Healer: A Novel

by Carol Cassella

  Claire borrows textbooks from the donated library Dan keeps on a shelf above their desks. After a rushed dinner, Addison and Jory play cards, or Jory improvises dance steps to Addison’s music (everything from Miles Davis and Nina Simone to Michael Jackson), while Claire studies, sometimes stuffing her ears with foam in order to concentrate over their noise. She focuses on diseases she’d only memorized for tests in school. Now she sees patients who carry inside them the medical legacy of the Third World, nourished in poverty, neglect and misguided folklore. From their rural villages and crowded slums they bring the parasites that thrive in their swine and river water, the viruses that multiply in their mosquitoes and lakes, the bacteria that bloom on their fruits and vegetables. They harbor the remnants of measles and mumps, the threat of tetanus and meningitis, the stalled growth of protein and iodine and vitamin deficiencies.

  Mixed in with the migrants are America’s working poor, too rich for Medicaid and too broke to buy insurance, who’ve ferreted out how forgiving Dan’s sliding scale can be. At least their problems don’t have to be filtered through a translator, leaving her to wonder—as she does with the Spanish speakers—why the words Anita says don’t match the look of pain or humiliation on her patient’s face.

  Procedures are even worse. She can’t relearn those from a textbook.

  “Patient in room two needs some labs drawn, can you get it?” Dan asks her at the end of a day after Frida has already gone home.

  Claire starts to say, “Of course.” She has drawn pints of blood, gallons of blood. Fourteen years ago. Is it a skill like riding a bike? Does one forget? He must see her blanch; the narrow crease ditches between his brows and he grabs a yellow paper gown from a box Anita has placed beside the door. “Put this on. This, too.” He hands her a white mask and pulls one over his own mouth. “Chest X-ray looks like TB.”

  He opens the door after a sharp rap and leans against the exam table, one lanky leg propped on the stepstool. He is limber for his age—Claire guesses he’s at least seventy-five, though the high desert sun out here steals years from anyone who doesn’t relentlessly shield himself. The paper mask looped by thin elastic bands behind his ears appears nearly inconsequential on such an imposing man, as if his height and composure could wither the potency of any stray bacterium hitching a ride on flecks of sputum.

  An elderly woman sits on one of the plastic bucket chairs. Her skin is the color of the unpolished copper cookware that used to hang above Claire’s Wolf range—not gold, not brown, not bronze, but some mottled blend of harvest hues, more an armor than a living organ. She has a knotted braid of gray hair at the nape of her neck, and when she smiles at Dan, Claire sees more pink flesh of gum than ivory of teeth. Her granddaughter, a child of four or five, squats on her heels in the corner of the room.

  Dan addresses the old woman in his blunt Spanish, asks her something about a Saturday night escapade; she laughs and calls him her novio. She fumbles in a colorful woven shopping bag and pulls out two bananas and several caramel-colored blocks wrapped in waxed paper, wagging one of the bananas at Claire until she comes over and takes it. Dan makes much of the gift and holds her dry, arthritic hands in his own.

  There is a moment of transition then. “Con permiso,” he says, turns one palm up and lays the first two fingers of his right hand longitudinally along her radial pulse while he counts with his head bowed, as if he could hear her heart through his touch.

  Claire watches, wishing she could make herself invisible. The woman wears a faded black housedress with a pattern of dots, belted at the waist with a length of nylon cord, and over that a loose-knit cardigan. Her breasts sink onto her lap with the weight of generations and the labor of her life. Her shoes are bent over at the back and her heels, leather thick and cracked, scrape against the floor. After a moment Dan turns to Claire and introduces her to Maria Solano. The woman takes her hands and clasps them together as if she were praying, murmurs something indecipherable. Her clouded eyes scan Claire’s face, taking in her hair and her earrings, staring at the pleated paper over her mouth until she slips one elastic band off her ear just long enough for the woman to see her full smile. She reaches up and strokes Claire’s cheek with the tough palm of her hand, says something to Dan that makes him laugh. He takes a pink plastic emesis basin from the cabinet over the sink. “Draw a CBC, liver panel and creatinine. I’m next door if you need me.”

  The basin holds three glass vials with different-colored rubber stoppers, a butterfly needle, tubing and a tourniquet. The woman smiles. Claire smiles back from behind the mask, then raises her eyebrows to intensify whatever eyes alone can express. The child clutches a Cheetos bag between her chest and folded knees and watches the scene wordlessly. Claire smiles at her, too, but the girl’s face looks frozen, either because she is shy, or totally absorbed with trying to figure out the mask. Without moving her eyes she plucks an electric orange Cheeto out of the foil bag and pops it in her mouth, shedding dust like bright pollen down her chin and shirt. Her grandmother breaks the spell with chattering Spanish, pulls a Kleenex from deep within her cleavage and passes it toward the child. Claire grabs a paper towel for the girl instead. “¿Más limpia?” she says, forgetting the word for germs. The old woman beams and nods, though Claire suspects she would do the same regardless of what Claire told her.

  Then she turns back to Claire and pushes up her sleeve, offering the soft flesh and fine blue veins at the crux of her right arm for the tourniquet and needle. “Aquí, mira, Doctora. No tengo miedo.” She smiles and stares at her exposed bare arm, seeming to will the flow of blood.

  Claire slips the tourniquet around the pendulous bulk above her elbow and seats herself on a footstool, legs planted square and firm. She searches for the words for ‘Make a fist,’ but only those for ‘hand’ and ‘tight’ come to her, so she emulates the motion and the old woman copies, nodding and watching for the veins to balloon.

  Claire also watches. She taps the antecubital fold with the ball of her first finger, flicks the nail of her middle finger against the woman’s skin where it creases like a worn flannel sheet. She rubs hard over the surface with an alcohol-soaked pad. Nothing appears.

  “Aquí es una pequeña vena. Casi aquí. No se preocupe,” the woman says, scratching at an invisible rivulet of blood.

  Claire slips on latex gloves and readies the needle, swabs once more with the alcohol wipe. Then she holds her breath and pierces the skin with the razored bevel. She gently pulls the plunger on the small syringe and watches for the flash of red. Nothing. She withdraws and re-angles and pierces again. And then again. The woman doesn’t move, but Claire feels her arm tense and then relax as she overcomes an instinct to flinch.

  “Maybe your hand is better. Tal vez en su mano,” Claire says, keeping her voice easy. She snaps off the tourniquet and ties it lower on the woman’s forearm. Serpentine veins rise across the dorsum of her hand, swollen with the back pressure of blood. These should be easy, visible and close beneath the surface of her splotched skin. Claire stretches new gloves over her perspiring hands; again, alcohol is swabbed, a fresh needle and syringe prepared. The woman watches her veins fill, points to one with her scarred index finger. “Esta es la más grande, verdad?” she says, and thumps it as if assessing melons in a vendor’s stall.

  Claire’s needle pierces the skin again, tougher here than at the antecubital fossa; the vein slips away from the probing surgical steel like a lithe snake, loose and untethered. Suddenly there is a flash of red in the clear tubing and she teases back the plunger on the syringe, advances the needle a millimeter more. The flow stops. A dark purple welt oozes through the subcutaneous tissues and the map of veins disappears below a tender bruise. Claire pulls the needle out and presses a woven cotton pad over the wound until the blood stops spreading.

  The woman leans across her bounteous lap so that her face is quite close. She squeezes her eyes shut and whispers, consolingly, “Lo siento, chica.” Then she pats Claire’s knee, lifts her other arm onto the
fold-out table and rolls up her sleeve, ready for Claire to try again.

  “Espérame, okay?” Claire says, and tapes a bandage over the puncture, drops the needles into the red sharps disposal box and stands up. The little girl stays crouched in the corner of the exam room, her eyes brown and deep as lakes.

  Claire goes down the short hallway until she hears Dan’s voice in a closed exam room; a red flag lets her know he’s busy with a patient. She lifts her hand to knock but hesitates, reluctant to interrupt, trying to think of a way to tell him that she can’t draw blood from a vein the size of a fat spring worm. She considers going back alone to try one more time, but the thought of putting that tolerant woman through more blind sticks is worse than any look on Dan’s face. As if he’d heard her poised fist, Dan swings the door open until it bumps up against his metal chair. He holds a clipboard with a history and physical form on his lap. Through the half-opened doorway she sees a woman’s feet, small, tucked into black ballet flats—the drugstore kind—like a pair of small black birds.

  “I’m sorry to interrupt. Do you have a minute?” Claire says, her voice filled with humiliation.

  “No blood, huh?” Dan says, scraping the legs of the chair against the floor to push it away from the door. “Remind me when we get our next million dollars to build bigger exam rooms, would you?”

  She grimaces. “I don’t know. If you keep me on staff you might have to put the money into a phlebotomist.”

  “¡Nueva doctora, una mujer por usted!” he says to his patient, a girl of seventeen or eighteen who is changing back into her clothes. She smiles and immediately opens a conversation Claire can’t understand.

  They are at Señora Solano’s door when Claire turns around and catches Dan standing still with his hand over his abdomen.

  “Did you eat anything today?” The question pops out of Claire just as she would have asked Jory, almost mixing up her caretaking roles. “You don’t have to stay. I can try again. It’s already after six.”

  Claire can see he’s worn out, but he smiles and says, “What? Did my wife call to put you up to that?” He raps on the door of the exam room where Señora Solano waits with her sleeve still rolled up and positioned on the foldout table. He pulls a string of glittery pony stickers out of his pocket, loops it around the little girl’s upstretched hand and squats down to whisper some joke in Spanish; the child stares openmouthed and then animatedly tells Dan something about a caballo and busies herself pasting stickers onto the front of her shirt.

  And then Dan teaches Claire how to draw blood, as she had been taught in her earliest clinical rotation in medical school eighteen years ago, while the old woman smiles and chatters to him in Spanish. He labels the three velvet-red vials and translates for Claire. “She’s worried about you. Said you started going a little pale on her. Told me I should feed you a good dinner.” He winks. “Looks like we’ve both got people watching out for us.”

  “Let me lock up tonight. Go on home,” Claire says after they are back in the office. All three desks, lined up against one wall of the cramped room, are stacked with charts and lab reports and medical journals. Frida and Dan’s desks are the worst, the piled folders a testament to their productivity. Or popularity, Claire can’t help thinking. Claire’s desk, wedged into the corner after they had lifted one short filing cabinet on top of another to make room, has its own growing stacks—most of the folders still pristine and thin since Anita gives her the youngest, newest, and, therefore, usually healthiest patients. It still looks so temporary compared to Dan’s and Frida’s. Anonymous. None of the photographs and coffee mugs sitting like glass islands in oceans of paper. None of the Mexican milagros and woven ojo de Dioses they’ve both strung from thumbtacks and drawer pulls.

  Dan rubs his eyes. “Well. If you’re okay with that.”

  “Very okay. But I need a key.”

  He smiles at this and she sees that look he gets, where she’s tapped into some secret he’s kept wrangled up inside until the right snare catches and pulls it forth. “Still not quitting, huh? I thought you weren’t ever going to ask for it. Now I guess you’re going to want to know your salary, too. Should I hold on to the key till you hear it?”

  Dan leaves out the back door twenty minutes later. The salary is lower than she’d hoped—and she had not hoped for much. But she suspects at least part of it has been shaved from what he takes home himself. She takes her key ring out of her purse and drives a ballpoint pen between the spiraled circles to wedge in her new clinic key. It’s funny that a couple of inches of stamped metal makes her feel so included, like she’s been taught the clinic’s secret handshake. But the new key won’t easily fit on the crowded ring; not until she takes off the four keys that had opened and locked the many doors and garages to her Seattle house. She lines them up on her palm. She could send the keys back to the Realtor to give to the people who bought their home, it would be a nice gesture, but the locks have probably already been changed. They are worth nothing to anyone now. She walks out the clinic’s back door to the dumpster behind the building and drops all four keys into the dank and humid vat of waste.

  • 12 •

  “Your mother called,” Addison says.

  “Ah. Gretta,” Claire says, dropping onto the couch still packed into her down coat, hat, gloves and boots. “Why don’t you ever start the woodstove?”

  “‘Ah’? That’s all you can say? Here. Taste this.” Addison holds a wooden spoon over his cupped palm, tempting her into the kitchen like one might lure a stray animal. “Tell me if it needs more garlic.”

  Claire dips a finger into the red sauce and licks it, suddenly starved. “It’s great. So is this your new job?”

  He turns away, putting the rest of the contents in his mouth and hmmming in a satisfied voice, but Claire can tell he is miffed. She rests her head against his back, feels the rocking of his shoulders as he stirs, waits for the gentle push back toward her to know they can drop this one. It is slow to come. “I sent her an e-mail a few weeks ago,” Claire says. “Told her it would be too muddy to visit until June and her Ferragamos would be wrecked, but by summer the remodel should be finished and she can have her own bathroom.” She pauses, waits for a signal. Nothing. “And who knows? By then Pfizer could be your new best friend.”

  After a slow, cool moment, the press of her cheek into his back, he edges back toward her, her joke a bridge across the place they don’t examine. It is always one of them giving, one of them relinquishing, she thinks. But never both. Never together.

  She hugs him with a single fleeting clasp and goes up to change into her bathrobe and slippers, plays one round of “Answer Ten Questions and Find Out What Food You Are” with Jory, a link from some Seattle friend. Jory is a ripe persimmon. Claire an artichoke. Addison serves them all spaghetti.

  At dinner Jory seems electrified, zinging through a backlog of gossip about people she hasn’t seen in more than a month: who had started driver’s ed, who had gotten the ballet lead, who had pierced the most remote corner of their body. It is as if her own uncertain future is so scary it’s pushing her in reverse.

  Claire flashes a look across the table, watches Jory coiling noodles around her fork with intense concentration. She rests her fingers lightly on her husband’s arm. “Did you show Dad the school stuff we picked up?”

  Jory shakes her head, furrows her eyebrows without lifting her gaze from her food. “May I be excused, please?”

  “You’re done? You didn’t eat much.”

  Jory shrugs. “It was good. I’m just not hungry.” She carries her plate to the sink and swirls it quickly under the water before dropping it in the dish rack. Even from the table Claire can see it is still streaked with tomato sauce.

  Before bed Claire asks Addison, “Did you talk to her about it? She’s less defensive with you. She has to go. It’s already three weeks into the semester.” They are both sitting on the rim of the tub, trying to keep their voices low enough not to carry through the thin walls. Where did par
ents talk to each other for all the centuries entire families lived in one room? God, for that matter, how did they couple enough to have more than the first few children?

  “She thinks if she enrolls here it means we’re never going back.” He says it in a nearly defeated voice. Claire doesn’t even want the replay of the conversation Addison and Jory must have had.

  “There are some things a fourteen-year-old doesn’t get to choose.” They hear the computer shutting down in the living room and stop talking for a minute. “When is your next meeting?” Claire finally asks.

  “I have to be in San Francisco Friday afternoon.”

  “So she’ll be alone until I get home from the clinic. Six thirty or seven. An oncology meeting?”

  Addison brightens up a little, and Claire feels the small rush of hope she is learning to dread, learning that the safest space has been compressed into the single step from this moment to the next. “It’s a venture capitalist meeting. Some big names—big biopharm investors.”

  Claire nods, scraping off a blot of dried toothpaste from her bathrobe. “You won’t be here when the moving truck comes, then?”

  “I can’t miss this meeting. All I need is one big investor. If I have that, I can go to a bank for more. Nash would probably come back in, too. As soon as we repeat the animal trials everything could fall in place.”

  “Assuming the mouse data comes back normal this time.”

  “Yes. Assuming that. And I think it will. I’m still convinced those results were a fluke.” Claire feels his eyes on her but doesn’t look at him. “It could happen quickly, Claire. Everything could turn around.”

  “Well,” she answers, brushing white flecks off the lap of her robe, “not quite everything.”

  At the end of clinic the next day Frida waves her into the back office. She drops a white cardboard box in the middle of Claire’s desk, pasted all over with the superhero and baby animal stickers they hand out to pediatric patients.