loop, infinite

The first patient I saw today was on the phone when I stepped into her room. She waved when she saw me.

“Hey,” she said, “I gotta go. I’ll call you back in ten minutes, okay? I love you.”

“Sorry about that,” she said. “My daughter.”

“I’m sorry for interrupting,” I said. “I won’t be too long. I just wanted to ask you a few questions about how you’re doing this morning, if that’s okay.”

It was a canned phrase, devoid of any meaning, not put together so much as called from my mind fully-assembled. I saw this exact woman yesterday morning and I said the same thing to her then, too. “I just wanted to ask you a few questions about how you’re doing this morning, if that’s okay.” I say that to everyone. Always the same sentence.

I hate that. I don’t do it on purpose. It’s fake and sickening. I can’t believe I fell into a pattern so quickly. In my defense I could say that it would have been hard not to. Except that’s no defense.

“It’s fine by me,” she said. “I remember you from yesterday. What team were you on? Were you one of the surgery dudes?”

“No,” I said. “I’m oncology. I’m with the cancer dudes.”

“Oh!” she said. “That’s great, because I got questions for you. I mean, I don’t know if you’ll be able to answer them, but – ”

“It’s cool,” I said. “Ask whatever.”

“Okay,” she said. “Well, I was – I just had my second radiation treatment, right? And I was reading this book they gave me, and some of the side-effects are . . . I was a little freaked-out.”

She grabbed a booklet off her bedside table. Before she opened it, I caught a glimpse of the title. “Whole Brain Radiation Therapy: What You Need to Know.” Something like that.

She flipped through pages of side-effects, each more disconcerting – nah, let’s be blunt here – each more fucking terrifying than the last. Fatigue. Nausea. Weakness. Permanent dry eyes. Permanent dry mouth. Permanent facial numbness. Permanent hair loss. Permanent difficulty swallowing.

“What really concerned me was this.” She pointed at a heading – “Cognitive Decline” – and started reading aloud.

“‘You may experience memory loss, personality changes, or difficulty doing math. You may also develop slow, slurred speech, and have trouble keeping your balance when walking.’”

She looked back up at me.

“See, it’s some scary stuff. I just don’t want to do this if it’s gonna turn my brain into pulp. You know what I mean?” She laughed; it sounded forced. “I know it’s silly,” she said, “but it kinda freaks me out.”

“It’s not silly,” I said.

“I like my brain. I want to keep it. It’s the only thing I have left. You know what I mean?”

“I know what you mean.”

“I mean, ‘difficulty doing math’ . . . I teach high school math. That’s my job. I kind of need to be able to do my job, right? It’s not time for me to retire just yet. This is like, it seems like one of those cases where the cure’s worse than the disease.”

I know something she doesn’t, though: I know her disease has no cure. She was diagnosed with lung cancer two years ago. She went through chemotherapy and was told the cancer was “gone.” Now it’s back.

That’s what cancer does. It comes back. When it does, it’s a bad sign.

The cancer is in her brain now and it won’t go away, ever. The radiation therapy’s only going to buy her a little time. She’ll live for maybe six months instead of maybe three months; that’s all.

She doesn’t know she’s going to die soon. Somebody will tell her this next week. It’ll be a calculated “disclosure” of information. I’ve had entire fucking lectures about it. How to Break Bad News.

Yesterday she told me her daughter doesn’t know the cancer’s back.

“She knows I’m in the hospital, but I said it was no big deal, you know. Just a little bronchitis. I’ll tell her the truth someday, of course. It’ll be great. I’ll say, hey, remember when I had bronchitis a few years ago? It was actually cancer! She’ll get a kick out of it.”

She is younger than both of my parents. Her daughter is younger than I am.

Her daughter knows she’s sick, but doesn’t know about the cancer. And she knows about the cancer, but doesn’t know it’ll kill her. And I know it’ll kill her, but I’m not supposed to tell her.

If she stops getting radiation because she’s afraid of cognitive decline, the tumor in her brain’s going to grow until cognitive decline happens anyway. Her brain is pulp either way. She’s pulp if she does, pulp if she doesn’t.

Her cure and her disease are the same thing: brain damage and brain damage respectively. And then death.

“I know probably it’s no big deal,” she said. Talking about radiation therapy again. “But it freaks me out.”

“Look,” I said, “it makes sense that you’re freaked out. if I were in your place I’d be freaked out too. I’d have the same misgivings. Radiation really is some scary stuff.”

Not the “correct” thing to say. Like I give a fuck.

I left soon afterwards. I had to. There were more people to see. You can’t spend more than ten minutes in somebody’s room. People start asking tough questions if you do. Why are you such a slacker? Why aren’t you more efficient?

In the hallway I saw a guy with ripped jeans, rotted teeth.

“Hey,” he said, “hey, doc.” He was talking to me.

“Hi,” I said.

“You think you can give me something stronger for this back pain I got? I got real bad back pain, man. Real bad. You got OxyContin or some shit like that? You write me a script, man? I need a hundred OxyContin.”

I threw up my hands. “I’d do it if I could,” I said. “Believe you me. I wish I could give you a million OxyContin, man, enough to get you high every day for the rest of your life. But I can’t write prescriptions. I’m just a student.”

“It’s okay,” he said. “I understand. I’m just a patient myself.”

“Yeah,” I said. “You are.”

I remember this great episode of The Wonder Years where Fred Savage’s character was working as a delivery boy for a Chinese restaurant. He went to an apartment with a bag of food, knocked at the door, and the guy who answered was this hippie.

“Oh man,” the hippie said. “Food! Great! I gotta – I gotta tip you for this! I gotta give you something!”

Then he reached for his wallet, opened it, and looked at its contents with shame.

“Of course,” he said, “I wish I had something better. Something more worthwhile. I mean, I’d give you rainbows, if I could, man. I’d give you sunshine and love and happiness and peace. But all I got is this” – he sniffed – “money.”

He stuffed a wad of bills into Fred Savage’s hand and closed the door.