Дуглас Кеннеди: Five Days

‘Are 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 — 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.

‘I’m telling you that I cannot give you the all-clear. That is Dr Harrild’s job.’

‘But you think it’s “all-clear”.’

I looked at him directly.

‘I’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.

‘I get it. and thank you. Thank you so much.’

‘I hope the news is good from Dr Harrild.’

Five minutes later I was knocking on Dr Harrild’s door.

‘Come 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 ‘the geek’ — 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 — 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 ‘Pope 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 — and an absolutely first-rate diagnostician. The diffidence and the slight social awkwardness mask reinforced steel.

‘Hey, Laura,’ Dr Harrild said as I opened his office door. ‘Good news on the Jessica Ward front. It looks very all-clear to me.’

‘That is good news.’

‘Unless, 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.

‘I saw nothing worrying or sinister,’ I said.

‘Glad to hear it.’

‘Would you mind talking to Jessica’s father now? The poor man. ’

‘Is he in the waiting area?’

I nodded.

‘We have Ethel Smythe in next, don’t we?’ he asked.

‘That’s right.’

‘Judging by the shadow on her lung last time. ’

He let the sentence hang there. He didn’t need to finish it — 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 — 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.

‘Anyway, 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 — 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 ‘the meanest man this side of the Mississippi’. The fact that her physician, Dr Wesley, was ‘a dreamboat, always so kind and reassuring’, and how he told her he ‘just 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 — 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:

‘Surely it can’t be anything. Surely that shadow Dr Wesley told me about was an error, wasn’t it?’

‘As soon as our diagnostic radiologist has seen the scan we’ll be taking today—’

‘But you saw the X-ray. And you don’t think it’s anything bad, do you?’

‘I never said that, ma’am.’

‘Please call me Ethel. But you would have told me if it had been bad.’

‘That’s not my role in all this.’

‘Why can’t you tell me everything is fine? Why?’

Her eyes were wet, her voice belligerent, angry. I put my hand on her shoulder.

‘I know how frightening this all is. I know how difficult it is not knowing what is going on — and how being called back for a scan like this—’

‘How can you know? How?’

I squeezed her shoulder.

‘Ethel, please, let’s just get this behind you and then—’

‘They always told me it was a stupid habit. Marv — my ex-husband. Dr Wesley. Jackie — that’s my sister. Always said I was dancing with death. And now. ’

A huge sob rose in her throat.

‘I want you to shut your eyes, Ethel, and concentrate on your breathing and—’

More sobs.

‘I’m going to step away now and get all this underway,’ I said. ‘Just keep breathing slowly. And the scan will be finished before you—’

‘I 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.

‘Stage Four,’ he said quietly. We both knew what that meant — 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.

‘Where is she right now?’ Dr Harrild asked.

‘She 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 ‘with 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.

‘You 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.