Bedside Manners Read online

  Let’s make a list, I said.

  I have one. Where is it? Oh dear, I can’t find it. Husband and son groped in her purse, pockets, backpack, and eventually produced a small piece of paper:

  Back pain—I need a pillow between my knees when lying on my side.

  Pillow at back.

  Control over pain meds—I changed my mind from when I talked to the anesthesiologist.

  Fungus in mouth—is it related to antibiotics?

  Antibiotics: currently taking for sinus infection— what to do?

  Will you talk to the surgeon?

  And the anesthesiologist?

  No interns asking questions.

  I’m not sure about that last one, I said. This is a teaching hospital, and one of the big reasons people come here is the brain trust that collects at university centers. The trade-off is that you may have to put up with extra interviews and examinations, but overall it’s a bargain. Besides, you underestimate the interns and students — they’re smart and well trained, and sometimes they pick up key bits of information that have a significant effect upon outcome.

  I don’t want them to touch me.

  Doctor Markbreit will do the surgery, if that’s what you’re worried about. But if we are to train the super-docs of the future, they have to at least be in the vicinity.

  I’ve heard horror stories.

  From who?

  Friends.

  I don’t know what it is about “friends,” I said, that makes them scare the hell out of people. I laughed, but she didn’t.

  Let me give you an example, I said. I do colonoscopies practically every day. It’s a simple procedure. I can always tell when someone has paid attention to bad advice. They’re frightened and their blood pressure is on the ceiling. They get all worked up over nothing, and when it’s done the best they can do is ask if I’ve started yet. It’s mostly piss and bluster. As it turns out, interns are pretty nice people. Give ’em a chance. You’ll probably end up liking them a lot.

  Oh, all right, but will you personally talk to the anesthesiologist?

  Now don’t worry about the stuff you shouldn’t worry about. If you or I were calling the shots for the anesthesiologists, we’d all be in deep doo-doo.

  But how will I know everything is okay?

  Because I’ll tell you, that’s how.

  A little silence followed in which I reflected upon how I might have been a little rough. Maybe not rough but blunt, blunt with a little extra weight for effect. There was no time to convince her by the usual time-consuming pathway of reason and trust. She would have to be carried on charisma until we had time for confidence.

  Come on, Elaine, I said. You need to get a move on. I’ve still got to listen to your heart and lungs, take a blood pressure—you know—check you over a bit and scribble down all that stuff that will make this happen.

  She was crying.

  Anticipation is worse than the event, I said.

  I can’t cry.

  Maybe it’s good for you.

  No, I mean it gets in my bandage.

  We all laughed.

  Scut work now: record the physical exam, fax it to the hospital, get the lab work done, call the surgeon:

  Saw Elaine, I said.

  Oh my God, thanks a lot.

  She has a list of requests.

  Shoot.

  He took it pretty well. All but the part about no antibiotics.

  Have to, he said. If I lay fresh tissue down on a front yard of bacteria, it’s just going to lift right off again.

  Well, you’d better give her some kind of antifungal lozenge to suck on, then.

  Fine, he said. And I can keep the interns pretty quiet. I guess I owe you for this one.

  Yes, you do. And I won’t let you forget it.

  Two days later I got a call that she was being discharged from the hospital and wanted to see me. She was having problems with her sense of taste. I was a little embarrassed I hadn’t been to see her after her surgery. The thought occurred to me I’d been avoiding her. Then it hit me. She was a carbon copy of my mother—not physically but emotionally—her practiced skill to collapse in the vicinity of help, the sideward glance, the need for rescue, her failure before the word cancer, the clutch of support that seemed so necessary and moved with her like rings and rings of undulating petticoats.

  I called it manipulation when I was growing up, a word I used to place the impact a safe distance from me, a way of naming and thus gaining a sense of mastery over the machinery that could set expectations and wield guilt, and that had had such a controlling effect on my life. I always thought I was more than willing to give support. What got to me was the expectation .

  Not going to see her until now stirred the same kind of little lie I might have used with my mother. I would tell Elaine I thought she had already been discharged. I hated that but was glad to dodge the bullet. Face it. I was a child again.

  When I arrived, seven people were in the room: the nurse, the discharge social worker, the family I had met before and some I hadn’t. Everyone seemed to be having a good time. The father and son were in nifty gray suits, looking like they’d just stepped out of Macy’s front window.

  I delivered my lie that everyone expected and accepted as part of the game.

  Well, in a way I was already gone, she said. One foot in the other world. I guess I’ve been there and back.

  Opening gambit a success: knight to bishop three. We were now in midgame.

  I examined her tongue. It was flat. The little papillae denuded. Probably yeast from all those antibiotics, I said. Taste buds got scared away. They’ll be back.

  They will? Oh, I like the sound of that.

  The husband asked if the surgeons might have accidentally cut the nerve.

  No. No. They weren’t in that area at all. Let’s pick the simpler explanation. It has a better outcome.

  Oh, I like that, she said. Let’s take that one. The family and nurses all nodded and smiled.

  I’m seeing another side of you, I said, something I’ve not seen before. You’re actually . . . pesky. Perky.

  Yes, and I’d like to thank you.

  Don’t thank me. I didn’t do much.

  Yes, you did. You said you’d take care of me, and that means a lot. You don’t hear that very often these days.

  I was now witness to the other side of my mother, the part I admired and tried my best to copy: gracious, benevolent, quick to compliment, genuinely concerned about the welfare of others, and very, very proud of her family. There was conviviality, and—how should I say it—I was having fun.

  I was struck with the irony of the struggle I had had with her manner while at the same time she was showering me with praise. She was a nice person. My struggle was not with her. It was with myself.

  I moved toward the door and changed the subject. You look like you’re ready for the cotillion, my dear, maybe a coming-out party.

  Yes. I’ll write the Clintons and invite them.

  We were in the hall now. The family, as I knew they would, followed me. They asked the same questions I had already answered. It wasn’t about answers. It was a little ritual called We Are Showing Concern. It could have been irritating, but I knew they were doing what they were doing because of how well it worked to hold things together.

  Meet my other son, the father said. The son was dressed in a leather jacket, open collar, pleasantly unkempt linen slacks. He was leaning against the wall in the shadows off to the side, and after shaking hands, he separated himself again from the group. This one I recognized as the rebellious one. I knew in a flash how he felt, so I made a point of making eye contact with him, to signal, perhaps, a confederacy of sorts. He, I imagined, showed his struggle by acting out, as my younger brother did, and then paid for it later.

  I walked down the hall with a sense of closure. She had been witty and gracious, not at all the clingy, needy person of three days ago. The husband was right to say she was not herself when she first visited me. At le
ast not the self she was now. The surgery was over. She’d made it.

  She had triumphed.

  A month later I ran across Dr. Markbreit in the hall by the emergency room. How’s Elaine? I asked.

  That reminds me, he said, I’ve got to call her. You know, the initial biopsies were all read as negative, and I went ahead and started the reconstruction that would become her new nose. Now they tell me they’re all positive. It means I’ve got to go back in there, take down all that work, take the skin back to the skull, and start over. It’s going to be a big deal.

  His words split me in two. My medical part already had the details of the next pathway worked out. I could hear that part speaking from my mouth, discussing the case with Dr. Markbreit. The other part was shaken. Maybe like hearing the news about a member of your own family.

  All that optimism I spewed forth to get us to the table — how would she see it now? As support? As betrayal? Or did she understand it was all part of the game we play to get the earnest work done?

  I imagined her hearing the news. She would have to go through, all over again, the terrors her fear would bring and the cascade it would send shuddering down through the family. She would say she couldn’t do it. Her family would rally around her, encouraging her, patting her on the arm as she stayed away as long as she could, and finally, on the last day before surgery, she would come and see me again.

  I would be ready this time. I would recognize her. I would recognize myself.

  HER LANGUAGE

  I’d like to be better at it, she said. I’d like to read how other people do it so I can be perfect.

  Sondra is about twenty-four years old, medium build, attractive, slightly underweight. She sits absolutely still except for the slight motion of her mouth talking and smiling.

  I ate a whole loaf of bread last night, she said. Butter on every slice. And then . . .

  I knew what came next, and I knew her background: wealthy family, domineering mother who constantly trashed Sondra while praising her sister, a mother whom she nonetheless loved greatly and tried to get to love her in return.

  I do it because it’s the only thing I feel close to, she said. And when I’m doing it, I’m invincible.

  It’s going to kill you, I said.

  You see, I don’t believe that . . . because that’s my whole life — I’ve always taken the hard road. I could have had all kinds of money, stability, if I’d just done what my parents wanted. Instead I chose boyfriends who were drug addicts, rapists.

  And they treated you badly?

  Yes, but I didn’t stop loving them just because they beat me. I’ve always taken chances and survived.

  I think I could stop at one hundred pounds, she said, . . . but then I might want eighty.

  You’ll never be satisfied, I said. When you run out of muscle, it goes for your heart. That’s how these people die, you know.

  But I can see my body. I can see that fat. It’s all over me. It’s disgusting. As long as there’s anything between my skin and my bones, it’s too much. And I know I have to do better.

  There was a pause in which I tried to intuit some kind of opening. I offered a metaphor from the movie Alien. Imagine that it’s a monster someone put inside your body, programmed to kill.

  It’s all about consequences, isn’t it? she said. And I don’t believe in consequences. When people tell me all these bad things that can happen, I just smile because I know they’re not going to happen to me—mouth moving, body still.

  Then she smiled, in case I didn’t get the message.

  The time for the visit had expired long ago, and we weren’t even speaking the same language. I couldn’t be sure I was even speaking to her and not the voice that inhabited her.

  I had one more angle, a little desperate perhaps, a little risky, but I thought I’d take the chance: I make this effort, I said, because you’re worth it.

  But the compliment ran off her and lay on the floor as if to mock us both.

  In the stillness a window formed through which I could see the hospitalizations coming, the tubes, the forced feedings — hatred rising inside her for those who would dare try to come between her and the one she loves, her accomplishment, her perfection, her art, the alien who speaks her language.

  EVENING IN THE

  TWO WORLDS

  It’s what they thought it was, he said. Has Doctor Horton talked to you?

  Not yet.

  He found implants all over the wall of the abdomen. He’s sure it’s cancer, though he couldn’t find its source.

  The call was late at night, from Clifford’s son, who had hung around the surgery waiting room long enough to get the news.

  Will you be the one to tell him? I’m afraid it’s going to tear him apart.

  Clifford had come to see me three weeks before — seventy-four, still hard at work as an architect. He had belly pain. We were in the process of finding out why when his stomach blew up like a pumpkin on hormones.

  We tapped off some of the fluid. No answers. That led to the operation that had just finished. The pathology report said cancer.

  In a wave of regret, I wondered if there might have been some clue I missed. Retrospect is prejudiced by what it already knows. I let it pass.

  I knew that tomorrow I would rise early, go in to the hospital over the same commute I always take, speed to the room where Clifford would be recovering from today’s surgery, and tell him that what he fears most is true.

  My words will not form until they are spoken, reading the twitch of his face, the subtle motions of head and trunk, the silent conversation that will tell me how to deliver the news.

  I am as good at this as anyone, and as bad. This conversation, like a blossoming, moved so slowly as to be imperceptible. Yet when remembered, remembered as lightning speed.

  I enter the room I have imagined over the last twelve hours. He waits like an architect for his client. I begin with words like peritoneum, cells out of place, cells that secrete mucus lined up in clumps.

  What kind of cells? he asks.

  I choose the word tumor—it allows him a small place to hide. New growth, I say. Not the cells of normal organs.

  Where do they come from?

  We don’t know. They’re what we call anaplastic, which means they are primitive. They don’t look like the tissue they come from.

  I have not used the C-word. But he is an architect. He is accustomed to hard data. So he says the word.

  Is it cancer?

  I do not flinch here. My own sorrow, not a part of this, postponed, suspends like smoke over choppy water. I look into his eyes. It’s cancer, I say.

  He looks away, letting the weight of it catch up with him. You mean I’m going to die.

  Behind my eyes I am thinking yes, and probably soon. But I’ve seen people shrivel and disappear, faced with that reality. The moment will tolerate only truth, but that truth has to contain promise. It’s about words, words and the weight they carry.

  It depends, I say. It’s not the best news, but we can’t tell how the cancer will respond by just looking at it. It might surprise us . . .

  Message delivered. Ripples moving out. We both know we have reached the end of knowledge. But even now I feel him passing from me. He will be the chemotherapy patient, the surgery patient, the hospice care patient—this whip of the pendulum that swings him to the next landlord, filled more with the present than the past, failing gently before the rush of the future.

  And after this meeting that feels like departure, I’ll return home to my family, still intact despite everything, and wonder at its fragile perfection — my son toddling off to the living room to gather his favorite books before bedtime, words he lifts like water to his mouth, rushing at life unguarded, not yet aware of the fear that moves as we move, determined to give it his best try.

  PART

  THREE

  WHEN CRAZY GETS SICK

  Geraldine is out of her cage again. She called three times on Monday before I could call h
er back, twice, that I know of, on Tuesday, and now, Wednesday, she, her son, and her psychiatrist have all called. It’s a bad sign.

  I have a stack of papers in my hand. They seem to say that Geraldine is about to go into orbit if I don’t call her in the next five minutes, her son wants her transferred to somewhere where she can be watched twenty-four hours a day to see what goes into her body and what comes out of it. And the psychiatrist, as psychiatrists often do when the going gets tough, asserts that it has to be something medical that’s causing all this.

  I have seen this picture before.

  I call the son. Can’t you just put her in the hospital and watch her a few days, he says.

  If there’s a good reason to.

  But she’s in pain . . .

  I know that doctors are supposed to be sensitive and understanding, that they are supposed to respond sympathetically to suffering and disease. And especially to the word pain. And I do. But she irritates me . . .

  . . . well, let me put it this way. We just worked her up for her complaints of abdominal pain and constant nausea for the umpteenth time a couple of months ago. Getting her through the tests was a major undertaking for everybody concerned. She had a thousand questions about the risks of the CT scan, obsessive worries about gagging during endoscopy, strong opinions that damage to the delicate balance of her colonic milieu would occur during colonoscopy . . . she wanted to know ahead of time what we would do if we found this or that, which of course, I could not say . . . and when she got to the table she held us up for long periods of time while she was getting herself in the right state of mind for us to begin sedation. After trying many options and letting her try many, I finally gave the ultimatum: It’s right this minute, or I’m going home. At some point we just have to step up to the plate.

  All the tests were normal. Which didn’t do a lot for her image as a person with a real disease.

  Afterward the nurse who would have bet we’d never get the tests completed in the first place wanted to know if I had a degree in psychology. No, I’d just been there before.