He placed the cold stethoscope back into his starched white coat. “I’ll be back shortly,” he said as he exited the exam room.
Once in the narrow corridor, he slowed. His patient, Richard, not only had developed enlarged neck nodes despite radiation therapy to that area, but now had new ones in his axillary and groin regions. Amid 20 minutes of cheerful conversation, it took seconds to discover that Richard was a terminal patient. Yet, he had left him in the room the way he had done it so many times before: the reassuring smile and the gentle closing of the door. He heard Richard’s muffled voice, “I think Carol wants to speak with you.”
He reached the waiting room, took a deep breath, and entered. There was nothing in the room to suggest that it was a physician’s office. The chairs were natural wicker with floral upholstery; several original Calder paintings hung on the walls, and an antique table sat in the middle of the room covered with Gourmet, Arts & Antiques, and Esquire magazines. Only the sliding opaque glass panel shielding the receptionist suggested that an entirely different world existed behind this facade.
She was sitting in the corner. He was glad that it was lunch time and the room was empty, given that she tended to be so emotional when they discussed her husband’s condition. She was 10 years younger than her husband and very much an artist: black hair pulled back in a bun and long gold earrings. Her mouth was a striking red against the absence of all other makeup, her blouse was a colorful South American weave, and her skirt full-length denim. He looked for sandals, but she wore simple, flat black shoes.
He was not certain if any of her paintings had ever sold, but in the years he had been caring for her husband, she was always between paintings; abstracts, she had told him, though she had never shown him any of her work, not even a photograph. He knew that she detested the Calders in the waiting room.
She immediately got up and kissed him on the cheek. “Thanks for coming out to talk with me,” she said, as if it were the first time. She was tall, and her eyes were level with his; green eyes that seemed to penetrate through his professional veneer.
“Did he ask you to come out to see me? You know how he likes to have everything told only to him; then he can pass out selected bits of information to everyone else.”
“Well, he did say that you might want to see me. He’s dressing now.”
“You are going to tell him, aren’t you?” she asked, squeezing his arm.
“Tell him what?” he asked, feigning innocence. How could she know what he had only discovered minutes ago?
“That he is dying.”
He stepped back suddenly, as if the words had struck him physically. He quickly recovered. “He’s been slowly dying for 2 years from his lymphoma-why tell him now? Besides, surely he knows.”
“If he knows, why is he doing crazy things? Since he completed his radiation last week, he has arranged for a cruise to the Caribbean next month, and he is out looking to buy a new house-after 25 years, he wants to move.”
He was puzzled by her surprise: didn’t she understand that that’s how the dying behave?
“That’s not unusual behavior,” he said, trying to be reassuring.
“Really? What about the fact that he wants to write several books; one’s a new translation of Thucydides and the other is a historical novel of a Greek boy in an Odysseus-like adventure. He’s already working overtime in his library, and yesterday he asked his agent for an advance on his novel. Tell him, John. Please tell him.”
He liked it when she used his first name. He managed to smile. “Look, he got through radiation; he may have another 6 months.”
“He’s acting like he has another 10 years.” She released his arm and slumped into her chair. She was crying. He hesitated. Then he sat down beside her and gently put his arm around her, comforting her. He could feel her shaking, and tears ran down her cheeks. He gave her his handkerchief. She took it and wiped her face. The tears continued.
“He might as well see me cry. He never has, you know. I’ve been afraid to do it in front of him. And he never says anything about not making it—not even a doubt. He directs all of his energy into his next project and the next . . . I can’t stand it.”
She jumped up and was standing over him. “Please tell him, please.”
He stood up slowly. He was pulled between her plight and her husband’s immutable will to live. The truth would crush his hope and plunge him into depression.
She handed him back his handkerchief. She had stopped crying.
“Please,” she said.
“All right, all right. I’ll go in and tell him,” he said as he closed the door behind him, not looking back. An avalanche of thoughts tumbled over him, his gait slowing to a shuffle: how had this journey from life to death suddenly gone awry? He had been there for Richard all this time, as a physician and an intellectual peer, and now what?
When he reached the door only the image of her pleading, tears streaming down her cheeks, remained. He turned the knob and entered.
He found Richard sitting in the large chair in the examining room, completely dressed: a loose tweed jacket, button-down shirt, gray trousers, and cordovan loafers. His hair had regrown into tight browncurls. His eyes were also brown, always with an intense stare. He still looked well despite all his previous treatment. However, anyone who knew him could appreciate that his usual full, youthful face was now more gaunt and his muscles were losing tone. Still, sitting there, he looked the full professor of Greek at the university.
“Did you satisfy Carol’s queries? She’s really been on edge lately,” Richard said nonchalantly.
“I did my best,” he said, trying to match Richard’s demeanor. He could feel his voice tremble. He wondered if Richard could sense his ambivalence.
He was always amazed that someone of Richard’s intellect could ask so little about his illness-the diagnosis, yes, and the treatment, of course, but never the ultimate prognosis. He had seen patients with much less education come into his office and ask more probing questions; they would even bring in pertinent Internet articles about new treatments. Richard was not indifferent. He was intense about everything, but his illness was just one of the many facets of his life that he was dealing with at the time. Actually, talking with Richard about anything non medical was the most exciting conversation he could anticipate on any day. He always looked forward to talking with him. Not today. Not now.
He had learned through years of caring for cancer patients never to present the brutal facts. Besides, in Richard’s case, there was initially plenty of optimism; at the onset, he had a 50% chance of cure. He tolerated immunochemotherapy despite nausea and vomiting, bouts of hair loss, and episodes of infection requiring admissions to the hospital. He took leave of absence from the university, and when his disease was in remission, he immediately returned to work. He was never jubilant about his remission, and when he relapsed, he barely expressed any emotion.
A month ago, he had asked Richard’s wife over the phone, “What did he say to you after I told him that he had relapsed?” At that time, Richard’s enlarged neck nodes had recurred despite immunochemotherap.
“Nothing, nothing. He said it was unfortunate, but you thought that local radiation would help.”
“I told him radiation was only for relief of symptoms. His neck was painful.”
“He never said that.”
“Maybe he’s protecting you,” he had told her.
“I doubt that. He never protects my feelings when it comes to anything.”
“There isn’t any option now but radiation.”
“Tell that to Richard, not me,” she said as she hung up.
The memory of that phone call stuck with him now as he turned and looked out the window. The sky was a bright blue. The silence was palpable. He had to tell Richard his life was ending. He needed a cue.
He turned back to Richard. “Carol says you’re planning to resume writing.”
“Not resume, continue. I have two manuscripts that I’ve been working on for a while.” He seemed genuinely excited. “You know that I’ve always been interested in Thucydides. I’ve decided to do my own translation. I’ve been working on it. I could probably finish it in the next few years. There are actually full paragraphs that have different meanings than was originally thought. It’s tedious but full of potential.”
He could see Richard in the classroom, pacing, exciting the students with his belief in the yet undiscovered.
“And I always wanted to do a historical novel,” he continued.
“About the Greeks; I’ll use Odysseus as my main character: the ultimate physical specimen against the unknown.”
“Are you going to take any more disability leave from the university to work with your books?”
“No, I’ll be working and writing.”
He sat down on the stool opposite Richard. “How do you see the situation, Richard?” He gripped the stool tightly.
“How do you mean?”
The intercom buzzed. A rasping voice announced: “The pathologist is on line two; he needs to talk with you.”
“Tell him I’m doing a procedure, and I’ll call him back,” he yelled, twisting his head toward the intercom.
He turned back to Richard. “Well, now that you’ve finished your radiation treatment, what do you think will happen?”
Richard got up deliberately and turned to face him. There were tears in his eyes. “I’m going to die, you fool.” He was suddenly out the door.
Through the smoked glass of the waiting room he could see Richard and his wife embrace. Then they were gone.
The intercom buzzed again. “Doctor, you have another call on line four.” He stared out the window. A few clouds had appeared, but the sky was still blue.
“Doctor, you have a call on line four. Did you hear me?”
He did not move. Outside, he heard a motor start. Perhaps it was Richard and his wife. He rose slowly to answer the phone. His legs were weary.
(Source: By Michael J. Messer – The author(s) indicated no potential conflicts of interest – link at: http://jco.ascopubs.org/cgi/reprint/27/22/3723)
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A 13-year-old girl is suffering from Alzheimer’s-like dementia after developing an extremely rare form of the disorder.
A major research grant will help scientists study the links between memory and oral health in a bid to establish control over Alzheimer’s disease. The news of a $1.3 million study to be carried out on thousands of participants has been welcomed by the UK’s leading oral health charity – the British Dental Health Foundation.
A split-view image showing PET scans of a normal brain (L) and a brain with Alzheimer’s disease. Reuters/National Institute on Aging/Handout
