Authors: Douglas Kennedy
âSir, you need to understand â I can neither legally nor ethically offer my opinion on the scans.'
âWell, there's a first time for everything. Please, ma'am. I'm begging you. I've got to know what you know.'
âPlease understand, I am sympathetic . . .'
âI want an answer.'
âAnd I won't give you one. Because if I tell you good news and it turns out not to be good news . . .'
That startled him.
âAre you telling me there's good news?'
This is a strategy I frequently use when the scans show nothing, but the diagnostic radiologist has yet to study them and give them the all-clear. I cannot say what I think â because I don't have the medical qualifications. Even though my knowledge of such things is quite extensive those are the hierarchical rules and I accept them. But I can, in my own way, try to calm fears when, I sense, there is clinical evidence that they are ungrounded.
âI'm telling you that I cannot give you the all-clear. That is Dr Harrild's job.'
âBut you think it's “all-clear”.'
I looked at him directly.
âI'm not a doctor. So if I did give you the all-clear I'd be breaking the rules. Do you understand, sir?'
He lowered his head, smiling, yet also fighting back tears.
âI get it . . . and thank you. Thank you so much.'
âI hope the news is good from Dr Harrild.'
Five minutes later I was knocking on Dr Harrild's door.
âCome in,' he shouted.
Patrick Harrild is forty years old. He's tall and lanky and has a fuzzy beard. He always dresses in a flannel shirt from L.L.Bean, chinos, and brown desert boots. When he first arrived here three years ago, some unkind colleagues referred to him as âthe geek' â because he isn't exactly the most imposing or outwardly confident of men. In fact he does veer towards a reserve which many people falsely read as timidity. Before Dr Harrild the resident diagnostic radiologist was an old-school guy named Peter Potholm. He always came across as God the Father, intimidated all underlings, and would happily become unpleasant if he felt his authority was being challenged. I was always ultra-polite and professional with him â while simultaneously letting him play the role of Absolute Monarch in our little world. I got along with Dr Potholm, whereas three of the RTs actually left during his fourteen-year tenure (which ended when age finally forced him to retire). Dr Harrild couldn't have been more different than âPope Potholm' (as the hospital staff used to refer to him). Not only is he unfailingly polite and diffident, he also asks opinions of others. But he did quietly engineer a staff member's early retirement when she messed up five scans in a row. He's a very decent and reasonable man, Dr Harrild â and an absolutely first-rate diagnostician. The diffidence and the slight social awkwardness mask reinforced steel.
âHey, Laura,' Dr Harrild said as I opened his office door. âGood news on the Jessica Ward front. It looks very all-clear to me.'
âThat is good news.'
âUnless, of course, you spotted something I didn't.'
Peter Potholm would have walked barefoot across hot coals rather than ask the medical opinion of a lowly RT. Whereas Dr Harrild . . .
âI saw nothing worrying or sinister,' I said.
âGlad to hear it.'
âWould you mind talking to Jessica's father now? The poor man . . .'
âIs he in the waiting area?'
I nodded.
âWe have Ethel Smythe in next, don't we?' he asked.
âThat's right.'
âJudging by the shadow on her lung last time . . .'
He let the sentence hang there. He didn't need to finish it â as we had both looked at the X-ray I'd taken of Ethel Smythe's lungs a few days earlier. And we'd both seen the very sinister shadow that covered a significant corner of the upper left ventricle â a shadow which made Dr Harrild pick up the phone to Ethel Smythe's physician and tell him that a CT scan was urgently required.
âAnyway, I will go give Mr Ward the good news about his daughter.'
Fifteen minutes later I was prepping Ethel Smythe. She was a woman about my age. Divorced, No children. A cafeteria lady in the local high school. Significantly overweight. And a significant smoker, as in twenty a day for the past twenty-three years (it was all there on her chart).
She was also relentlessly chatty â trying to mask her nervousness during the X-ray with an ongoing stream of talk, all of which was about the many details of her life. The house she had up in Waldeboro which was in urgent need of a new roof, but which she couldn't afford. Her seventy-nine-year-old mother who never had a nice word for her. A sister in Michigan who was married to âthe meanest man this side of the Mississippi'. The fact that her physician, Dr Wesley, was âa dreamboat, always so kind and reassuring', and how he told her he âjust wanted “to rule a few things out”, and he said that to me in such a lovely, kind voice . . . well, there can't be anything wrong with me, can there?'
The X-ray said otherwise â and here she was, now changed into the largest hospital gown we had, her eyes wild with fear, talking, talking, talking as she positioned herself on the table, wincing as I inserted the IV needle in her arm, telling me repeatedly:
âSurely it can't be anything. Surely that shadow Dr Wesley told me about was an error, wasn't it?'
âAs soon as our diagnostic radiologist has seen the scan we'll be taking todayâ'
âBut you saw the X-ray. And you don't think it's anything bad, do you?'
âI never said that, ma'am.'
âPlease call me Ethel. But you would have told me if it had been bad.'
âThat's not my role in all this.'
âWhy can't you tell me everything is fine? Why?'
Her eyes were wet, her voice belligerent, angry. I put my hand on her shoulder.
âI know how frightening this all is. I know how difficult it is not knowing what is going on â and how being called back for a scan like thisâ'
âHow can you know? How?'
I squeezed her shoulder.
âEthel, please, let's just get this behind you and thenâ'
âThey always told me it was a stupid habit. Marv â my ex-husband. Dr Wesley. Jackie â that's my sister. Always said I was dancing with death. And now . . .'
A huge sob rose in her throat.
âI want you to shut your eyes, Ethel, and concentrate on your breathing andâ'
More sobs.
âI'm going to step away now and get all this underway,' I said. âJust keep breathing slowly. And the scan will be finished before youâ'
âI don't want to die.'
This last statement came out as a whisper. Though I'd heard, over the years, other patients utter this, the sight of this sad, frightened woman had me biting down on my lip and fighting tears . . . and yet again silently appalled at all this new-found vulnerability. Fortunately Ethel had her eyes firmly shut, so she couldn't see my distress. I hurried into the technical room. I reached for the microphone and asked Ethel to remain very still. I set the scan in motion. In the seconds before the first images appeared on the screen I snapped my eyes shut, opening them again to see . . .
Cancer. Spiculated in shape, and from what I could discern, already metastasized into the other lung and the lymphatic system.
Half an hour later Dr Harrild confirmed what I'd seen.
âStage Four,' he said quietly. We both knew what that meant â especially with this sort of tumor in the lungs. Two to three months at best. As cancer deaths go, this one was never less than horrible.
âWhere is she right now?' Dr Harrild asked.
âShe insisted on going back to work,' I said, remembering how she'd told me she had to hurry back after the scan because the school lunch she'd be serving started at midday, and âwith all the cutbacks happening now I don't want to give my boss an excuse to fire me'.
Recalling this I felt myself getting shaky again.
âYou OK, Laura?' Dr Harrild asked me, clearly studying me with care. Immediately I wiped my eyes and let the facade of steely detachment snap into place again.
âFine,' I said, hearing the enforced crispness in my voice.
âWell,' he said, âat least the little girl's news was good.'
âYes, there's that.'
âAll in a day's work, eh?'
âYes,' I said quietly. âAll in a day's work.'
PEMAQUID POINT. A
short stretch of sand â no more than a quarter-mile long â facing the open waters of the Atlantic. The âpoint' is more of a cove: rocky, rugged, fringed on either side by vacation homes that are simple, but clearly upscale. Ostentation is never liked in this corner of Maine â so even those âfrom away' (as anyone not born in the state is called) know better than to throw up the sort of garish shows of money that seem to be accepted elsewhere.
In Maine so much is kept out of sight.
I had the beach to myself. It was three-eighteen in the afternoon. A perfect October day. A hard blue sky. A hint of impending chill in the air. The light â already beginning to decrease wattage at this hour â still luminous. Maine. I've lived here all my life. Born here. Raised here. Educated here. Married here. All forty-two years I've had to date rooted in this one spot. How did that happen? How did I allow myself to stand so still? And why have so many people I know also talked themselves into limited horizons?
Maine. I come down to this point all the time. It's a refuge for me. Especially as it reminds me of the fact that I am surrounded by a natural beauty that never ceases to humble me. Then there is the sea. When I was in a book group we worked our way through
Moby-Dick
two years ago. A retired navy woman named Krystal Orr wondered out loud why so many writers seemed to be drawn to the sea as a metaphor for so much to do with life. I heard myself saying: âMaybe it's because, when you're by the sea, life doesn't seem so limited. You're looking out at infinite possibilities.' To which Krystal added: âAnd the biggest possibility of them all is the possibility of escape.'
Was that woman reading my mind? Isn't that what I was always thinking as I came out here and faced the Atlantic â the fact that there is a world beyond the one behind me now? When I looked out at the water my back was turned to all that was my life. I could dwell in the illusion of elsewhere.
But then there was the distinct
bing
of my cellphone, bringing me back to the here-and-now, telling me that someone had just sent me a text.
Immediately I was scrambling in my bag for my phone, as I was certain that the text was from my son Ben.
Ben is nineteen; a sophomore at the University of Maine in Farmington. He's majoring in visual art there â a fact that drives my husband Dan just a little crazy. They've never been able to share much. We're all products of the forces that shaped us, aren't we? Dan was raised poor in Aroostook County; the son of a part-time lumberman who drank too much and never really knew how to spell the word r-e-s-p-o-n-s-i-b-i-l-i-t-y. But he also loved his son, even if he often thought nothing of lashing out at him while tanked. Dan grew up both adoring and fearing his dad â and always trying to be the tough outdoorsman that his father considered himself to be. The fact that Dan himself rarely touches alcohol â and looks askance at me if I dare to have a second glass of wine â speaks volumes about the lasting trauma of his dad's considerable drink-fueled furies. He privately knows his own father was a weak, cowardly little man who, like all bullies, used brutality to mask his own self-loathing. As such, I've tried to talk to Dan on many occasions about the fact that he is a much better person than his father â and that he should extend his innate decency to his son, whatever about their polar differences. It's not as if Dan is in any way cruel or hostile towards Ben. He shows only nominal interest in him, and refuses to explain to me why he treats his only son as a stranger.
Only recently, after Ben was written up in the
Portland Phoenix
as a young artist to watch â on the basis of a collage he had exhibited at the Portland Museum of Art, which turned âthe deconstructed remnants' of lobster pots into âa chilling vision of modern incarceration' (or, at least, that's what the critic in the
Phoenix
called it), Dan asked me if I thought Ben was, in any way, âdisturbed'? I tried to mask my horror at this question, instead asking: âWhat on earth makes you think that?'
âWell, just look at that damn collage which all those smarty-pants down in Portland think is so fantastic.'
âPeople respond to the piece because it is provocative, and uses something indigenous to Maine â a lobster pot â as a way ofâ'
â“Indigenous
”,' Dan said with a decided sneer. âYou and your big words again.'
âWhy are you being so hurtful?'
âI'm just voicing an opinion. But go on and tell me I'm shooting my mouth off again. And this is the reason I'm still out of work twenty-one months afterâ'
âUnless you were keeping something from me, you didn't lose your job for saying the sort of inappropriate things you're saying now.'
âSo I'm also inappropriate, am I? Unlike our “brilliant” son. Maine's next Picasso.'
Ever since he'd lost his job Dan had begun to increasingly display flashes of unkindness. Though an apology for this last harsh comment was immediately forthcoming (âThere I go again, and I really don't know why you put up with me') the effect was, yet again, corrosive. Even if these momentary lapses only arose twice a month, they were coupled with the way Dan was increasingly withdrawing into himself â and refusing to share any of the understandable anger he felt about being laid off. The result was that things just seemed askew at home. I can't say ours was ever the most romantic or passionate of marriages (not that I had anything since my marriage to compare it to). But we had rubbed along for years in a reasonable, stable way. Until the lay-off that suddenly opened up a dark recess which seemed to grow larger with each ensuing month when Dan was stuck at home, wondering if his career would ever be resuscitated again.