I grabbed the shirt atop my dresser, wrapped my hand to protect it from the heat, and reached for the doorknob.
“Don’t,” Lois shouted as she grasped my shoulders pulling me backward as the door swung inward engulfing me in smoke and flames. I began coughing and choking then…
“Arnie…Arnie…wake up…wake up.”
“What happened?” I said fighting for full consciousness. “Lois…it was horrible…so horrible. The smell…the fire…the kids!”
“It was a dream, sweetie. Everything’s fine except for the potatoes au gratin. They ran onto the oven burner, stinking up the house.”
A dream, I thought…that was one hell of a dream.
Chapter Eighteen
For Debbie Wallace, Katy Howard’s warning, ‘it’s going to get rough’, ranked as the understatement of all time.
Predictably, after each chemotherapy infusion with Adriamycin and Cytoxan, she became deathly ill with nausea and vomiting, often lasting for up to six hours.
Debbie pulled her head from the sink and wiped the stringy mucous from her mouth. “That was the eighth time in the last thirty minutes. I can’t take much more.”
Matt ran the washcloth under the cold water and wiped her face.
Debbie grasped his hand. “Oh God, that feels good.”
She recalled Matt’s comment about seasickness, when you had it, you were afraid you weren’t going to die. Three days ago, she laughed at the joke. Nothing seemed funny anymore.
“If the nausea wasn’t bad enough,” she said, “I feel so weak afterward. That scares me more. I feel helpless. All I can do is stay in bed.”
This was the specter of cancer she feared the most.
Debbie thanked God that Matt and her closest friends didn’t attempt to cheer her up—she’d have killed the first one who tried. Instead, they let her take the lead, provided sympathetic ears, sat by her while she cried, and shared the everyday events of their lives.
I’d give anything to be able to focus on trivialities, she thought.
Two weeks after each treatment, she felt better, and by the third week, nearly human. Unfortunately, that only made her dread the next round of chemotherapy.
Her beautiful chestnut hair fell out in clumps each time she brushed it, and soon she accepted the inevitability that getting rid of it all would be best.
“Are you sure you want me to do this?” Matt asked as she sat at the kitchen table with a towel over her shoulders.
“I’m sure.”
She closed her eyes as the electric clippers vibrated over her scalp. Tears streamed over her cheeks. Debbie remembered her reactions to seeing the bald women of chemotherapy. While she’d been saddened and frightened by the sight, she was a caring woman and had empathy for them. As she thought back, she hated to admit it now, but she’d felt an element of revulsion, too. Maybe it’s in my genetic code—to react that way—like any human faced with the specter of disease and death.
She had endured the best medicine had to offer, but chemotherapy acted as if its intention wasn’t salvation but destruction.
The term ‘side-effect’ was like calling a tsunami, a ripple on the ocean’s surface. Chemotherapy became the disease itself relentlessly affecting all of her body—collateral damage, to borrow from the war metaphor.
I might survive cancer, she thought, but not the treatment.
The faces of Debbie’s children hid nothing of their despair…cancer was their nightmare, too. Her eight-year-old didn’t fully understand what was happening to her mother, but all understood the dramatic change in Mommy’s energy level, her prostration following each chemotherapy treatment, and the striking changes in her appearance.
Kelly, her five-year-old, stared at Debbie this morning as she posed before her mirror trying on several wigs. “What happened to your pretty hair, Mommy?”
“It’s the medicine, but don’t worry, it will all grow back. Meanwhile, I need your opinion.” She posed for her daughters with several wigs. “Which one do you like the most?”
“The blonde one,” said Heather. “It makes you look like Beyoncé.”
She kept explanations to the girls casual. They couldn’t fully understand, so she used their questions and their behavior to monitor their emotional reactions and as a guide to what they needed to know. The younger child knew that Mommy was sick. She missed the many activities they shared, but she knew nothing about the effects of the disease. Even Heather, who knew a little about breast cancer, and what death meant, could not relate these things to her mother. She had become more attentive to Debbie, more helpful, and showed anxiety only when her mother was her sickest after chemotherapy.
“The kids have been amazing, Matt,” she said one night as they prepared for bed.
“It’s a tribute to you, Deb. You’ve kept it together. You gave them the luxury of security.”
“It’s so hard,” Debbie said, crying and seeking the safety of his arms.
Matt resisted the impulse to say something; to reassure, to remind her of what the docs had said, and to tell her that everything would be okay. Instead, he kissed her. “I love you. I’ll always love you.”
Debbie completed the cycles of Adriamycin and Cytoxan, and met with Dr. Jordan Goodman for the next phase, the home stretch.
Jordan sat at his desk with her chart. He smiled. “I know it wasn’t easy, but we’re exactly where we should be in your treatment. We’re ready to start the second, and I hope, the final phase in treatment, Taxol. This is a compound extracted from the bark of the Pacific yew tree. It’s a potent anticancer drug that received FDA approval in 1994 for individuals with your tumor.”
“Please don’t tell me that the side effects are as bad as the first combination of medications.”
“It’s hard to predict how anyone will respond to a specific drug, but in general, Taxol may be easier on you than the others. Keep in mind, however, that with this final step we’ve increased your chances of beating this thing to more than 80 percent after five years.”
Debbie tried to smile. “You say 80 percent survival, I think 20 percent recurrence and…”
“By type of tumor, your response to the first course of treatment, and my experience, I think it’s much higher. People are too used to the 80 percent chance of rain from the weatherman. If our reliability was like theirs, I’d worry too. It’s not. We do much better.”
At first, the Taxol infusions produced similar ghastly side effects, and one she hadn’t had before, mouth sores. They were painful and produced large amounts of mucous, frequently choking her. She found it necessary to carry a washcloth or tissues at all times.
How can Matt watch this? It’s disgusting…I’m disgusting, she thought as she wiped the stringy mucous from her mouth.
When Matt rubbed her shoulders, she wept.
She lifted her head from the sink after vomiting for the third time in fifteen minutes. “I’m sorry. You shouldn’t have to deal with this.”
Matt hugged his wife. “And if I were sick, you’d be out playing tennis, right?”
I’m so lucky, she thought, to have Matt. I must find a way to make him know it, but she knew he already did.
“Hang in there, Baby. We’re nearly through this nightmare.”
After the second cycle, the side effects had diminished. I’m practically there, she thought.
Chapter Nineteen
Jim McDonald made rounds on Connie Rinaldi and received frequent detailed phone reports from the nurses during the day. For the next three days, she teetered at the abyss then stabilized. Jim felt better until the repeat chest x-ray showed persistent infection in both lungs.
She should have responded, he thought. What’s wrong?
On morning rounds, day four, Connie looked terrible. She’d again become less responsive, the oxygen saturation in her blood had declined, and she struggled more than ever to breathe. She needed to be in ICU, but the unit was packed. He’d have to call Jack Byrnes, the ICU director for a bed.
The severe influenza epidemic had Jack Byrnes’s ICU in full triage mode, too few beds for too many sick patients. Setting priorities, deciding which patients needed the ICU the most, put Jack on a collision course with Brier Hospital physicians.
“Jack,” pleaded Jim McDonald, “you have to find an ICU bed for my patient, Connie Rinaldi. She’s too sick for the medical floor.”
“Look, Jim, I don’t like this any more than you do. I’ll see Ms. Rinaldi and make an assessment. If she’s sicker than anyone in ICU now, I’ll transfer someone out and make room for her; otherwise, you’ll have to make do. We simply don’t have enough acute care beds.”
“If they were sicker than Connie, they’d be dead. She almost coded this morning. If she dies because we treated her on the ward rather than ICU as I recommend, all of us will be liable for her death.”
“Don’t give me that crap, Jim. I know what’s at stake, and I know that triage is not only necessary, it’s essential when we have limited ICU beds. I’ll look at her right now. You’ll have my answer in thirty minutes.”
“I’ll wait in the doctor’s lounge.”
Jack went to the fifth floor medical ward to see Connie Rinaldi.
“You look beat, Jack,” the charge nurse said.
“I am. I may be the next victim of this epidemic. Can you get me Ms. Rinaldi’s chart.”
She returned with the chart and a cup of coffee. “She’s too sick for us, Jack.”
“So I hear.”
Jack reviewed her chart, and examined her briefly. “My name is Dr. Byrnes. We may need to move you up to the intensive care unit.”
Connie looked up through watery frightened eyes, but didn’t respond. As she struggled with each breath, Jack noted her ashen color, blue lips and impaired mental status. Jim was right. He’d have to push someone out of the unit and suffer the ire of that patient’s physician. He’d try persuasion first, but he knew that all the patients in the unit were very sick, and that no physician would willingly relinquish the security of an ICU bed.
During Jack’s review of Ms. Rinaldi’s chart, he saw that her sputum and blood cultures teemed with pneumococcus, the infecting organism. Pneumococcus was the most common severe bacterial infection causing pneumonia and physicians, especially old-timers, called the infection, ‘the old man’s friend’ because in the past, it brought death to the elderly and debilitated. Hospitals were seeing less of this organism and this type of pneumonia due to the administration of Pneumovax, a highly effective vaccine against pneumococcus. Connie Rinaldi, like several of his sickest patients in the ICU, had received the vaccination, yet developed the infection. That was odd.
Jack rang the doctor’s lounge. When Jim answered, he said, “That’s one sick lady you have there, Jim. Give me a little time to find a bed and we’ll transfer her.”
“Thanks Jack and I appreciate your help.”
“By-the-way, Jim, don’t you think it’s a little strange that she has pneumococcal infection when she’s been vaccinated?”
“It should be unusual,” said Jim, “but this is the third patient I’ve seen recently who developed this infection after receiving Pneumovax. Maybe we have a bad batch out there?”
Maybe, thought Jack.
The signs of change were subtle at first, but when Henry drove up in a new Lexus SC 430, Ruth Fischer knew that something was different. Her questions over the last few months about Henry’s business problems evoked only glib responses.
“I’m entitled to know what’s happening, Henry. It’s my ass on the line, too.”
“You worry too much, Ruth. I told you that I’d take care of it. Thank God that Medi-Cal claims came through with those delayed payments and that the new Regency Drug store opened with a bang.”
“What about the $650,000 that you needed?”
“It’s no longer a problem.”
“Where did you get that much money?”
“I didn’t get that… ,” Henry stopped, a scowl on his face. “Don’t give me the third degree, Ruth. I don’t like it. I told you I dealt with this.”
“Now you really have me worrying. What are you hiding?”
“I’m not hiding anything. I’m trying to run our business the best way I can, and excuse me, but I don’t like being second guessed by a rank amateur.”
“Why are you being so deliberately offensive, Henry? What are you hiding? I have legal rights here. I’d prefer to keep this discussion between us and avoid attorneys, but if you force me…”
Henry stood. His face was red with rage. “Don’t mess with me Ruth. You have no idea what you’re doing or what damage you can cause.”
I’ve never seen him so angry, so out of control, Ruth thought. What’s going on?
As Ruth rose to leave the room, she turned to face him. “This is far from over, Henry. Count on it.”
Chapter Twenty
Maybe it was the near death experience, but after two weeks at home, life never felt so joyous or as rich as it did now. My heightened senses were confronting the world anew. Food never tasted so good, Lois’ skin never felt so soft, my children never smelled so sweet, and music, its beauty, touched my soul as never before.
I was sitting on Jack Byrnes’s examining table when he walked in. “How’s it going Arnie?”
“It’s crazy, but I can’t recall ever feeling better in my life.”
Jack wasn’t a primary care physician, but because he was smart and compassionate, he’d become a doctor’s doctor and cared for Brier physicians and nurses.
After he listened to my heart and lungs, and felt my abdomen, he did a neurological examination testing muscle strength, reflexes, and sensory perception. When finished, he smiled. “Can’t find anything wrong with you, Arnie. You’re life of leisure is over. You can get back to work like the rest of us.”
“Encephalitis was one hell of a trip. It scared us all, especially the kids. The experience gave me new insight into what it’s like to be that sick. That’s called learning the hard way.”
Jack slapped me on the back. “Anyway, get back to your office and let me see you again in three months.”
“Thanks for everything, especially for how you and Beth helped Lois. We can never thank you enough.”
“Buy us dinner sometime, and let me pick the place. Maybe you’ll treat us to Chez Panisse?”
I hugged Jack. “You’re on.”
I’d surprised him, I thought, as he initially stiffened, paused, and finally hugged me in return.
Monday morning and my staff had strung a banner across the entrance. “Welcome Back Arnie!” They applauded as I walked in.
I felt my face turn red. “Thanks guys. You don’t know how good it feels to be back.”
After a few hugs and handshakes, I knocked on the wall to get everyone’s attention. “I’d like to thank you all for your help in carrying on while I was away. You did a terrific job. We’re a team, and I know that for me this is more than a place to work. In spite of all our problems, I look forward to coming here each day, and you’re the reason why.”
I paused for a moment, grabbed a stack of envelopes from my briefcase, and handed them out. “You’ll find a small token of my appreciation here.”
Beverly Ramirez stood. “Wonderful having you back, Arnie, we missed you. You won’t mind if we run out and cash those checks before we start today?”
I stared at Beverly and smiled. “Don’t tell me…Missy Cabot’s in the waiting room.”
The staff erupted in laughter.
My return to work was seamless. It was satisfying to do once again all those things I took for granted. My enthusiasm was boundless and my mood, ebullient. What had irked me in the past, I ignored. I even enjoyed the moments of silence while stuck in bay area traffic—that, more than anything else, said that nearly dying had changed me.
At Debbie Wallace’s request, I agreed to resume her chemotherapy.
Debbie stood outside the examining room. “I’m so happy to have you back, Arnie. Thank Dr. Goodman for m
e , but his chemotherapy clinic’s depressing.”
“It’s good to be back.”
When I entered the examining room, I sensed body powder’s strong aroma, a common occurrence as many women showered and powdered themselves before coming to the office. I wished more patients paid attention to their hygiene. In addition, I sensed something else, a more subtle tangy scent like that of tonic water—quinine?
After examining Debbie, she sat before my desk while I finished reviewing her course under the chemotherapy protocol, and her recent laboratory results.
“I’m pleased with your progress. I know you may not feel terrific, but chemo is tough. You know that better than anyone. Side effects following the more recent treatments have been easier, is that right?”
“The last two infusions of Taxol weren’t bad at all. I must be getting used to that miserable medication. How many more, Arnie?”
“Two more should do it. Then you can get back to a normal, happy life.”
“Excuse me, Arnie, but with breast cancer, a normal life, if I live so long, will be decades ahead.”
“I’m as close to breast cancer as I can be without having it myself, and I can tell you that I like your odds for a long life. The happiness part is up to you and Matt. Let me see you again in a month.”
Debbie gave me a hug. “Thanks, Arnie. I’m so happy to have you back.”
Chapter Twenty-One
People complain about routine. Even those living ‘exciting’ lives like doctors, lawyers, rock stars, and racecar drivers, find tedium in their day-to-day activities. That wasn’t true for me, at least not for this moment as I released the pause button on my life, and pressed play.
After my third month back at work, the encephalitis faded into memory. I felt relaxed and more satisfied with my life than ever before.
The Sixth Sense (Brier Hospital Series Book 3) Page 9
