The Patient (6 page)

Jonathan got himself to work early and answered his messages. All the while, he was looking up at the clock. At 9.01, he rang the urologist's rooms, which he had established were located not too far from his office.

‘Our opening hours are eight-thirty to five o'clock, Monday to Friday. If you have an emergency, then please go to your nearest …' The voice changed from a recording to a real person, a young woman. ‘Hello? Hello? How can I help you?'

‘Hi, I need to make an appointment,' said Jonathan.

‘Can you hold for a moment?' the receptionist said and was gone before Jonathan could say, ‘Well, I'm in a bit of a hurry.' He was left listening to Big Ben-type chimes: four notes played in a variety of sequences, over and over again. Jonathan heard several renditions, and each time he got more agitated, more upset.

‘Hello, have you been attended to?' It was a different voice this time.

‘No. I'm trying to make an appointment. I have blood –'

‘Just hold the line. Shouldn't be much longer.' Big Ben played its tune again. Several minutes passed.

‘Hello. Were you waiting to make an appointment?' The first receptionist was back.

‘Yes,
please
.' Jonathan sounded exasperated.

‘When would you like to see the doctor?' she said.

Jonathan consulted his diary. ‘Look, I have a spot between three and four this afternoon. I also have an opportunity around six this evening. Any of those times suit?'

There was silence. The girl tittered. Jonathan was confused.

‘I meant do you prefer a morning appointment or an afternoon appointment? The first available slot is in three months' time. I can give you mornings or afternoons from then on.'

The girl waited.

‘Are you serious? Surely I can get an appointment sooner. It's pretty urgent. I've had blood –'

‘What do you want to do? I have other patients waiting,' she said.

‘Well, what choice do I have? I'll take the earliest available afternoon slot, I suppose, but it's not exactly … well …'

‘Not a problem. I'll post you an appointment card with the details. Please bring with you all the X-rays, blood-test results and any other tests you've had. Make sure you also bring the referral. There will be a charge of a hundred and fifty dollars, payable on the day. Thank you.'

It was well rehearsed. Jonathan hung up the phone with resignation. The rest of the day, he dodged comments from his colleagues.

‘Are you OK, mate?'

‘You look fine.'

‘I'm sure this is nothing.'

‘A friend of mine had blood in his urine – turned out to be nothing more than an infection. These days, they can cure anything.'

With each reassurance, Jonathan became more worried. He rang his wife. ‘Trace, the specialist can't see me for three months.'

‘Oh, babes, that's crazy. I thought going private made it quicker? You can't wait that long!'

‘I know, it's nuts. Do you have Brian's phone number?' he asked. They'd met Brian, a radiologist, at a party some months ago and had gone to dinner with him a couple of times since. He was more than a radiologist: he was the head of the radiology department at another big hospital.

‘Good idea. He might know how to get you in sooner.' Tracy gave him the number, and Jonathan called straightaway and related his story.

‘Oh, God. You don't want to see that doctor anyway,' said Brian. ‘She's hopeless. They'll only have referred you to her because she's on call this week, so she automatically gets all the Emergency patients with urological problems. Let me make a call and get back to you. I know a good urologist: Derek Johnson. Let me see if I can pull a few strings for you.'

An hour later, Brian rang back. ‘I've got you an appointment next Monday at ten o'clock. Make sure you tell Derek you're a friend of mine.'

‘Thank you so much, Brian. I don't know how to repay you.'

He was genuinely grateful to Brian for helping him get an earlier appointment; a feeling of relief washed over him. Leaning back in his chair, he thought to himself that the health system was quite corrupt. It was about who you knew. Well, he was glad that he knew someone who could steer him through it.

The rest of the day, and throughout each of the ensuing days, he tried to get on with his work, but his mind kept returning to the blood, the hospital and the doctor's words: ‘Maybe tumour, maybe stone.'
So it really could be a tumour
, he thought, and then quickly told himself,
but tumours aren't always malignant
. The sites he found on the internet, though, all featured the word ‘carcinoma'. What did that mean? Wasn't that cancer?

Jonathan sat in the doctor's waiting room enjoying the classical music coming from the CD player in the corner. It was soothing – just what he needed. He loved music and had an eclectic taste, acquired almost entirely after he'd left home and was no longer under the control of his father. He remembered the trouble he got into at home once for buying a record, Pink Floyd's
Dark Side of the Moon
. It was as if Jonathan had taken up devil worship. Even classical music was not tolerated by his father.

‘God made music so that we can worship him with it, not give ourselves pleasure!' his father had declared after he had belted the boy and confiscated the LP. Jonathan had grown up in the shadow of his tyrannical father. Staunchly religious, his father had no time for anything other than working hard and praying hard. The only songs they played at home were hymnal songs of praise. The only art was devotional. It was not until Jonathan, an only child, rebelled at the age of 16 and left home that he was able to make his own life. To this day, Jonathan and his father had not talked about the conflict. They had started seeing each
other again after the birth of Jonathan's first child, Emma, and were now cordial, if terse and tense.

It was not that Jonathan was anti-religious, more that he didn't believe in the God that his father espoused: a fearsome God who destroys towns that do not obey his decrees; a vengeful God; a jealous God. Surely this was just man-made religion. Surely, infinite wisdom, mercy and grace did not come from a judge sitting on a throne deciding whether, on the basis of your conduct, you should spend eternity having your flesh burnt off your body or surrounded by angels playing harps. This was not a God that Jonathan could believe in, could pray to, could ask for help.

‘Brewster? Mr Jonathan Brewster?'

Jonathan looked up from the old magazine he was reading to see the doctor standing beside the reception desk with a file in his hand. He was a middle-aged balding man with a slight paunch. He had a kindly face and a prominent nose.
Nice suit
, Jonathan thought as he stood up and followed the doctor into his consulting room.

‘Please come in.' The doctor's voice was soft but firm.

He sank into his leather chair and signalled Jonathan to sit down. ‘So, tell me what happened,' he said, staring down at the notes, test results and referral before him on the desk.

‘I'm sure I'm wasting your time, but last week I woke up with this intense need to pass urine, and then I went to the toilet and passed a lot of blood. It happened twice, and since then everything's been fine. Nothing like this has ever happened to me before.' The doctor continued to look down at the paperwork in front of him as Jonathan
continued: ‘I went up to the hospital and had all sorts of tests and X-rays, and then they said I needed to see a specialist, so here I am. They said it could be a stone or maybe a tumour. I read a bit on the internet and saw something about carcinomas.'

‘Well, yes. It could be a lot of things. The most worrying thing is this appearance on your ultrasound. Let me show it to you.' Derek Johnson stood up and turned on the X-ray viewing box on the wall, above his chair.

Jonathan had only heard one word: ‘worrying'.
Did he say ‘worrying'? What does he mean, ‘worrying'? What does it mean when a doctor uses that word?
He focused his attention back onto the conversation.

The doctor pointed at a grey area on the ultrasound and said, ‘See this part here? Can you see how the bladder curves around but it's interrupted by a protuberance from its surface? That looks like it could be a tumour.'

‘A tumour? So do you think this could be a cancer?' said Jonathan disbelievingly.

‘I'm afraid so.' Derek looked at the patient now, waiting to see his reaction. If he sensed that the fellow was not coping with the news, he would soften his next words. If he felt that he was coping, he would keep going.

Jonathan was struggling to take it all in. Cancer. Tumour. Bladder. ‘So, what do you need to do next?' he asked, trying to appear composed despite the tide of anxiety he could feel rising within him. He wanted to cry. Sensing his lower lip beginning to tremble, he bit it to keep it still.

But Derek had picked up on the signs of sheer fright.
This bloke is a wimp
, he thought.
Better keep it short and not too involved
. ‘Well, we need to get you admitted to perform
a cystoscopy. That's a procedure where we insert a telescope with a light on the end of it into your bladder, and then we check out the appearance of this growth and take some biopsies. If it's possible, we can resect it away at the same time. There are some possible complications. You can bleed afterwards. Of course, you do have to have a general anaesthetic, so you can have a heart attack, a stroke and a thousand other problems. If you are happy, please sign here.' This was called an informed consent. Derek Johnson could remember a time when patients just trusted their surgeons to do what was right. Now, with the increasing litigation problem, one had to spell out all the side effects of an operation to the satisfaction of the patient, explain the reasons for having the operation, the consequences of not having it and answer every question the patient asked. Derek thought this to be a waste of time, and his consent talks had remained fairly perfunctory. He had read the literature that suggested that no matter how much time one spends on a consent, patients remember less than ten per cent of what they are told in a consultation with a doctor.

This certainly applied to Jonathan, who had stopped listening after the words ‘insert a telescope'. ‘Is this serious, doctor?' he asked.

Derek had been asked that question a thousand times. He never knew what to answer. What he wanted to say was, ‘Well, if you consider having a growth in your bladder that could cause you to die serious, then, yes, it's serious.'

Instead, Derek said, ‘The vast majority of these tumours are superficial. Once we resect them from your bladder, then that is usually all the treatment they need. You will need to be monitored afterwards, however.' It was the pre
rehearsed answer he gave every patient who asked this question. ‘By the way, are you in a health fund?' he asked casually.

‘No. Why? Does it make a difference?'

‘Well, only in so far as if you had private health insurance I could get you into a private hospital this week and do your operation straightaway. Of course, in that case I would do your operation. Otherwise, I can put you on the waiting list at the Victoria Hospital and we can take our chances,' the doctor said matter-of-factly.

‘When you say “take our chances”, doctor, do you mean as to how long we wait or who will be doing the operation? I've heard that if you go to the public hospital, it's probable that a trainee would be doing the operation.' Jonathan had read the horror stories in the papers about unqualified trainees doing operations for which they were not competent. Derek Johnson enjoyed these articles because they increased his private practice considerably. He earned a lot more per operation in the private hospital than he did in the public hospital, so the more patients who took out private insurance or paid for their own operations in the private hospital, the more profitable it was for him.

‘Well, it is a teaching hospital, and hence the trainees have got to learn.' He smirked as he said it, knowing it was the type of statement that frightened the patients into paying. ‘I am the supervising surgeon at the Victoria Hospital, though, so at the very least I will be there to oversee the operation.'

‘Can I pay for you to do my operation privately?' asked Jonathan.

‘Absolutely. Yes. My secretary can give you a quote, and you can decide which way to go. Do you have any other questions?'

Jonathan's mind was a blank. He wished he'd taken Tracy up on her offer to come with him. She would've known what to ask. She would've known what to say and do.

Still numb with the shock of it, Jonathan left the doctor's room and went and waited for the secretary, who was dealing with another patient.

‘So, is the doctor taking out the stitches in your penis today?' he heard her ask.

‘Yes. He said to come back today to have them taken out.' The man's face flushed red as he looked around the waiting room and realised that there were ten other patients engaged intently in this conversation about his penis. Now that the secretary had broadcast his private details throughout the waiting room, did everyone realise he'd had a penile prosthesis inserted and was here to get instructions on how to inflate it, ready for use?

‘Take a seat, then. I'll check with the doctor.' The man sat down. The secretary now turned her attention to Jonathan.

‘Yes?' she said.

‘The doctor said that you might be able to give me a quote on having my operation in the private hospital.' Starting to get embarrassed as well, Jonathan was whispering.

‘Did he say which operation you were having?'

‘Yeah, the one where they stick a camera up the … up the, um, you know, to look inside the blad–'

‘A cystoscopy?'

‘Yeah, I think that's the one.' Jonathan nodded, his face now as red as the previous patient's.

The secretary turned to her computer, found the right file and printed it out. She handed the information to Jonathan. ‘Have a read and let me know,' she said. The vast majority of patients baulked at the cost and ended up going public. She gave Jonathan the forms for the public hospital as well.

The quote for the surgery was huge, but Tracy was insisting that Jonathan go to the private hospital.

‘Honestly, I think I should just wait and have it at the public,' he told her firmly over the phone from his office. ‘He said that most of these growths are very superficial and cutting them out is enough.'

‘Well, if you think that's best. God, if we'd only bloody signed up for health insurance. When does he think you'll get in if you go public?'

‘I don't know when he can get me in.'

‘Don't forget about our holidays, Jon.' Her tone was alarmed; she'd fought hard to get him to book some time off work.

‘Yeah, I'll tell his secretary to avoid that week, but surely I won't have to wait that long anyway – our holiday's months away. Is there anything else on our calendar that's unchangeable? OK, Trace, I've gotta go now. I'll let you know later.'

His in-tray was piled high, and he'd missed three meetings that morning – important meetings that influenced major projects he was working on.
The sooner this thing is treated and I've put it behind me, the better,
he thought.

He dialled the doctor's surgery and told the secretary he would go public. The wait, she told him, was going to be about two months.

‘Jesus Christ! This thing could be a cancer!'

Jonathan heard only silence from the secretary for a few seconds, and then she spoke, slowly and firmly: ‘Mr Brewster, I'm not the one that determines who gets in and who does not. You take your turn, and they call you when they have a spot.' Jane handled calls like this every single day from patients who were concerned about when they were going to get their treatment. At 22, she wondered whether she would be better off finding a job where her major concern could be like some of her friends', such as whether her nails had chipped on the keyboard that day, rather than the pain of the doctors' cancer patients – the type of pain that makes a person wish for death; the type of pain that hollows out a man and creates, instead, a walking skeleton. Jonathan was deeply worried and concerned, yet to Jane he was but one of many callers in a similar – or worse – position. Though she hated to admit it to herself, he was just another irritation for her to endure before 4.59, when she could switch off the computer and turn on the answering machine.

‘OK, thanks for your help.' Jonathan hung up.

He was to repeat this conversation several times over the next few weeks. Several times, he had a strong urge to pay to go private, but he and Tracy had never been good with money. While he had a substantial income, they had huge expenses. To any who observed them, they must have seemed comfortably off, but the reality was that they spent more than they earned and had borrowed a lot. There were
payments to make on the house, school fees, credit cards, entertaining and good clothes. Every now and then, they would go on a budget. Then they would need a holiday or a new table for the dining room, and another credit card would be filled. Banks were fighting to give them more credit cards and higher limits, and Tracy and Jonathan were only too happy to accept the next level of American Express torture or the Platinum Mastercard.

They had certainly not saved anything for a rainy day. Jonathan's father had been strict with money, and as an adult Jonathan had rebelled, becoming a spendthrift. Now that he was making some real money, he wanted his girls to have everything that he hadn't as a child.