Death in the Polka Dot Shoes

by Marlin Fitzwater

  “I got the pictures back yesterday,” she said, shaking the folder to indicate I was about the see them. “And the doctor says I have a meningioma, which is some kind of tumor in the brain. She wants me to go to some kind of brain surgeon immediately to talk about an operation. Will you go with me?”

  “Of course, Martha,” I said, adopting her formal name, I guess to signal I took this seriously. “I’ll be glad to go. Do you have an appointment?”

  “Tuesday,” she said.

  I couldn’t think what to say. The questions were there, but I didn’t want to say anything insensitive. The thought, Martha is going to die, ran through my mind. Then incomprehension. How could this be happening? She didn’t look or act sick. She never complained. There must be an explanation, or at least some confusion.

  “What do the pictures show?” I asked, assuming she brought them to be shown.

  Martha bent the clamp on the folder, and pulled the negatives free. I held the top one up to the light and could see about ten different views of her brain, but what they meant was blank. Martha moved next to me on the couch, and started to describe the MRI.

  “This is the brain part,” she said. “And you see this dark area, like a hole of some kind, that’s the tumor.”

  I almost gasped. The tumor ran from her neck to the top of her head. It was the whole center of her head. I kept staring at each picture, hoping somehow that the angle would change, and the picture would change, that it would be smaller from the back, or the side. But it wasn’t. I just stared, trying to think how to ask the most devastating question; she looked at me as if judging my reaction. I wondered what bravery looked like in this situation; how would tears look. My God, she must be scared. I’m scared. But she only looked sober, frightened by the unknown. Then she said the only negative thing she ever said about the whole situation.

  “I always thought you would go first.”

  It was the kind of thing a wife might say to her husband, and I suppose I was a surrogate husband. How could this happen? I thought of my brother. Two catastrophic deaths, unexplainable and unfathomable, to a husband and wife in the same year. What had our family done to deserve this?

  “The doctor said she thinks it’s meningioma, which usually isn’t cancerous, but we need to see the neurosurgeon as soon as possible,” she said. “That’s Tuesday.”

  I noticed the change to ‘we’ in her language. It felt comfortable, and I was glad to help share her load, although it raised so many questions. What about Mindy? Regardless of what this was, who would take care of Mindy? What would be my role? I felt ashamed of that concern, ashamed that I would think of myself.

  “Let’s not try to speculate about what we don’t know,” I suggested. “Let’s go to the computer, learn all we can, and make a list of questions for the doctor.”

  “OK,” she said, and began to slide the negatives back in the folder. She put her arms around my neck and held on, for dear life, as my mother used to say.

  The office of Doctor Robert Noon seemed a little spartan for the man who was going to save Martha’s life. I guess I expected a modern high rise with large glass windows, modern furniture, and a larger than life feel, as if this indeed was the office of the savior. But Dr. Noon’s outer office was small, with a leather couch cramped in one corner, a receptionist behind a six-foot counter, with metal files behind her. The doctor’s inner office was a mirror image. The only thing oversized was Dr. Noon, who stood about six feet three inches tall, with large puffy fingers, and a huge belly that hung over a wide leather belt, and left little doubt that this man either drank or ate a lot, without remorse. My immediate reaction was: how does he hold a scalpel, and how does he get close enough to the operating table to work? But he was friendly. He welcomed us to two captain’s chairs in front of his desk, and said he had been called by Martha’s regular doctor with a briefing on the MRIs. I had trouble concentrating, in spite of the seriousness of the moment, because I couldn’t resist the yellow post-it notes stuck all over the walls, the sides of his desk, the window ledges, and any other spare location. I was surprised he didn’t have some stuck to his belly, a sizeable oversight. Most remarkably, even though some of the yellow post-its were only a couple inches square, every one had some kind of scull drawing with a brief note. I couldn’t tell how he kept the patients identified, but maybe the little yellow slips were just educational and not supposed to be patient specific. Honestly, most brains look alike. So I forced myself to turn back to the doctor, who had taken the MRI pictures from Martha, and was sticking them on back lights behind his desk. Under this intense light, the tumors lit up like Christmas bulbs in row after row of brains.

  Dr. Noon explained that meningiomas are normally hard, encapsulated tumors that grow slowly, and seldom are malignant. That was the good news. Unfortunately, they are also very hard to remove, often entwined with nerves that affect various parts of the body, and can be fatal if severed. Noon said Martha’s tumor was extraordinarily large, and probably had been growing very slowly for fifteen or twenty years.

  “Is that why I didn’t have any symptoms?” Martha asked.

  “Probably,” he said. “I’m surprised you haven’t had balance or hearing problems.”

  “I have,” Martha said, looking at the floor. “I just never said anything.”

  Noon was direct but sympathetic. “Well,” he said, “here’s the problem. I think I’m a very good surgeon, but I know I’m not good enough to do this operation. That’s the difference between most surgeons, you know. Those who don’t know their limitations.”

  “What if we do nothing?” I asked.

  He focused directly on Martha. “It will kill you.”

  “How much time?” I asked.

  “Soon,” he said. “Maybe within a couple of months. You see, this tumor has grown so slowly, that it has pushed the brain nerves back into the head without causing them to react. But now there is no more room to push. And as the tumor grows, it could hit the nerve at any time that could kill you, or paralyze you, or make you go blind, or do something else.”

  “Who can we go to?” Martha asked. She was remarkably stoic; no tears, or screams, or expressions of fear or even exhaustion. She just wanted to know how to get rid of this problem.

  Noon looked at the ceiling. “I tell you,” he said, “I only know one doctor who could do this. Nablani in Philadelphia.”

  “Who is he?”

  “Meningiomas are all he does,” Noon said. “He used to be chief of neurosurgery at a big hospital in New York. But they weren’t rich enough to buy all the equipment for brain work, so he left for Philadelphia. They promised him the moon. He’s writing a book. And every day he does this kind of surgery.”

  “What about other great hospitals: Hopkins, Mayo, others?” I asked, thinking it might be good to find someplace closer to home.

  “They are all good hospitals,” Noon said. “But do they have the doctor who can do this? I don’t know.”

  “Give us the three best hospitals or doctors in America to do this operation,” I said, a bit more aggressively than I intended, especially if the answer was in Los Angeles or some other distant location.

  “I only know two,” he said. “Nablani and the Ward Institute in Austin. They only do meningioma and they teach it to other specialists. You should get some copies of these MRI pictures that you can send to other hospitals.”

  I couldn’t think of any other questions at this point. It was clear that we were on our own. Perhaps Noon could sense that we were starting to feel the loneliness of the search ahead.

  “I have phone numbers which I’ll give you,” he said. “But I should add one thing. All of these hospitals you go to may tell you, ‘Don’t go to Nablani.’”

  “Why?” I asked quickly.

  “Because Nablani only cares about the operation. He takes risks the others won’t take. He has no bedside manner and you may never see him again after the operation. But I still think he gives you the best chance.”
/>   After a long pause, he said, “Good luck. And if you run into questions along the way, call me.”

  Martha and I walked out of the building in silence, climbed into the car, and simultaneously let out a sigh of exhaustion.

  “I’m so sorry,” Martha said. “That I had to come to you, Ned. I don’t know anybody else that could have handled that conversation. Let’s go home.”

  “And start contacting hospitals,” I added.

  The first person I called was Vinnie. I needed to tell someone about Martha, just to get the feel of the words. Saying it made it real. I had experienced this same phenomenon when my brother died. One can understand a car crash, when the twisted metal is there to witness or a long illness when the effects of disease are evident in appearance. At least there is some time for preparation, to think about what is happening. But with murder, or a brain tumor, there is no time and no rationale. So talking it through was necessary, at least for me. And Vinnie seemed like the perfect candidate. He might even have some perspective, or some experience, that would be helpful.

  Vinnie wasn’t home, but I found him at the boat. It was evening, and red sky left its warm glow on the deck of the Martha Claire. She had been delivered back to her slip by the Marina only yesterday, completely retrofitted following the sabotage. She received a new engine, a 345 horsepower diesel, and all new electrical wiring. Her old wooden body looked as good as new, with a white paint job that sparkled in the sun, probably brighter than it ever would again. With the first rubber boots that set foot on her deck, the ageless deterioration process would begin again with crab pots, and buckets, fish guts, and crab claws, and hundreds of other appearances that scrape and scar a boat. It was a rebirth that seemed slightly incongruous in view of the human events of the day. It made me sad that people can’t be put back together quite as easily.

  Vinnie was arranging and rearranging the fishing rods that hung from the cabin ceiling. The deck was clean and empty of crab pots. I had a couple of white plastic chairs, the kind that most discount stores sell for seven bucks apiece, stacked near the engine.

  I climbed into the stern, and separated the chairs for Vinnie and me to talk. Watermen often sit in the back of their boats, just to think and survey their world, sometimes to have a drink of bourbon, or ponder their problems. Vinnie heard me hit the deck and he turned away from the cabin to say hello.

  “Hi Ned,” he said. “How did things go with the doctor?” I had told Vinnie I was going with Martha, and the broadest outlines of why. He could take the boat out by himself, or try to find a mate, or not go at all. I left it up to him. It turned out he did go crabbing in the morning, caught several bushels, and returned to the Bayfront early afternoon.

  It took me about forty minutes to spill the whole story to Vinnie, including descriptions of how I felt about the situation.

  “Vinnie,” I said, “I feel so close to Martha, certainly like family. She is, of course. But I never felt this close to her when Jimmy was alive. But now I do. I have to take care of her Vinnie, to get her through this. I don’t know if she’s going to die. I don’t know anything really. I suspect we’re just starting down a long road together.”

  “How’s she holding up?” Vinnie asked.

  “I can’t tell. Too early,” I said. “It will take her a while. But I’m sure she has already thought about dying, and about the welfare of Mindy. Beyond that, I don’t know.”

  “How can I help?”

  “Vinnie, the first issue for me is the boat. Martha doesn’t have much time, so we have to start now to find a doctor, a hospital, and a place for Mindy. I would like to just put the boat on hold, shut down the law practice, and deal with this problem. Would you like to run the Martha Claire yourself? I’ll take ten percent for expenses. You can hire your own mate. Just run it like you own it.”

  “How long?” he asked.

  “That’s the hard part. I don’t know. But let’s figure two months at least.”

  Our first hospital was in Philadelphia, a large teaching hospital with a celebrated neurosurgery department. It was recommended by one of the partners in my old law firm. I discovered that as people found out about Martha’s condition, everyone seemed to have a recommendation, perhaps a family experience, perhaps the name of a doctor they had read about or seen on television. We couldn’t figure out how to judge these things. In addition, if one doctor was recommended, another doctor would say he’s a quack. There seemed to be significant jealousies and competition between doctors and between hospitals. So we made our own rules: we wouldn’t consider anyone who didn’t have three positive recommendations; work in a teaching hospital which meant they did a lot of operations; and be located near affordable hotels where I could stay, or Martha could recover if rehabilitation was necessary.

  The first hospital was modern and seemed quite efficient. We soon came to realize that the quickest way to judge a hospital was by their computer system. The best gave us a personalized plastic card with an identification number. If we visit the hospital a hundred times, all we had to do was show the card. As one nurse said, “You only check in once a lifetime here.” The most remarkable aspect of this system is that not every hospital has it. We immediately crossed those off our list.

  In Philadelphia, we were assigned a young neurosurgeon who had studied at the Ward Institute and specialized in meningioma. This made Martha feel some comfort.

  “I like the feel of this hospital,” she said. “And at least the doctor was trained someplace we have heard of, someplace that Dr. Noon has recommended.”

  The doctor walked directly to us, shook hands, and introduced himself. He took the MRI’s from Martha and invited us to follow him into a nearby conference room. He was young with a smooth southern draw, wore horn-rimmed glasses, and was thin enough for his clothes to hang straight with sharply defined creases. I couldn’t get over the fact that we were choosing a strange man, in a very short time, in a strange place, who would either save or lose Martha’s life. What if the very best surgeon was ugly, or cold, or arrogant or any of a hundred other things causing us to reject him? What if the doctor is warm and wonderful, but a terrible surgeon? We had already heard about several of these. There didn’t seem to be any way to ascertain competence, so we decided to consider recommendations, education and compatibility. It all seemed like a crap shoot anyway.

  It was beginning to be a ritual for the doctors to stick the MRIs onto a backlight and start their analysis. Remarkably, every doctor was different. The Philadelphia doctor was meticulous, moving from frame to frame, showing the size and location of the tumor. We had learned to wait patiently for the part where remedies were discussed.

  “Martha,” the doctor said sympathetically, “this is very difficult. This tumor is so large, that I expect the top half could be hardened, with some nerves inside the solidified area. The bottom half may be more liquid because it’s newer growth. I don’t believe there is any way we can remove the entire tumor… without threatening your life.”

  We were silent. The doctor stopped, letting it all sink in before starting again.

  “We might be able to put a shunt in your head and drain some of the spinal fluid off the brain. That would relieve the pressure and the immediate danger.”

  He stopped again. But Martha interjected, “How would that solve the problem? Would I just live with a drain in my head?”

  “For a while,” the doctor said. “But I think we could do a skull-based surgery that might allow us to remove the lower half of the tumor, the soft part. Then if it’s growing slowly enough, you could live with the other part remaining in place.”

  The reality was setting in that no one thought an operation could take this tumor out. But Martha pursued it. “What are the risks?”

  Now the doctor stopped. He paced back and forth behind the long conference table, looking at the MRIs from different angles, as if he might notice a crevice that would allow a different conclusion.

  “I would say this,” he began. “If
we assume an operation to remove just the soft part, there might be a twenty percent chance of facial paralysis, some droop in the right side of your face. Probably a fifteen percent chance of hearing loss. And probably a five percent chance of death.”

  That stopped us cold. I was on the verge of running through a laundry list of physical repercussions, asking for the odds on paralysis of the arms, or legs, or ability to talk. But the odds on death rendered all that moot. To me that meant a greater than five percent chance that anything could happen, and probably all involved wheelchairs and permanent disability. I looked at Martha and she was coming to the same conclusion. I felt the tears coming, welling up behind my eyes, driven by some emotional force in my body beyond control. I didn’t know how to turn it off, until I looked at Martha. She was without expression. That’s when I realized for the first time that she was far stronger than me.

  Within hours after we returned to Parkers, we heard from the Ward Institute. The doctor said they had received our MRIs and had studied them very closely. He wasted no time in going through their analysis and it was reassuring at least to hear their view of the problem was nearly identical to that of Dr. Noon and the Philadelphia hospital: a total operation couldn’t be done. But the Institute did offer two operations, a first to remove the bottom half of the tumor, and if that worked without undue damage to the brain and its nerve system, go back in two weeks for a second operation to remove the other half. The doctor wasn’t very optimistic for the second operation, but he said it was possible. He gave us the same odds on serious damage and death.

  I found this “odds” business very strange. It’s one thing to come to terms with death, but quite another to calculate the impact of blindness, or a drooping face, or hearing loss in one ear. In many ways a five percent chance of death is much easier. It’s all or nothing. At least it was in my mind. I suppose you could live and beat the five percent odds, but still be blind or deaf. But once you get home, the doctor isn’t there to ask about all the possibilities of the numbers. I wondered, for example, the odds of surviving the operation, going blind in one eye, and then the tumor returns in a few weeks to start the whole process again. What would be the odds of that? So I just assumed that death met death, and life met life, good and full and long lasting. But I knew that wasn’t true. Nothing is ever that clear cut. And I should discuss it with Martha, but I decided to let her raise the issue. And I wondered how she could ever sleep through the night, with all these consequences running through her head. Strangely she never raised the issue. But the next morning she called to say, quite bluntly, “Let’s go see Nablani.”