Douglas Kennedy: Five Days

‘I have to go into that?’ she said, eyeing the door as if she wanted to make a run for it.

‘It’s nothing, really. You lie on the bed there. The machine lifts you up into the hoop. The hoop takes pictures of the things the doctor needs pictures of. and that’s it. We’ll be done in a jiffy.’

‘And it won’t hurt?’

‘Let’s get you lying down first,’ I said, leading her to the bed.

‘I really want my daddy,’ she said.

‘You’ll be with your daddy in just a few minutes.’

‘You promise?’

‘I promise.’

She got herself onto the bed.

I came over, holding a tube attached to the capsule containing all that inky liquid, covering with my hand the intravenous needle still encased in its sterilized packaging. Never show a patient an IV needle. Never.

‘All right, Jessica. I’m not going to tell you a big fib and say that getting a needle put into your arm is going to be painless. But it will just last a moment and then it will be behind you. After that, no pain at all.’

‘You promise.’

‘I promise — though you might feel a little hot for a few minutes.’

‘But not like I’m burning up.’

‘I can assure you you’ll not feel that.’

‘I want my daddy. ’

‘The sooner we do this, the sooner you’ll be with him. Now here’s what I want you to do. I want you to close your eyes and think of something really wonderful. You have a pet you love, Jessica?’

‘I have a dog.’

‘Eyes closed now, please.’

She did as instructed.

‘What kind of dog is he?’

‘A cocker spaniel. Daddy got him for my birthday.’

I swabbed the crook of her arm with a liquid anesthetic.

‘The needle going in yet?’ she asked.

‘Not yet, but you didn’t tell me your dog’s name.’

‘Tuffy.’

‘And what’s the silliest thing Tuffy ever did?’

‘Ate a bowlful of marshmallows.’

‘How did he manage to do that?’

‘Daddy had left them out on the kitchen table, ’cause he loves roasting them in the fireplace during Christmas. And then, out of nowhere, Tuffy showed up and. ’

Jessica started to giggle. That’s when I slipped the needle in her arm. She let out a little cry, but I kept her talking about her dog as I used tape to hold it in place. Then, telling her I was going to step out of the room for a few minutes, I asked:

‘Is the needle still hurting?’

‘Not really, but I can feel it there.’

‘That’s normal. Now, I want you to lie very still and take some very deep breaths. And keep your eyes closed and keep thinking about something funny like Tuffy eating those marshmallows. Will you do that for me, Jessica?’

She nodded, her eyes firmly closed. I left the scan room as quietly and quickly as I could, moving into what we call the technical room. It’s a booth with a bank of computers and a swivel chair and an extended control panel. Having prepped the patient I was now about to engage in what is always the trickiest aspect of any scan: getting the timing absolutely right. As I programed in the data necessary to start the scan I felt the usual moment of tension that, even after all these years, still accompanies each of these procedures: a tension that is built around the fact that, from this moment on, timing is everything. In a moment I will hit a button. It will trigger the high-speed injection system that will shoot 80 milligrams of high-contrast iodine into Jessica’s veins. After that I have less than fifty seconds — more like forty-two seconds, given her small size — to start the scan. The timing here is critical. The iodine creates a contrast that allows the scan to present a full, almost circular image of all bone and soft tissue and internal organs. But the iodine first goes to the heart, then enters the pulmonary arteries and the aorta before being disseminated into the rest of the body. Once it is everywhere you have reached the Venus phase of the procedure — when all veins are freshly enhanced with the contrast. Begin the scan a few critical seconds before the Venus phase and you will be scanning ahead of the contrast — which means you will not get the images that the radiologist needs to make a thorough and accurate diagnosis. Scan too late and the contrast might be too great. If I fail to get the timing right the patient will have to go through the entire procedure again twelve hours later (at the very minimum) — and the radiologist will not be pleased. Which is why there is always a moment of tension and doubt that consumes me in these crucial seconds before every scan. Have I prepped everything correctly? Have I judged the relationship between the diffusion of the iodine and the patient’s physique? Have I left anything to chance?

I fear mistakes in my work. Because they count. Because they hurt people who are already frightened and dealing with the great unknown that is potential illness.

I especially fear moments when I have a child on that table, that bier. Because if the news is bad, if the images that emerge on the screen in front of me point up something catastrophic.

Well, I always absorb it, always assume a mask of professional neutrality. But children. children with cancers. it still pierces me. Being a mom makes it ten times worse. Because I am always thinking: Say it was Ben or Sally? Even though they are now both in their teens, both beginning to find their way in the world, they will always remain my kids — and, as such, the permanent open wound. That’s the curious thing about my work. Though I present to my patients, my colleagues, my family, an image of professional detachment — Sally once telling a friend who’d come over after school: ‘My mom looks at tumors all day and always keeps smiling. how weird is that?’ — recently it has all begun to unsettle me. Whereas in the past I could look at every type of internal calamity on my screens and push aside the terribleness that was about to befall the person on the table, over the past few months I’ve found it has all started to clog up my head. Just last week I ran a mammogram on a local schoolteacher who works at the same middle school that Sally and Ben attended, and who, I know, finally got married a year ago and told me with great excitement how she’d gotten pregnant at the age of forty-one. When I saw that nodule embedded in her left breast and could tell immediately it was Stage Two (something Dr Harrild confirmed later), I found myself driving after work down to Pemaquid Point and heading out to the empty beach, oblivious to the autumn cold, and crying uncontrollably for a good ten minutes, wondering all the time why it was only now so getting to me.

That night, over dinner with Dan, I mentioned that I had run a mammogram on someone my own age today (this being a small town, I am always absolutely scrupulous about never revealing the names of the patients who I’ve seen). ‘And when I saw the lump on the screen and realized it was cancerous I had to take myself off somewhere because I kind of lost it.’

‘What stage?’ he asked.

I told him.

‘Stage Two isn’t Stage Four, right?’ Dan said.

‘It still might mean a mastectomy, especially the way the tumor is abutting the lymph nodes.’

‘You’re quite the doctor,’ he said, his tone somewhere between complimentary and ironic.

‘The thing is, this isn’t the first time I’ve lost it recently. Last week there was this sad little woman who works as a waitress up at some diner on Route 1 and who had this malignancy on her liver. And again I just fell apart.’

‘You’re being very confessional tonight.’

‘What do you mean by that?’

‘Nothing, nothing,’ he said, but again with a tone that — like much to do with Dan right now — was so hard to read.