Pileated Woodpecker
Clever, Cookie thought. A clever diagnosis. Hypothyroid with no symptoms other than the growth faltering. No one had praised her cleverness; she had not expected praise. Not even from the little girl's mother. People expect doctors to know everything. Cookie touched her own neck, and her smile faded. She felt a small lump just under the corner of her jaw on the right side. Her fingers patted carefully around its edges. How long had it been there? She pushed up at it. Did it move? She pressed. No pain. Probably my parotid gland, she thought. And on the other side? Another lump, but a small and soft one. She felt again on the right. Definitely bigger, firmer. A lymph node, maybe, reacting to a sore in her mouth? But what sore? She moved her tongue around behind her teeth. Nothing. And a reactive lymph node would be painful. This lump wasn't.
Cookie was a healthy person who worried a lot. Being a doctor didn't help. In fact, it made it worse. Until she was well into medical school, she hadn't realized how many more things she could find to worry about. Like when the class learned to do breast exams and she found that her own breasts were full of irregular lumps she had never before noticed. Of course, she had panicked for nothing. And the migraine that made her vision blur so that she had backed her car into a wall. The neurologist clearly felt she was wasting his time. He'd said, "You know, if a patient had told you this story, you would have been able to diagnose a simple migraine. But no, when it's your own problem you go to pieces. Too emotional," he muttered, turning away. Angry as she was, Cookie said nothing.
Should I call Bob Gross? she wondered. He was the internist she had asked about her breasts. He'll be fed up, too. Especially since she had decided to stop doing breast self-exams. With so many lumps, how could you remember which were old and which were new? And how could you live with your breast gone. Even her mother had been sickened by the jagged healing wound reflected in the mirror. Cookie, helping with bandages, had faced the immediate reality, unsoftened by distance or reflection. She had tried to remain expressionless, looking at her mother's skin blotched purple with extravasated blood. Her mother had decided to keep living. A brave woman they said. A cure, her mother had boasted. But the payment for that cure had been too high.
Cookie paged her boyfriend who was a sixth year resident in thoracic surgery.
Jav met her in an empty patient room on the Pediatric floor. Down the hall a child screamed as the IV team tried to find a vein, and Jay hunched his wiry shoulders and grimaced. His thin face looked pinched with strain and fatigue. "I can't stay long," he said, reaching for her neck almost before he had planted his feet. "Dawson is on my
back about yesterday's double bypass. We had to go back in for a bleeder. And the guy's family went berserk, even though he did great afterwards." He frowned and pressed upwards. "Put your chin down." Cookie watched his eyes, focused, intense. In bed, his gaze was softer. There was no intimacy now. "OK, turn to the right a little." She waited, holding her breath. "Yeah, I definitely feel something. And it doesn't hurt?"
"Maybe it's a lymph node," she said, wanting him to hold her.
"I suppose." Jay sounded doubtful. "Look, phone Gross. Page me later and tell me what he thinks. I can't leave the hospital tonight; I've got to deal with the new interns. But we can have dinner in the cafeteria. I'm sure I can get free for half an hour." He looked at his watch, and kissed at her, his lips barely brushing hers. Cookie started to cry. "I've got to run. Don't worry," he said, opening the door to leave. He didn't say the word they were both thinking.
Although Gross agreed it was probably a lymph node, he got Cookie an immediate appointment to see an ENT guy. McAndrews was a tall and hearty, red-faced man in his forties with a thick southern accent. When he bent down over her, Cookie smelled pungent after-shave lotion and juicy fruit gum.
"Ex-smoker," he explained about the gum, as he prodded Cookie's neck and jaw with large well-manicured fingers, all the while humming to himself. It sounded like the Anniversary Waltz. McAndrews shook his head and stopped humming. He frowned at his resident who was dozing over a pile of charts. "Rod! Get a feel," he
barked.
Startled, Rodney jumped up and knocked a chart to the floor. Cookie wondered if he were as sleep-deprived as Jay. Did McAndrews give him a harder time because he was black?
Rodney closed his eyes as his fingers probed Cookie's neck under the jaw. His skin looked richly chocolate against the crisp whiteness of his hospital jacket. The closed eyes and gentle pressure reminded Cookie of a former lover who had seemed always to be dreaming of someone else as he caressed her. She tried to think instead about the chart on the floor. Was it hers? Did it feature snide comments by Gross about her lumpy breasts? Her emotional lability?
"So?" McAndrews asked, giving Cookie a broad, reassuring smile. "Probably nothing, right, Roddy? Want to try her on Keflex for a week and see if it goes away, or do you want to operate?" He winked at Cookie, as if they were colleagues testing Rodney's medical acumen.
Rodney said, "Let's wait."
Cookie said, "So there is something'"
McAndrews shrugged, still smiling. "Who knows," he said. "Look, a week one way or the other won't make the slightest tiny bit of difference. Maybe save you an operation, maybe not. You can never tell. Write her a prescription," he ordered Rodney. Turning back to Cookie, he said, "See you next week," and waved his hand as he walked out of the examining room.
Cookie felt tears rise again. "What do you really think, Rodney?" she whispered, as soon as the door was closed.
Rodney directed his analysis to the prescription pad. "Well, it's not matted down to anything, and it's pretty soft-feeling. On the other hand, there's no tenderness or redness, no sign of infection. I don't think it will be any different in a week." He finished writing and ripped the prescription off the pad. "Call me if you have any problems," he said, handing her the prescription.
Cookie got through the weekend by first finishing her review on Rocky Mountain Spotted Fever, then rereading most of Rasselas. Even as she laughed, she thought it was a little late to be choosing the best way to live one's life. Is there any point in calling Dad? What if he says it's a judgment on me? That I'm getting the punishment
I deserve. The great cancer cure commuted into a living death. A blood clot in the brain. A stroke. He'll drag up the whole business about not moving to Chicago to keep Mommy out of that awful nursing home. Why was I supposed to be her nurse? She doesn't know where she is anyway, so what's the point? Was I so bad?
You abandoned her, she told herself. Maybe her mind still functions, even though she can't talk. Maybe the neurologists are wrong and she understands more than anyone thinks. Does she realize that nobody is there with her? Does she know that everyone has written her off, that we have all deserted her?
Cookie patted her neck several times each day to see if the antibiotic was working. In the pediatric clinic, she acted as if nothing were wrong, maintaining her usual calm attentiveness as she focused on feeding problems, constipation, bedwetting. She was full of cheerful advice about school phobias and temper tantrums. The clinic nurses surprised her with a birthday cake. She blew out the three candles, one for each decade, imagining how their startled eyes would dart away from her with embarrassment, if she said she might never have another birthday.
At home when she cried, her collie Zora whined anxiously and nuzzled her hands. "You're the only one I can talk to," she told the dog, enjoying the feel of her wet face against plumes of golden fur. Enjoying the feeling of having been misjudged by her father, thinking how anguished he would be when he found out. How remorseful.
Jay was too exhausted to help her, too worried about his patients, his mistakes, the attending doctors. Dawson, still fuming about the guy who bled, had berated Jay during the weekly Morbidity and Mortality Conference.
"He humiliated me in front of everyone' All the new interns, the attendings, nurses, everyone! How can they call it a teaching session? So what if we had to go back to tie off a bleeder! It's not as if I'm the only one ever to screw up sewing a graft."
At last month's M and M Conference, Jay had condemned one of the interns for giving the wrong antibiotic. Cookie didn't remind him.
Jay thought only about work. Surgery and sleep. He hardly had the energy to make love anymore, and when, Cookie asked herself, were they going to find time for a conversation about that? At night he either dozed in front of the TV, or else he ran back to the hospital to help deal with victims of multi-car pile-ups.
Cookie spent her evenings filing the journal articles that lay in untidy heaps on the floor. She went back over her checkbook and found the error that had been annoying her for months. She organized the mess of scarves, gloves, and sports shoe's in the hall closet. Tennis, running, racquetball, aerobics, none of which they did any more. Still full of energy at midnight, she took Zora jogging, even though Jay had warned her not to run after dark.
On Thursday after supper, Cookie couldn't find her old Judy Collins LP with the whale song.
"Jay, what did you do with it? I've asked you a million times to put my records back in alphabetical order. Don't you ever listen?"
"Cookie, just leave it, " Jay said. He stalked out of the room, and turned on the TV in the bedroom.
Cookie was incensed. She decided to reorganize her CDs, and began to put them in piles according to category. At ten, she heard Jay get up to brush his teeth and then get back into bed. He won't even come out to say goodnight, she thought. She lay on the living room couch, stubbornly waiting.
In the morning she awoke stiff and chilly, despite the comforter that Jay had thrown over her before he left for rounds. She paged him midmorning after she saw McAndrews in the clinic. Rodney had been right. There had been no change in a week. Still cheerful and reassuring, as though she were a fool. McAndrews scheduled surgery for the following Thursday.
Jay decided that they both needed to get away for the weekend. "Things can't get any worse," he said. '''Now the bypass guy's lawyer wants to read the op note. Maybe I should look for a dermatology fellowship. Let's go to the coast and hunt for that bird you're always talking about."
"You mean the pileated woodpecker? But you can't just find a bird in the middle of winter, a rare bird like that."
"I don't think it's so rare. Anyway, it will be a quest, like Bill is always saying," Jay said. "To take your mind off things."
"My brother!" It sounded like a curse. Another one who hadn't forgiven her. If he was so anxious for involvement, why hadn't he moved to Chicago? A hotel manager could surely get a job anywhere. Why did everyone always assume that she was free to pack up and leave whatever she was doing, that she would take charge of their problems? Why did it always come down to her? She pictured her mother, a tiny mound pushing up against a spotless white sheet, mindless, waiting for death, her family bickering over who would do the least.
Cookie drove, Jay slept curled up in the back, and Zora, in the passenger's seat, watched for other dogs. Every time she spotted one, she jumped up, ears alert, tail twitching. Cookie gave up telling her, "Sit!" In Edenton, they sneaked Zora into the motel room and left her while they ate a greasy supper of fried oysters and hushpuppies at Captain Ed's. When they fell into bed, Jay was grateful, Cookie supposed, that she claimed exhaustion. Neither of them had any trouble sleeping.
In the morning a pale sun shone faintly through clouds as they walked to the pier.
When she looked through her binoculars, Cookie was startled to find that she had double vision. She squinted at a shrimp boat far in the distance. With the binoculars, she saw two boats side by side, the image on the right a little sharper than the one on the left. Without the binoculars she could barely see the boats against the gray sky. Everything close appeared normal. She lifted the binoculars again and trained them on a gray house near the water. Two images overlapped, the one on the right still better defined. Without the binoculars, there was no double image. This isn't a migraine, she thought. It's in my brain. The cancer has metastasized from my neck to my brain.
She tried to remember the neuroanatomy she had learned. Saul Lipshutz, the chief neurologist at her medical school, did such brilliant neuro exams that he could pinpoint the exact location of any brain lesion. Skills retained from the old days before MRIs and CAT scans. No matter how thorough she thought she had been, he would always find something neglected: "You mean you never did the red glass test!" or "What do you mean. you never tested for apraxia? Second-raters. You'd better get your act together before you kill someone." Cookie had lost her confidence very quickly on that rotation.
Lipshutz would know where in her brain the metastasis was. She watched herself point her right, then left index fingers at a nail that protruded from the top of the fence. Her arm was still steady. Then, she tried walking, as if on a tightrope, to see whether her balance was OK.
"What on earth are you doing?" Jay asked.
She had forgotten he was there. "I think I'm seeing double," she said.
"What?"
"Double. I see everything double."
Jay, his widened eyes showing white above the gray-brown irises, opened his mouth as if to speak, swallowed and began again, "What are you saying?"