The Patient (12 page)

The celebration following my acceptance of the position was a reserved and sad one. Colleagues patted me on the back at the apparent triumph of being appointed to the Victoria Hospital, and meanwhile my heart burnt with the unfairness of the conditions of my employment – conditions that guaranteed my failure both as a private practitioner and an academic. An empty victory indeed.

I could not understand why every other academic appointment had been offered the enticements of rooms and a secretary. I still don't understand why I was victimised in this way. Regardless, I commenced practice under these circumstances.

It was now over two months since Jonathan had first had symptoms. He and Tracy were waiting patiently in Derek's waiting room while the secretary played solitaire on the computer. They were waiting for the doctor to arrive from theatres, where apparently he had been held up.

Jonathan had had to take several days off work over the last week to have his tests, because openings for appointments were scarce and the tests were time-consuming to have.

The reason for Jonathan and Tracy's patience at this point was all the practice at waiting they'd had since the tests had begun. It was a more impatient Jonathan who'd fronted up to have the first one.

‘Are you here for a bone scan?' The young ward clerk had looked up from her desk while he was reading the signs on the wall above her head, trying to work out whether he was in the right section of the Victoria Hospital.

‘Yes, I am!' Jonathan was relieved to have found it.

‘The scanner's broken down today,' she said. ‘We're waiting for parts to come, so I'll have to reschedule your appointment.'

‘What do you mean, you'll have to reschedule my appointment? I've taken a day off work. I cannot afford to take any more time off work.'

‘All I can do is reschedule you.' The girl's matter-of-fact tone made Jonathan livid.

‘Are you serious? This is absolutely ridiculous. Why didn't anyone ring to tell me? I wouldn't have taken the day off.'

The ward clerk just stared at him, waiting for him to finish ranting. Most of the other patients had simply made another appointment; he was only the third patient to make a fuss. It wasn't her fault. Why was he angry at her?

‘So, do you want to make an appointment?' she said.

‘What bloody choice do I have? What's the soonest I can get one?' Jonathan wanted his disgust to be plainly apparent to her. As she looked down at the appointment book, he was about to ask her to pass his criticisms on to her manager, but just then he spotted the old fading poster on the column behind her head: ‘We value your feedback. We're working towards the best health system.' Nothing was going to change because of his rant. He felt almost embarrassed that he had even wasted his breath on this young woman who cared little about his opinions, or any other patient's.

‘This Friday, 9 am. That's the earliest I can give you, OK?'

Almost everyone he had dealt with in the health system so far had finished their statements with ‘OK?'. It was like code to say, ‘We know this is far from ideal, this is far from suitable, but this is all you are getting, OK?'
It is
not
OK. I want it to be different
, thought Jonathan.
Well, that is not possible, OK?

Jonathan had returned on Friday after an unsettled day back at work. The same girl was behind the counter.

‘Are you here for a bone scan?' She looked at him with those uninterested eyes. Several people sitting in the waiting room looked up, waiting for his answer as well.

‘Yes. I had an appointment on Wednesday, but when I came in you said the machine wasn't working. As I didn't get a call cancelling that appointment, I can only hope that no news is good news today.'

Jonathan's sarcasm was lost on the girl. ‘Oh, yes. The machine is working today. What's your name, please?'

He told her his name.

‘Please take a seat. Won't be long,' she said as she moved his medical records to the pile of files of patients waiting to be done.

Jonathan found a seat in the waiting area, a U-shaped row of seats around the walls opposite the front counter. He immediately noticed a big Middle Eastern woman with a head-covering on. Next to her was a woman he guessed was her daughter and a young grandson who looked at Jonathan with suspicious eyes that pierced him steadily. The grandmother had her hands crossed in front of her voluminous abdomen and was looking up at the ceiling as if in silent supplication.

Next to them was an old man, perhaps 90, who was impeccably dressed in a navy blazer and grey pants. Jonathan recognised the blazer to be a Gieves and Hawkes. He was impressed. Yet the man's skin was a sickly yellow-tinged grey. There were lumps under the skin on his neck. Jonathan smiled at him when he caught his eye. The man just stared back. In one corner, a middle-aged woman was
sitting with a drip stand next to her. She had a scarf on her head, but not because she was Muslim – she was covering her baldness.
Chemotherapy
, thought Jonathan. He nodded to her. She smiled back, but only half her face moved; the left side was paralysed. Jonathan was repulsed. Again, he had the feeling that he didn't belong here at the hospital. Next to him was a spare seat with old magazines on it. He picked up a
Woman's Day
and started thumbing through it.

His five companions and he sat quietly and patiently for a very long time. Every now and then, the mother whispered to the child to be quiet or to stop playing with something. When the digital clock on the wall above the old man in the good blazer read 9.45, Jonathan got up to ask if it was going to be much longer.

‘Shouldn't be too long, OK?' said the girl behind the desk.

At 11, still no one had been called in from the waiting room to have his or her test. Jonathan had long run out of patience by then. He was unspeakably angry at having to wait. ‘Why is this taking so long? My appointment was at nine. How is it that I have waited two hours? How can you be this disorganised? I could have gone, done other things and come back if you'd let me know. I'm a very busy man.'

The girl behind the counter simply waited for him to finish talking. ‘Shouldn't be too long, OK?'

Jonathan returned to his seat and looked for some sympathy in the faces of his waiting-room companions, but they were seasoned users of the Victoria Hospital. They knew that their energy was best spent protecting themselves
from the onslaught of the diseases that were threatening their continued existence on this earth. The girl behind the counter was not worth expending energy on.

The woman with the half-paralysed face said, ‘I've long stopped asking questions like that, you know. Ha! I have been waiting here since eight. The ward nurses just plonked me here. My drip has run out. Do they give a shit?' She was struggling to draw enough breath to speak.

‘I'd appreciate it if you could be civil, please.' It was the old man. ‘I'm sure they're doing their best.'

She sniggered, then shook her head ruefully. She had so little time left, and she was wasting it in a waiting room in the Victoria Hospital to have a bone scan that was only likely to announce the extent of her tumour's progression. It was an academic matter; she was a dead woman walking. But she didn't have the strength to say, ‘I'm not playing this evil game any more. I'm going home to die.' There was no one at home. Anyway, she still clung to the hope that she might be one of the lucky few at the Victoria Hospital to be included in a trial of that new type of chemotherapy the doctors were telling her about that had some promising early results in Scandinavia.

‘Why are you here?' she asked the old man.

‘I have a carcinoma of the lung,' he said, without betraying any emotion. ‘And yourself?' he asked.

‘Brain tumour. How about you, young man?' She was looking at Jonathan.

‘I've got a growth in my bladder,' he said. It hurt him to say it out loud to strangers for the first time – he felt as if he had only now taken ownership of the problem – and he struggled to hold back the tears.

A nurse came out. ‘Youseff Adnan,' she said slowly and haltingly, purposely struggling with the name to highlight its difference.

The younger Middle Eastern woman picked up her child. He was old enough to walk, but somehow he seemed to enjoy being scooped up by his mother. He was smiling. She walked towards the nurse, with her own mother by her side.

‘Is this Youseff?' the nurse asked.

Mother and grandmother looked down at the child. ‘Yes,' said his mother softly, ‘this is Youseff.'

‘This way, please.'

The three left in the waiting room sat in silence until the old man broke it. ‘I felt sorry for myself because I had no shoes, until I met the man with no feet,' he said as the boy disappeared with his carers around the corner.

‘Fucking world,' the woman whispered to herself.

Eventually, at 12.30, Jonathan's name was called.

He was shown to a change room and told to strip completely. The small white gown he'd been given didn't cover his body, and he felt like he was wearing a miniskirt.

‘To see if the cancer has spread to your bones, we'll be injecting you with a radioactive solution, and then this big drum here will be positioned above you so that we can measure where your cancer is,' said the nuclear physician. ‘It will take about half an hour to do the test. It won't hurt, but you'll get a metallic taste in your mouth when the solution's injected. OK?'

Once again, the ‘OK'. It was not OK.
I do not want to be here. I want to be back at work, or, better still, at home in bed with my wife, making passionate love to her. I want to be on an
island sunning myself. I want to be shopping for clothes. I want to be playing with my kids. No, it is far from OK.

‘Yes, fine,' Jonathan said.

As he spoke, the man placed a rubber tourniquet around Jonathan's arm, then he patted the back of his hand to raise the veins. With a syringe, he drew up some solution from a vial that had radioactive signs all over it. Jonathan saw a skull and crossbones on it as well.
This can't be good for me
, he thought. The doctor removed a cannula from its package, donned gloves and took the cover off the needle.

‘Sorry, I'm going to faint, I think.' Jonathan felt extremely light headed.

‘Just lie down then.' The doctor pushed on Jonathan's chest to lie him down on the metal table on which the test was to be conducted. Jonathan looked up at the big metal drum and the fluorescent lights shining in his face, bright and silent witnesses to all the suffering in this hospital. Just as he composed himself, he suddenly felt a sharp deeply uncomfortable pain in the back of his hand.

‘Shit, I've missed it. I'll just have to try again. Your veins are really difficult,' said the doctor.

‘Sorry,' said Jonathan, feeling ashamed that his veins were causing trouble.

Another sharp pain.

‘That's better. I'm going to inject you now. You could feel some warmth going up the arm as I do this. Oh, I'd better take the tourniquet off now. We don't want your arm to drop off, do we?' The doctor was making light conversation, to reassure Jonathan.

Jonathan was not reassured.

‘OK?'

Jonathan nodded.

‘I'll be stepping out of the room now. You will hear a lot of whirring and mechanical noises. Please try and lie still. Do not move at all. It shouldn't take too long.'

Jonathan heard the doctor's footsteps as he left the room. A big red light came on. The drum started moving, descending towards Jonathan until it was only a centimetre in front of his face. He panicked slightly.

‘Stay still, please.' The doctor's voice came to him through a speaker somewhere in the room.

Mechanical noises now. The drum started to move again. This time it was slowly edging its way down Jonathan's body, to his feet. It seemed to take an eternity. His back was getting sore lying on the metal bed, and it took a lot of effort not to move to relieve the pressure on his tailbone. Suddenly, the drum stopped and then ascended to its starting position, about a metre above the bed.

‘All over now. You did well. That wasn't so bad, was it?'

‘For whom?' said Jonathan, at which the doctor smiled.

He had gone to the hospital another day for a CT scan and blood test; now he was in Derek's waiting room with Tracy, grasping all the results in his hands and waiting, with his newly acquired patience, or resignation, for Derek to appear to interpret them for him. The doctor rushed in, spoke briefly to his secretary, who suddenly became animated, and disappeared into his room. Minutes later, he came out and asked Jonathan to enter.

‘Did you have the scans and blood tests I ordered?' he asked before Jonathan and Tracy had sat down.

‘Um. Yes. Here they are.'

There followed a long silence as Derek arranged all the
scans on the X-ray viewing box behind his desk. Slowly and methodically, he went through each of the images, as Jonathan sweated expectantly.

‘Good news. The bone scan and CT scan show that the cancer is still contained in your bladder. We now have to talk about treatment. The two options are cystectomy or BCG instillation.' Derek was once again talking his special language, with the air of a schoolboy who knows the answer to the question the teacher has just asked.

Jonathan and Tracy were sitting before him with baffled looks on their faces. It was Tracy who spoke up. ‘Please, doctor, I don't understand what you just said.'

‘Well. As you know, the cancer was superficial. But it's an aggressive type of tumour that has already made roots in your bladder. I was concerned that it may have spread. However, the bone scan and the CT scan show that there is no evidence that it has travelled anywhere.' He paused to gauge their reaction. ‘It is amenable to treatment. Now the two treatments that would be appropriate would be either removing your bladder completely or treating you with weekly instillations of tuberculosis – what is called BCG treatment.'

It was Jonathan who spoke now. ‘Tuberculosis? Isn't that dangerous?'

‘If you take certain types of tuberculosis and instil them into the bladder, we find that they do not cause tuberculosis. However, they set up an inflammatory reaction in the bladder that then destroys the cancer cells. It was ingenious research that first let us know that this was the case.' Derek looked quite proud but got no reaction from the couple. ‘Anyway, some would argue that it is best to take out the bladder, but most urologists would agree that for your age
and stage of cancer at least a trial of BCG treatment is worthwhile. The choice is yours, of course.' Derek waited for their response.