The granddaughter’s voice was steel as she reminded the doctor he sure didn’t have a problem recommending the injection of chemotherapy drugs into an old woman’s spinal fluid before tests had confirmed the cancer had spread there.
The doctor flinched and responded, with some ire, that he made a diagnosis; and the granddaughter did not flinch, and said she knew he did, and he should diagnose this. He should prescribe this for her.
People were openly gawking. Orderlies and nurse-practitioners had stopped in place to watch. The doctor’s voice was searing now as he said the grandmother would take the drug and the odds were she would be dead in a week. Even today her condition was serious. He might need to perform a procedure to clear her lungs that was traumatic to say the least, and was going to require that the granddaughter and her dad finally make a decision on the do not resuscitate form.
The doctor then reminded the granddaughter that hospital policy was to do the most humane treatments for their patients. In reply he was told it was awfully big of him to consider this option so seriously and decide what was so humane.
The granddaughter could not make him prescribe that drug, said the doctor.
They locked eyes and the doctor maintained his gaze and purposefully slowed his words and said the hospital would do their best to get the grandmother stabilized and home to the granddaughter. He told the granddaughter that if the grandmother felt sick again, they could bring her in, or could choose not to. He said he was sorry, he could imagine how the granddaughter must feel.
“You can?” she answered. “You can understand, but still say no?”
Welcome to my body
THE BLUE OF cloudless skies. A woven mesh, lightweight metal, materials designed to ward away, to shield. Everyone who entered wore one. And of course the usual gloves. The masks.
Alice asked if she at least got a smock. Carmen gave a small laugh, made eye contact with the second nurse. Working as a pair, they made sure that the patient number on Alice’s plastic bracelet corresponded to the numbers on each round glass bottle or plastic bag, asking Alice when her birthday was, then checking that item off their list. Carmen showed Alice each bottle, explaining: This is an antibiotic drip of penicillin. This is Sapeptamonizene.
In the two big windows the sky had darkened, the snowfall thickening even further, and between this and the colored crepe paper over the lights, the near side of the room was enveloped in gloom. Carmen asked if it was okay to take down the mood paper, they needed to be able to see everything. Alice looked disappointed but nodded, then mouthed out her recognition of the second nurse, the name emerging as a question. Requita winked back, kept on hooking up the glass bottles of cloudy drips, the transparent bags bloated with mucus-looking liquid. Above the battery pack, an almost ghostly tree formed, branches thick and limbs spreading, tubes running down toward Alice’s port like so many vines. Carmen was using a red Magic Marker to write on Alice’s skin the current military time and date, so the next nurses would know when to change dressings, replace catheters; Requita was casting evil eyes toward the battery pack’s infernal beeping. Now she rolled back the sleeves of Alice’s robe, began wrapping gauze around Alice’s forearms; she wanted to ensure Alice’s arms stayed warm. This would help the medicine circulate.
“We’re putting you on a steroid,” she said. “It’ll run through the course of the consolidation. It makes you feel energetic, even a little high.”
“With any luck,” Carmen added, “you’ll start that appetite.”
Near the entrance, Dr. Eisenstatt began fitting his arms into his blue smock, leaving the strings that were supposed to go around his neck untied, giving the smock a looseness, a droopy scoop around his upper chest. When he stepped forward the nurses ceased jawing. The doctor’s forehead was flushed; his eyes darted, wide, a bit wild, but disciplined. He acknowledged Oliver, checked that the nurses were properly subdued.
“Where have you been, Howie?” Alice called. “I thought you’d abandoned me.”
It was evident Dr. Eisenstatt was not accustomed to being teased, especially not by patients. His already flushed face turned a deeper shade. The doctor seemed to stare through his chart. He did that thing where he pinched the bridge of his nose. Rubbing his eyelids with his thumbs, he murmured something unheard, took a few breaths. In the scoop of his undone smock, Alice recognized his starched and narrow pin collar, replete with gold bar running behind the raised tie knot — a flourish that defined custom-made, high-end dress shirts. Alice also noticed that his shirt was a bit too large, couldn’t have been custom made. The thought flashed through her mind that the doctor’s mother bought it for him at a Barneys Warehouse sale. Alice chided herself but also felt nourished — not merely by the doctor’s brain freeze, his vulnerability, or even his confusion, but rather, by the vehemence of her own cattiness.
“Aside from your concerns with my tardiness,” Eisenstatt said, “which I certainly understand and can sympathize with, and apologize for.” Eisenstatt refocused and paused, gracious. “Now that I’ve finally managed to get here, from all indications, things appear to be going quite well, which is heartening.” He stepped toward the bed. “It also came to my attention that you and the nurse had a meeting of the minds.”
Breezing past the nurse to whom he’d just referred, and whose name apparently did not matter to him, Eisenstatt stopped at the side of the bed. “Mrs. Culvert, let me assure you. You are exactly where you need to be. If the cancer was present, you’d be back in reinduction, understand?” His intelligence added weight to each sentence, and his focus impacted this weight, landing smack between Alice’s eyes. “We want to keep your cancer in remission. This is the treatment.”
Alice’s silence conveyed acquiescence. Readying the late pages of a tattered notebook, she followed the doctor as best she could, scribbling along while Eisenstatt explained that her consolidation chemo cycle was scheduled to run over the course of six days. Alice would get her dose at 7:00 P.M. and 7:00 A.M. Would have a day of rest afterward, on-off, this the pattern through her six-day cycle.
“So before and after seven, Doe can come.” She wrung out her writing hand.
“She misses you,” Oliver said. “I’ll have her here.”
On her side, Requita was wrapping a blood pressure sleeve around the arm nearest her port.
“I don’t think that’s a good idea,” Alice told her. “I’m not meaning to be difficult.”
Eisenstatt watched the nurse undo the sleeve. “A lot of our patients take for granted that consolidation is routine,” he said, a hint of the scolding father coming through. “Assuming things go according to plan, you’ll feel fine for most of your stay. When you go home and your numbers start to drop, that’s when you’ll get weak and tired. Probably half my patients end up coming back to the hospital — not from the chemo but from infections. Consolidation chemo is actually more potent than the induction.”
“Already you are bringing clouds of doom, O Jewish granny. Does this officially make you a yenta? Is that the term?” Motioning to the pictures on the bedside table, she spoke to Oliver. “Little kumquat.”
“You’ve been through this already, I understand. But we don’t want expectations working against you. It is not uncommon. After patients have been through chemotherapy once, they think they know what’s coming.”