Internal Medicine: A Doctor's Stories (5 page)

He was the only occupant of a double on the west side of the tower. Here on the sixth floor the view out the window was a sweep down the hill to the town, garish under sodium-vapor streetlights. The yellow glow from the street was the only light in the room. Mr. Jenkins was in bed, asleep. He was snoring unevenly, a little puddle gleaming darkly on the pillow beside his open mouth.

I stood at his bedside, listening to him breathe. Regular, unlabored, a little rattly, but basically the automatic tidal motion of a man in the middle of his life, the rhythm he had been maintaining from the moment of his birth. I stood there and listened to it, unconsciously holding my own breath for a long time until I realized what I was doing and drew a ragged breath out of the dark.

“Mr. Jenkins?” I said softly.

No answer.

“Mr. Jenkins?” I said again. This time I reached down and pressed his shoulder slightly. He stirred, and abruptly he was wide awake, astounded, raised on his elbow staring around the room.

“Wha’?” he said, or something to that effect. He was starting to pull back from me. In the darkened room, his eyes were enormous.

“Easy, Mr. Jenkins,” I said in what I doubted was a reassuring tone. “You’re in the hospital. Remember? I’m Dr. Harper. We met this morning.”

Mr. Jenkins continued to stare at me as if I were a ghost, but he gradually subsided, muttering something I didn’t catch beyond the tone of ebbing shock.

“Are you awake, Mr. Jenkins?”

He nodded, perhaps a more polite answer than the question deserved. And he lay there, still propped up on one elbow, waiting.

I realized that I had no idea how to proceed. I tried to think of something, but all I could come up with was the tune to “The Yellow Rose of Texas.” It kept repeating itself unhelpfully, scattering my thoughts: beyond that, all of the advice from that long-ago dreary afternoon with Emily Dickinson had evaporated. And Jenkins was waiting. As if aware of my uneasiness, he was starting a shy, reassuring smile.

“Mr. Jenkins,” I began.

He nodded at me encouragingly.

“I’m afraid I’ve got some bad news.”

For a horrible ten or twelve seconds, the smile lingered on his face while the rest of his features abandoned it until it hung there in empty air.

“That test we did this afternoon?”

He nodded.

“It found a—a mass.”

This wasn’t right, I realized. I should just name it.

“They found cancer, Mr. Jenkins. That’s why you’ve been having trouble swallowing. That’s why you’ve been losing weight.”

I stopped for a moment, unable to go on. In the silence that lay between us I recalled dimly that I was supposed to do this, supposed to give the patient time to grasp the news. Reassured by this, I let the silence grow.

Finally, his voice coming with effort, Mr. Jenkins said, “What’s it gonna do?”

Patients have this terrifying ability to ask the question, the one of all others you don’t want laid at your feet. I could feel myself start to choke. The easy answer, the immediate one, was
I don’t know
, but I couldn’t bring myself to say it—it would be too palpably a lie. Because I did know. We both knew. But I couldn’t say that either.

I was wrestling with all of this, starting to hyperventilate, when I heard Mr. Jenkins sigh. “That’s a bad question,” he said. The ghost of a smile shimmered in the dim light. He settled back against his pillow, ran the back of a thin hand across his forehead. “Ain’t nobody knows, do they.”

“That’s right,” I said fervently. “But, Mr. Jenkins, I do know this. There are a lot of people in this hospital who can help you. The next thing that will happen is we’ll present your case”—no, I thought, too legal—“we’ll present you”—too formal—“we’ll bring in a lot of specialists”—that was it: “specialists” had a reassuring ring—“and we’ll help you fight this thing.” Unless, of course, fighting wasn’t what he wanted. What if he didn’t want to fight it? I was just about to babble, I realized. “Would you like to see the chaplain, Mr. Jenkins?”

Mr. Jenkins lay back on his pillow with his left arm beside his head, fingers curled delicately as if waiting for something to fall into his palm. He closed his eyes.

“Maybe tomorrow,” I said.

I don’t know if Mr. Jenkins slept that night. I didn’t, of course, being a green intern on call, prone to jump bolt upright at the sound of my pager, and feeling the need to go see every patient I heard about, whether the situation warranted it or not. But if I had been allowed to lie down for more than fifteen minutes at a stretch, I doubt I would have fallen asleep without Mr. Jenkins’s expression hovering in the dark above me. I had nothing constructive to think about, nothing really to do about him. The machinery of oncology would be unleashed on Mr. Jenkins tomorrow, there would be a routine series of studies to go through, and his pneumonia would undoubtedly respond to the IV antibiotics he was getting every six hours. There was nothing in particular to think about at all. So it was only his smile that might have haunted me, if I had been available for haunting.

The next morning I was up and moving around, having gotten perhaps forty-five minutes of jumbled sleep and short-term memory disturbance somewhere between five and the sounding of my alarm at six in the morning. Rounds began at seven-thirty, and I had nine patients to see before then, giving me about ten minutes per patient, which even in my first week of internship was more than I needed to check the vitals, wake the patient, and do a quick exam. But I had set my alarm early with a thought to Mr. Jenkins, feeling that I would probably need more than ten minutes to see him this day.

I left him for last, of course, walking into his room with fully thirty minutes to go before rounds. The sun had risen by then, the world below his window blazing with color, each red leaf on the far hills distinct in the clear air. Mr. Jenkins was asleep, his pillow blotched with pink, green, and brown, his mouth slack, the same regular rising and falling of his chest.

“Mr. Jenkins,” I said gently.

He roused more easily this morning, his eyes opening sleepily but without the terror of the night before. They opened, then opened wider, scanning the room quickly with an odd, stock-taking motion, as if he were in the habit of cataloging, every morning, the contents of his room.

He finished his survey with me, eyeing me with what I can only describe as a mild surmise. As he looked at me, uncertain, perhaps a little curious, I realized how deeply miserable I was to be standing before him. Not that I could think of any particular thing I’d done wrong. Just that it was miserable to be there, having to enter into it again.

“How are you?” I said gently.

“I’m not bad,” he said. “Been coughing up a bit, not so bad.”

“Good,” I said. I moved to the bedside, sank down in the chair, and took a breath.

Mr. Jenkins regarded me, and his gaze as I looked back at him took another one of those curious sweeps around the room, returning to me. His expression was open, friendly, almost perky.

“So tell me,” I began. “Have you been thinking?”

Jenkins looked puzzled. “Thinking,” he said noncommittally.

I waited, but he had nothing more to add.

“Yes,” I said. “About . . .”

He elevated his eyebrows helpfully. “About?”

“You know.”

“Oh,” he said. The eyebrows settled, pressed down by a pair of deep furrows. “I don’t know,” he added after a while.

“I understand,” I said. “It’s a lot to take in.”

“Yeah,” he said. And then: “A lot.”

“Yeah,” I agreed.

We sat there for a little while longer, thinking about a lot together.

“What do
you
think?” he said finally.

“Me?” I squeaked. I was suddenly aware of the time. “It’s not really what I think,” I began. “Is it?”

If I was thinking he was going to help me out, I was wrong. Mr. Jenkins stared back at me across his bedclothes, his hands lying on top of the cotton blanket as inert as old socks, the expression on his face an open blank. Open and blank. Not frightened. Not worried. Not remotely comprehending what had me so solemn and upset.

“Mr. Jenkins?” I said finally.

The eyebrows lifted a half degree.

“You do know what we’re talking about, don’t you?”

No change at all. For an instant I hoped wildly that this was cultural, this was some strange thing that came from class or poverty that I wasn’t getting, and I shouldn’t mess with it. But it was too late for that.

“We’re talking about your diagnosis,” I said slowly. “You remember, don’t you?”

Now the eyes did begin to widen, the whites showing between the irises and the upper lids.

“What I told you last night? About the cancer?”

The face went stricken.

“I’ve got cancer?” It was a hoarse whisper, twisting upward at the end.

“It’s in your throat,” I said, pointing to mine. “It’s why you’re having so much trouble swallowing.”

He blinked at that. “I got cancer,” he mumbled, looking inward for a moment, nodding again. Then back at me. “What’s it gonna do?”

I told the story on rounds. After the recitation of vital signs and exam findings, I added a brief anecdote describing his reaction to the news. The attending nodded and shook his head. “You’ll get used to this,” he told me. “We get so hardened to other people’s bad news. It’s hard to remember what a shock it is to them. Give him time to get used to it.”

T
HEY SAY THAT TIME
assuages, and time was, for once, something we had to give. This was Friday; we had an entire weekend before the breakneck rhythm of the hospital took hold of Mr. Jenkins and clutched him to itself. The pieces of aberrant flesh that were snipped from his mass in the GI-procedures suite spent the weekend absorbing stains in the pathology lab. On Monday, Tuesday at the latest, we would have the definitive diagnosis. In the interim there were some things we could get done despite the weekend, and we went ahead and did them—CT scans, chiefly, looking for possible metastases. The goal was to assess the spread of his disease—to “stage” him—and to assemble every other relevant bit of data in time for the multidisciplinary oncology conference that met in the cancer center every Wednesday. There, about two dozen representatives from medicine, surgery, pathology, radiology, pharmacology, and probably theology reviewed the dozen or so new cancer cases that had come up in the previous week, with the goal of arriving at a consensus and a plan.

But for now, Mr. Jenkins had time, a quiet weekend in a room with a view of Fall descending over the Piedmont.

Having been on call on a Thursday, I was facing my Golden Weekend—the once-a-month privilege accorded interns: two consecutive days off. I spent them with my family. Sixty hours together. On my return early Monday morning to the upper floors of the hospital I had a sensation of having been out of the action a very long time. Many of the patients I had been taking care of on Friday were gone, having been discharged by my resident over the weekend. Mr. Jenkins, naturally, was not one of those. I found him in his room, sleeping, a towel wrapped carefully around his head.

One of the things I passionately hate about my job is that it requires me to disturb people’s sleep, sick people who have managed, against the odds, to achieve some measure of oblivion. As I’ve grown older in the profession, I have become less conscientious—I often let patients sleep—but in those days I was conscientious to a fault. I roused each patient so that he or she could bear witness to the events since I had seen them last.

It was no different with Mr. Jenkins. I called his name from the doorway, softly, then as I moved to the bedside called again, using the same tone I use when waking my children. I pressed briefly on his shoulder and called his name again. This time he stirred and peeled himself a peephole in the towel.

“Whazzat?”

“Hi, Mr. Jenkins,” I said softly. “It’s Dr. Harper.” I paused to let that sink in. “How was your weekend?”

The eye goggled around the room in the same odd stock-taking I’d seen the first morning, before returning to settle on me.

“Okay,” he said softly. Then the eye inspected again. It seemed to be looking for something.

“Did you get any visitors?”

“No.” The eye was still, some small creature sulking in its hole.

“I’m sorry,” I said, and I meant it, too, thinking about him spending the weekend with nothing to think about but his dismal prognosis. If there’s any time you want family around, it’s when you’re looking at something like that.

I said as much to Mr. Jenkins. I can’t remember the exact words I used. I don’t suppose they mattered, because I found that eye of his staring at me and growing rounder until the towel came off his face and he was lying there looking at me with horror everywhere in the bed around him.

“You say
what
?”

Then it was my turn to stare back at him, and maybe there was a little horror in my face, too. All I know was that for a long time we stared at each other as if each found the other completely incomprehensible.

But it was up to me to break out of it first, and I did.

“Your . . . cancer,” I said.