathophysiology and treatment, not relishing a return to the drama.

  But he kept going back to it. Any lull was the needle drop for the broken record.

  I don’t want to appear insensitive, I said, but I don’t know a thing about the trouble you’re in. Maybe you need a lawyer, or the police . . .

  I wrote some prescriptions, made a few recommendations, drew blood for chemistry and hematology, and scheduled a return visit in two weeks.

  He came back, no better. I told him he needed to resolve his life before his body was going to cooperate. He said he had a lawyer and was going after the bastards . . . things were getting tight.

  I began to realize this was his life. He thought about it night and day, got up in the middle of the night to take down notes, replayed it in his mind a thousand times, one violent scenario after another. Now he was drawing me into it.

  Can you do something? Talk to the police or something?

  My two minds squared off. Give help. Keep yourself and your family out of the way of crime.

  Stanley, I said, I’m a doctor. If I had the training and experience, it might be different. I can say what I know to say: There is a relationship between your stress and this flare-up. After that it’s a legal matter, or a police matter. Best if I don’t know details.

  The arthritis smoldered like an iguana in an angry sun. I adjusted medications, told him to get psychiatric help, try to separate himself from this freight train or it would drag him deep into the next county. He wasn’t listening.

  He came back saying his lawyer had advised him to drop the case and move out of town. Stanley was certain they’d bought the lawyer off. He was having nightmares. The arthritis was worse. I felt as if I were listening to a man with a brain tumor whose tumor was doing all his talking.

  Why are you going so far with this? I asked.

  I have all these bills to pay, and I need to get on with my life. But I have to say I’m sick of talking to lawyers. Everybody knows I’m a wreck. My cat jumps off my lap when the telephone rings.

  I have no way of knowing if what you say is true. But if you are in grave danger, you have to remember, it’s just money.

  His girlfriend had accompanied him that day. She broke into tears, saying something about obsession.

  He told her he would drop the lawsuit. Everything appeared to be settled. And if it were a Hollywood script, it would end right here: protagonist chooses not the heroism of self-sacrifice but the valor of a peaceable life.

  Next day there was a lawyer’s brief on my desk. It suggested how my testimony might help once they got to court. It’s clicked over, I said to no one in particular.

  I was in the dark. Beyond what I knew about his medical condition, there were parts of this large fiction I couldn’t see, shapes that moved like bats in a dangerous cave. How could I know
the border between the real and the imagined, between safety and danger, between the external theater of images and the real story? I had struggled not to be out of my element, but somehow I was, an unwilling a player in someone else’s dream, a direction without plan or denouement, knowing no more than the demand in front of me, reading no message more clearly than the expression on the face of the next request.

  I was never called to testify. For all I know, the matter never went to court. Stanley disappeared from my practice just as he had before, without warning or explanation. I worried about his safety, armed only with his memory and his notepad against a danger too unimaginable to name, too invasive to turn him loose.

  A year later, driving home, I caught a glimpse of him standing at a bus stop. He looked good, happy even. I was shocked to see him, more shocked to see him this way, so different from the projections of his future he had conjured up for me. This image made the heft of his story waffle and lift away with a sigh. He could still be in some sort of trouble, I supposed, but it didn’t appear that way. I guess I was just glad to see him alive, alive and spirited, standing patiently, notepad in hand, waiting for the next bus to come.

  CONSULTATION

  I’m seventy-five and I have severe heart disease, he said.

  He’s a doctor, so I assume he knows what he’s talking about. He’s been sent here by his primary physician to have a colonoscopy. We’ve already had that discussion with his wife, and I know by his interjections he is not enthusiastic about the idea in general. She has decided on good grounds to schedule hers. Now it’s his turn to step up to the plate.

  Already I know that part of the reason they’ve come is to be sure I don’t have two heads or something—that I’m human, not likely to duplicate unpleasant experiences they’ve had at the hands of others. She flashed with anger at her gastroenterologist of six years for losing her previous colonoscopy report and not seeming to care. But she has decided. I must have passed the test.

  Now it’s her husband’s turn. I’m not sure I want to do this, he says.

  Several times during his wife’s interview he had said, I don’t think you should do it. Decisions, especially wrong ones, love company.

  If she came to test my professionalism, he was here for something else.

  I studied him for a moment. He was going to be tough.

  So you don’t want go out at colonoscopy? I said.

  He laughed, but a little fleck of fear was in his eyes. Good, I thought, a myth exposed, often dispelled.

  Oh, I’m not worried about that, he said. I’ll survive colonoscopy.

  I was still watching him, closely.

  He paused, considering whether to say the next thing, as if to assess whether he and the room could take it.

  I’m not interested in finding a tumor that already exists. Then he paused and turned to his wife. Though just saying that makes me more inclined to go ahead.

  So that was it. He didn’t want life ruined by the knowledge of something fatal, something he could do nothing about. Okay with me, I thought, as long as the tumor is already terminal. But what about the ones you can catch in time? In front of us was the door with the words “Ideas of My Death” written on it. We had to open that thing up to get beyond it.

  How long are you planning to live? I asked.

  He squirmed, then laughed the kind of laugh that realizes at the heart of his discomfort lies a critical issue.

  Well, as long as I can, he said.

  I should hope so, I said. And who knows, you could go on for another fifteen years. But if you’re already planning to die of heart disease five years from now, well, then I guess you don’t need a colonoscopy.

  I don’t know, he said, turning to his wife. Do you think you could put up with me another fifteen years?

  Better if you don’t have colon cancer, she said.

  He was on the spot. His wife was looking at him as though hearing something she’d never heard before.

  This goes back a bit, he said, and shifted in his chair.

  When the cardiac surgeon finished my coronary bypass and came out to talk to my family, the first thing he said was, I’m sorry. I’d hoped for another ten years. It was a horrible thing to say. Affected my whole family . . . for years. That was twelve . . .

  Thirteen, his wife said.

  . . . thirteen years ago this fall.

  Well, now that you’ve proved him wrong, I said, no need to continue living under his spell.

  Maybe this is all crazy, he said.

  No, it makes sense, I said. It seems to me like you’re just trying to determine the intersection of some pretty unpredictable lines. Okay by me. Just don’t underestimate your trajectory. How is your heart, anyway?

  Good. It was his wife that answered.

  Well, the myocardium is okay, he said. I wouldn’t say the same for the coronaries.

  She has more faith than you do, I said.

  Probably.

  Have you had any trouble since the surgery?

  No.

  And I tried to imagine what it must be like for thirteen years in a row to think that you’re not going to make it to your next birthday. If I believed that, I wouldn’t want colonoscopy, either.

  He wanted to know what kind of preparation, what I used for sedation, my track record, after which he looked around the room as though checking his whereabouts, then said, Yup, I think I’ll do it.

  Too easy, I thought. This is a complex man. True, we can often think better when someone else is listening, but there’s a distinction to be made between cooperative deliberation and persuasion. I was afraid we might have done the latter.

  Take your time, I said, think it over.

  On the way to the front desk we talked of other things: He was a psychiatrist, didn’t I feel that gastroenterology was laced with a strong dash of psychology, what days did I do colonoscopies, how much he enjoyed his practice, loved to play golf . . .

  They chatted with my receptionist for a while, then left. When I stopped by the desk and looked, there was a place in my book with his name written on it.

  THE THIRD SATISFACTION

  The first time I saw her she was naked, stretched out on a chaise longue, sunbathing in the fourth-floor solarium of the University Hospital. I was a young doctor then, and I was startled not only for stumbling upon her in the buff, but for the unaccustomed feelings, a strange mixture of curiosity and embarrassment, that rose in me.

  What’s the big deal? she said. Isn’t this a hospital?

  She wasn’t my patient, but on weekends I took calls for an older doctor who, tirelessly it seemed to me, looked after her.

  What’s your name? she asked.

  I don’t give my name to naked people.

  Oh, all right, she said. You’d think by now everyone around here would have seen it all.

  Doctor Watts, I said, as she slipped on her blouse.

  I can see that on your name tag. I mean what’s your name?

  David. David Watts.

  Okay, David, she said. So is this the best excuse they have for doctors around here?

  She didn’t love house staff or young faculty, so any peace I was to negotiate was to be a fragile one—mostly, I noticed, on her terms. But then, I only had to take care of her on weekends.

  Now, J.B. forgot—he’s a dear, but he’s a little preoccupied sometimes—J.B. forgot to up my Dilaudid suppositories to three times a day instead of two.

  I must have had a blank look on my face.

  I’m in a lot of pain from my Crohn’s.

  I looked her over: sunglasses, matador’s hat, plunging (recently buttoned) neckline, aroma of Paris Nights, headphones . . . It didn’t look like pain to me.

  And I remembered only too well J.B.’s general view on narcotic prescriptions on the weekend: Anybody who can’t get their act together to arrange for pain medications during the week is up to something.

  Maybe I’ll call him up, I said.

  She rolled her eyes. Now, David, don’
t tell me we’re going to start what could be a perfectly fine relationship on such a sour note.

  It’s a matter of clarity.

  Okay, okay. Call him up. But do me a little favor and increase my prescription before you call him. I’m just a little tired of waiting.

  I didn’t do either. Well, at least that’s how I like to remember it. I was so easily intimidated in those days, I probably went right down the hall and wrote the order just as she instructed, not fully understanding the clinch I felt inside, like the ones I felt as a child when I did something only because somebody expected it of me.

  In any case, by the next morning the hot issue of the previous day didn’t exist. It had never existed, and any discussion of medications had been replaced by her growing perception that she had known me in a previous life. Wasn’t it I who, when she lived near Aransas Pass, came to her house as the spirit of a dead pirate looking for his gold?

  If I’d found it I wouldn’t be here, I said.

  Oh, it was you, all right. But the gold was under the floorboard, and I woke up just in time to shoo you back to your Spanish galleon. Don’t you remember?

  I said nothing.

  You remember. You just don’t remember you remember.

  You — and I paused for effect— are a wild woman.

  You jes’ have to get to know me, she sassed.

  Which is, of course, exactly what happened. My mentor died and left Rochelle to me in his will—well, almost like that. Just before he died he put his arm around my shoulder and said, You’re “Big John” now. Can I depend on you to take care of my people?

  That was just a few minutes after Rochelle had left his hospital room in a wild state of hysteria. What do you mean, dying like this? she screamed. Of all the heartless — Words sputtered at the prospect of finishing her sentence. How do you expect me to survive if you’re not around?

  Ten past midnight, and a call comes in on my cell phone. It is a few weeks later and I am on a short vacation with my family to Lake Tahoe, where I’ve just arrived or I would be asleep by now.