Dr. Goldfarb is small in stature, with a presence you could call contrived. I sense a method to this meekness, developed as a professional tool. Goldfarb’s non-threat has dynamic magnitude. I suspect issues here that warrant process and a sincere willingness to work through this thing with a reach inside for feelings. In hindsight Goldfarb frames up as an effective distraction; the moment casts him otherwise, as a sniveling nuisance.
He eases gently to the sitting position as I address our concern, as requested. That is, we went out for a few beers two days ago and now face brain surgery. My wife has been repeatedly injected and drugged with very little explanation. I ask him how hard it is to recognize people like us, who will not subscribe to a foreign regimen on pain of death. I tell him the staff seems rational, but the momentum is rough, maybe not like an inquisition, with satanic relations proven, but with similar pressure to confess. I tell him that we are processing a severe paucity of reasonable dialogue, and we only want a few answers and to participate in the decision making process before it happens, not while it’s happening, which has been the woeful case—or worse, after it’s happened.
“I have to tell you,” he begins. “You’re doing things that are making everyone here quite upset.”
“Things? What things?”
“Like sitting up. Or walking to the bathroom. Don’t you know these things can raise your blood pressure? Even little things like that can be traumatic.”
“What do you call a medivac helicopter ride? A walk in the park?”
“Well, yes, I suppose that could be traumatic too, but those people are experts.”
“You say that could be traumatic, but I sense an air of condescension here. Have you experienced the medivac helicopter?”
“I’m so sorry that came out wrong. I don’t mean to condescend or to humor you. I apologize. I only meant that the helicopter crew are very experienced.”
“Experience is not the issue. If someone dies in the helicopter, are these guys likely to admit that pressure change or turbulence was the cause of death?”
“I believe they would, if that was the case.”
“Have they ever lost anyone to pressure change?”
“They have not.”
“Bingo! Don’t you get it?” He is now hurriedly taking notes, getting it, I’m afraid, in a context other than the one intended. Still, I pursue. “Do they know about volume exchange and pressure gradients and Eustachian tubes?”
“Well, I’m sure they do—”
“You’re sure? That’s presumptuous. You’re coddling me again.”
“Well, yes, it is. I mean . . . presumptuous. I’m so sorry. I don’t mean to—”
“And what about that cunt from India who yelled at me because I asked too many questions?” This is from Rachel, which makes me laugh, because I can’t help it.
“She yelled at you?”
“Oh, yeah. She said I was wasting everyone’s time. She said I was a fool to worry about my hair, because it was coming off anyway, and don’t worry, they save it in case the mortician needs it to make me look good.”
“She said that?” I ask.
Rachel nods.
The shrink and I share a moment of disbelief. “What about that? It sounds on the surface like this doctor is bringing her own unresolved problems in here when we’re trying to understand something.”
“I’m sorry about that. Your complaint has already been filed.”
“By whom?”
“By staff.”
“Are we to presume that staff got the complaint right?”
“You’re going to have to trust us. You know that, don’t you?”
“I’m trying my best. In fact, I’m willing to give this hospital an A+ on technical proficiency. That’s presumptuous too, but I want to go along. The problem is, you get an F on presentation. How can we feel good about this when we’re surrounded by smiley-faced students assembled to witness the death and morbidity disclosures? Do you know how many times we’ve been assured that Rachel might die or go morbid in the next thirty minutes? This process is thick with legal defense that undermines our confidence. I think legal defense is procedural here and it derives from policy, which derives from politic. The political function of the AMA is to safeguard its members from legal action. That’s fine. Who doesn’t want to cover his own ass? We have been led to believe that something may go wrong and often does go wrong, but those things happen mostly to those people less healthy than us. We felt on arrival here that we’d be better off with alternative treatment, and for two more days we’ve felt correct in that assessment, because we could not get a case made otherwise. All we got was assumption, presumption and tour de force, until I got word from Florida. On the phone, from three thousand miles away. Before that, we were expected to accept all the products and services you have to sell here for our own good, because you say so. We got excellent service, but it felt like the bum’s rush followed by death and morbidity. I’m sorry too, but that’s not the nature of a healthy system. It’s like knowing what kind of car you want to buy and having a good idea of where you want to buy it, and then you go down to the dealer, and the first thing the salesman says is, ‘Okay, here it is, now give me a check.’ What do you do, pay up? This isn’t a car lot, is it? But you do have your customers by the short hairs. All we need is some straight talk, and look at you, taking notes on the most obvious truth in the world. Look up for Christ’s sake. You don’t need to write anything down. It’s written on the walls! We don’t have a problem. You do.”
“And they want to shave my . . . thing. I mean, not my . . . thing. You know . . .”
The little fellow is taken aback by my emotional display and Rachel’s blubbering, but he hardly slows his note taking. He nods vigorously, prompting for more. I have more, but the curtain opens on a Chinese woman, who enters saying she is Dr. Hsu. “I’n Dot-ta Shu. Speet Patorogy. I wou rike to talk witchou. Hokay?”
“Dr. Shu?” I ask. She nods. I ask, “S-H-U?”
“No. Ah H. Ah S. Ah U. Is ah Chinee, you know, so we sperr diffalent.”
“Ah. Dr. Hsu.”
“Uh, Doctor. Please forgive me, but I’m Dr. Goldfarb, and I’m conducting an interview here. Do you mind giving us, say, twenty minutes? Would that be okay with you?” I think Goldfarb is miffed, suffering interviewus interuptus, on the verge of witnessing my volcanic eruption with clinically historic and potentially legal significance, which could prove ironclad for the defense and put a feather in his cap with a possible promotion, perhaps, someday.
“Ah, yes. But ah, may be I stay just, ah, ten minute, ask question. Then I go, and you ploceed. Yes?”
“I need about twenty minutes here, Dr. Hsu.” Goldfarb is up with bold assertion in a three-meter pace, one lap and back down. “Make that thirty minutes. All right?”
“Ah! Hokay. Thuhty minute. Fust I ask, ah, tell me, do you hab speet pahrem?” She addresses this question to Rachel.
“What?”
“Ah, do you hab speet pahrem?”
“Do I hab speet pahrem?”
“Speech problem, goddamn it. Do you have a speech problem?” I’m laughing, can’t help it. Rachel laughs too, it’s so rich and so clear.
“No,” she says. “I don’t think so. Do I sound bad?”
“Ah, no. No, no. I come back. Hokay.”
She leaves, giving Goldfarb proper pause to reach inside his mental sensitivity for some sensitive mentality. “Tell me something.” He strokes his chin and thinks. “Do you feel . . . Okay, scratch that. Do you think . . . Do you think that we . . .”
But the curtain is swept again. It feels routine now, on a small stage, like Vaudeville. What an act. But the new arrival is a relief to all parties; we tired of analysis so soon, and Goldfarb was so lost in the script. “Hi. I’m Rebecca Nimmins, patient liaison. You have some questions?”
“Yes, we do,” Rachel says, and asks again what she’s asked four times already, about the length and placement of the incision. Nurse Nimmins
steps forward more slowly than the others who answered this question in the last two days. She has no witnesses. We like her movement and her smile.
“Excuse me, Nurse Nimmins. I’m trying to conduct an interview here. I need, say . . .”
“I’m so sorry,” she says. “I was sent by Dr. Luze. He’ll be here in five minutes and wants all their questions answered beforehand.”
Goldfarb sighs.
“It’s all right,” I tell him. “We’re done with the psychological profile.”
“You’re done?”
“Yes. This is a simple situation. We shared our view of it with you. You’re the first one who’s listened. Thank you. Now we’re done.”
“I see.” He moves to make a note.
“Good.”
“Excuse me just for a minute, but you know, I’m going to make a recommendation here.” We wait. “I’m going to recommend two signatures on the surgical consent forms. You’ll need to sign those, you know.” He is addressing me.
“You haven’t been listening, have you, Goldfarb? Here we are pissed off as bees in a bonnet, sharing our frustration with you, and all you can do is go along like you understand and then turn right around with more of the same. That’s rude, which is much worse than condescending.”
“I . . .” But he turns to Rachel. “I know this is very scary for you. This is horrifying for you—”
“Cut! Cut! Cut! Who do you think you are, standing here telling her she should be horrified? Do you know what you’ve just said? That’s what I profiled for you as the source of our problem here. So what’s the first thing you do but repeat the offense?”
“That’s validation, Mister.”
“That’s masturbation, Mister. You want to come in here and tell her she’s looking good and doing great, okay. You’re welcome. But preprogramming for fear is exactly what’s wrong here, and we won’t accept it. Furthermore, we’re already resigned to surgery, and frankly we felt better about it before you got here.”
“Look, I want to continue this dialogue. I’m going to recommend two signatures.”
“Dr. Goldfarb, are you now or have you ever been in contact with the legal department?”
“What does that have to do with anything?”
“You’ll get one signature. That’s all you need. I’ll stay clear and apart. If you press me on this or come back with more horror, I’ll sue. If the surgery isn’t scheduled on time, I’ll sue. If Rachel walks out of here without a surgery, I’ll sue. Do you get the picture?”
“You’re a very difficult man.”
“Bingo.” I turn to Nurse Nimmins, in whom I sense care giving of a different cut. “That’s the thing about this place. You take Goldfarb and me, both students of human behavior, human drive and need. But if we met under different circumstance, I wouldn’t want to sit down and have a beer with him. I wouldn’t want to hear what he has to say, because it’s all apology as prelude to further advantage. It’s like all those years of medical school were spent learning strategy.” I speak of Goldfarb in the third person because he’s gone. I overhear him in the hall, on the phone, debriefing on profile and intent. He refers to her and him, speaking with the legal department, I think, but I don’t care.
I’m right about Nurse Nimmins, who conveys all the time in the world, whatever it takes. She’s been to Hawaii and has personal interests of her own. Moreover, she understands that a five-percent annual chance times a million years is still a five-percent annual chance. The error comes from those who compile the front-end statistics. She explains the part of the printout from the Columbia University Neurology Department that Sue pulled from the Internet. The meaning I took from it was that all those people declining the surgery, if they were Grade I or II, with coherence and consciousness intact and only mild speech impediment, actually faced only a one in five chance of mortality.
No, again, she explains; this paragraph actually reiterates in better terms the five-percent concept. It further relates to the first six weeks following the bleed, in which most mortality occurs.
She is with us twenty minutes when the curtain opens on a woman who strolls in with another entourage. They circle the gurney and smile blissfully. “I’m Theresa. Dr. Smythe.” Theresa is early thirties but doesn’t exercise. She will administer the anesthesia. Her face is sweetly sad and tediously resigned. She recites the stats on death and morbidity that we’ll face tomorrow during administration of the anesthesia. The entourage smiles blissfully. “You’re scheduled for another angiogram this morning. You’ve been told what that is, and you’ve already had one, but I’ll tell you again. We go up from above the femoral artery to your brain, this time with radioactive dye. We’ll give you a local anesthetic for this procedure, and it probably won’t hurt you, but I have to tell you, you could die from this procedure. We’ve had people die during angiogram.”
“What about morbidity?” I ask.
Dr. Theresa Smythe turns slowly my way and just as slowly nods, not in confirmation of morbidity but in sizing me up. “Yes, you could sustain morbidity in angiogram as well. But we can’t be certain if the angiogram procedure would establish a cause and effect on the morbidity without . . .” She pauses, stopping short to keep from stepping in it.
“Without an autopsy? You know we’re really sick of this shit.”
“Of course you are. Have a nice day.” They march out with most of the blissful entourage showing dents in their idiotic smiles. Nurse Nimmins shakes her head.
“All these young folk,” I say, “calling themselves doctor. I’m not only unimpressed. I’m offended. These kids are way too full of themselves to be effective in the clutch or to know when to back down in the clutch. Whatever happened to humility and experience?”
“Your surgeon is that. Lawrence is the best. That’s where it counts. You have to understand, this is a training hospital. That’s why we have so many students. You’re right. But they don’t get next to the real procedures unless they’re very good.”
“I’m going to take a nap now,” Rachel says, gently closing her eyes. My skin tightens. I look at Nurse Nimmins, who looks at the monitors and then at me with a nod. It’s only a nap.
She whispers, “I’ll be back.” I ask how we can staunch the traffic. She nods and leaves, and the curtain remains undisturbed. I nod off as well but awaken every few minutes. Rachel sleeps so peacefully. I tense in the moments it takes to ascertain her breathing. In a while we both sleep. In another while the curtain opens again for Dr. Hsu, who tells us in her labored way that we will need speet patorogy after suhgely. This is nolmar, she says. We agree to everything, and she leaves, holding the curtain open for Sue, who has waited in the wings. I must tend to the dogs, take them for a pee and then take them home, back to the other side of Puget Sound.
“The dogs?” Rachel asks. “Where are they?”
I rehash the events of last night for her and assure her the dogs are fine. But I must go, if Sue can stay. The round trip will take me four hours. I’ll make some calls on the way, to see if I can line up a house sitter. If I can’t, well, we’ll see.
An hour later I’m on the ferry with the dogs. I phone the ICU and get patched through. Rachel is gone. “What!” Gone to get her second angiogram.
Sue left soon after because, “There’s nothing really you can do.” Rachel will be back up in ICU in two more hours, or three.
I think only of logistics; otherwise I drift to what-ifs and the system clogs. I don’t have Pamela’s number but I know she works at the pizza place near the house. She’s in, but she’s already house sitting, but she knows three other women who might be available. If not, don’t worry. She can come by morning and evening to feed the dogs and cats. I can’t help the angst of imagining Dino and Molly in the cold and rain, outside all night. Another casualty could overload the system.
I arrive home to find the gate on the ground. It was broken last week by the mail carrier who tried to open it with her Jeep. Now it’s fallen off the hinges, and though I can w
restle it back into place, it will need metal sleeves perpendicular to the through-bolts to keep the hinge pins vertically secure. I can cut the sleeves from ¾” pipe, available up the road only twenty miles at Home Improvement World.
I cannot doubt the wisdom of this errand nor challenge the tedium, nor can I hesitate. The gate serves no greater purpose than to keep the dogs alive, so I go, too easily imagining the impact of a death trifecta. No, first I stop and let the dogs pee and put them inside, but they cry and bark and whine, so I let them back out and into the car because dread and chaos is theirs to share along with the boredom of days on end, indoors. Now we go. They and the car whine for attention.
They want to go in with me but I tell them no. And stay. You stay. I stop at the espresso stand out front for a coffee, my first in two days. Or is it three? Or was that only yesterday? Never mind; I’ll make this quick.
But once down aisle 23, I’m told that plumbing fixtures are on aisle 72, which is a fur piece in any country but could require navigational charts and a compass at Home Improvement World. Aisle 72 is not where it should be but way back to the southeast, from where I just came. Or did I enter there, to the northwest? I finally find a friendly clerk and get rerouted to conduit, which is what I needed all along, which is not aisle 72 but is back by the nursery, where aisle 111 will eventually be, once our expansion is complete, and homeowners can improve even more.
This is not the time to draw unsettling parallels between a medical industry outrunning its headlights and a building supply store with matching chaos and overload. I think I’m tolerating things reasonably well, considering the barrage of this place. Traffic jam and franchise foods clog the perimeters, inside and out. You can stop for a snack on your way to aisle after aisle of stuff in bulk. My wife is in a bunker with optic fibers running from her femoral artery through her heart to her left temporal lobe. The mail carrier triggered this—but not really. The mail carrier only facilitated a propitious timing, in which Rachel and I could slide down the rabbit hole to a place of . . . healing? I feel helpless and resentful but wonder what anger will accomplish. And what sense does it make anyway?
Brainstorm Page 11
