Maybe he had said something more to James. Was it possible? Maybe he had said something like, "Play rough, if you have to." To which James had given a solemn, tight-faced nod. Had Tom said that? Could he have actually said that? (He felt calm!) "I know people who know some people." Why could he now hear James saying that to him? Why did it sound like something James would say, with a touch of the Brooklyn streets in his voice? They'd talked early one morning, at around eight a.m., when the caffeine was pushing Tom along, jacking him up. I know people who know some people. That was bad. Play rough. That was bad, too. Had these things really been said?
Tom looked over at Ann. She spent the day with patients. Blissful. Had no idea what he was walking into. He felt calm.
As soon as she'd stirred that morning, they'd come to her: Mrs. Thompson, with the heart disease; Mr. Bernard with the bad liver; Harriet Gorsky with end-state renal failure; her patients, all 1,690 of them, a milling, shuffling, coughing, anxious crowd in her mind, divisible by age and sex and of course illness as well as probable illness. Her lung cancer patients, for instance: the patients who in all likehood might have it, pending tests; did have it and were realizing they would die before too long; and those who were in the bed now, coughing weakly. Or there were the many women with anxiety disorders, who ranged from mildly obsessive to those needing immediate hospitalization. Put her in a room with all of these people (no, please don't) and she would be able to drift from one to another sensing disease in many cases, suddenly recalling the string of data that came with each patient, the hemocrit level, the path report, even height and weight at the last checkup. And their histories, their secrets—an enormous psychic burden she tried not to carry but always did. She cared for them, she found them interesting, this selection of humanity, skewed of course toward those who had health insurance and women (men so obstinate about caring for themselves). A few she genuinely didn't like, a few she might cry over when the end came, and a few she even loved, from afar, mostly, chastely, no hint betrayed, of course. Some of the older men who'd lost their wives came in wearing a coat and tie, as if still working, and they often were stoical and silent as she described their conditions, what the problem was. They pursed their lips and nodded, rubbed their dry hands together like it was just a financial matter requiring they write out a very large check. Broke her heart. Maybe they reminded her of her father in his last years. How could they not? They were human beings. They stood nearly naked before her (the men with their loose underwear lowered as she felt for hernias, common in older men and potentially quite serious if infection set in, or testicular swellings), they had odors (women generally wore perfume and cleaned themselves better), they burped softly, farted, grunted. Very occasionally they urinated by accident, especially during an anal exam. She never betrayed any emotion at this, never showed that such behavior was in any way shameful. Because it wasn't. We are animals and subject to the mortification of the flesh. Born so that we may die.
She looked over at Tom in the car. Lost in his thoughts. Seemed calm—for him, anyway. Hadn't asked her about her day. Had barely kissed her hello when she got into the car. Was she angry with him? Yes, but more than that, discouraged. They each worked too hard, they carried too much . . . and with that the day came back to her . . . after lunch she'd seen a young married man who complained of chest and stomach pain but admitted that he had just had an affair with his wife's divorced younger sister and probably given her herpes. Ann nodded patiently but thought, You creep. Ann had handed the man a prescription and told him to tell his wife, who was also her patient. Next was a young woman who'd asked to have her antidepressants adjusted upward. The woman was clinically obese, so much so that the fat had reached the last knuckle on each of her fingers, and was a heavy smoker. Ann had spoken sternly to her about her lungs and heart but doubted it would have any effect. The next patient had been an elderly woman whose lower spine and pelvis were deteriorating because of severe arthritis. She moved slowly, apologizing unnecessarily as Ann inspected her lumbar region.
So different from one another, these human beings. If you are a doctor, you have secret knowledge of these differences. And if you have secret knowledge, then you are always at risk of knowing things about people you love, knowing the very thing that you prefer not to know. And now there was something about Tom that was bothering her. She didn't know if she felt this or knew it, or if she felt it as his wife or as a doctor. He was, to all outward appearances, an utterly healthy forty-two-year-old man, six foot one, perhaps 230 pounds, which was too heavy, but vigorous. Yet there was something, a twitch in his eye, a distracted irritability. The animal was under stress, unusual stress. He'd said nothing. Either he knew what was wrong or he didn't. But she sensed that he knew exactly what was wrong. Underneath that affable glad-hander was a sharp mind. Tom could be very tough with people. He compartmentalized, internalized, rationalized. Valuable abilities in a corporate setting, she knew. But the animal always won. This is what she'd learned from her patients. The brain was an organ that privileged itself before other organs, arranged the perception of reality for its own comfort. But it could not control the body's reaction to its own perceptions, the secretion of hormones, the cellular flux. Tom was acting like nothing was wrong. He seemed calm, but she knew he was not. Something was wrong. Right now, as he was staring out of the window of the town car, telling her nothing. Why?
"This is it," he said to the driver.
A lovely apartment! Huge! High in the air! Some of the people were actual billionaires, not that it mattered to Ann. She chatted, drifted, let Tom do his thing, talk to the big wheels, over in the corner, each holding his drink. She'd shaken hands with some people but found her way to a huge sofa and sat there happily, half hidden by a giant spray of lilies, accepted a glass of white wine. The servants were all tiny Guatemalans. She was too tired to be of much use to Tom. So she watched. She'd been introduced to Connie, the youngish wife of someone important there, so Ann studied her. The woman sported a very expensive boob job. How natural and yet grotesque! How impossible yet marvelous! One hardly knew who was most responsible for this aesthetic state of affairs, men or women themselves. And yet, equally strange to Ann was the fact that the fake tits worked. Men who were otherwise among the most sophisticated and brilliant, worldly and perceptive, lawyers, bankers, artists—men who had buried parents, friends, spouses, even children, and who thus knew the essential tragedy of the flesh—were themselves so often rendered helpless before these unnatural yet unarguably beautifully executed falsies. Smart men! Thoughtful, sensitive men! Doctors! Yes, doctors, who should know better, who were well informed about infection rates, adhesions of muscle tissue, immune system response, nerve damage, tissue scarring, ligament failure, the complications of burst implants, and so on. Yes, even doctors. The male response was hardwired in, kicking off testosterone pulses in the endocrine system. Couldn't help themselves. Helpless. Helpless men. They lost the power of discernment and resistance. They lusted, and in the glare of that lust, women gained power, if for only a moment.
Now Connie spied Ann across the room, turned, and came to her, smiling with professional hospitality.
"Are you—you seem to be—"
"I'm sorry—bit tired. Long day."
This admission was on the outer edges of Manhattan dinner party protocol. You never admitted weakness or insufficiency. "Oh, are you—what—?" ask Connie politely, one eye on the room.
"I'm a physician and I just saw a lot of patients today, that's all."
At this Connie's posture softened, and she drew nearer, seeming to reappraise Ann with both admiration and a bit of fear, for people know that doctors know things the rest of humanity does not.
"May I ask your specialty?"
"I'm an internist. Internal medicine."
Connie sat down, intimately next to her. "I keep telling my husband he must see a doctor."
Ann nodded. Many wives said this.
Connie leaned closer, whispered. "Can I talk to you abo
ut this? He pees too often in the night. Maybe six or seven times."
"That is too many times."
Connie leaned closer. "And he has pain."
"When he pees?"
Connie winced, as if sampling such pain. "Don't think so."
"Trouble peeing?" Ann asked.
"Maybe. He's so private. I know he has pain you know, down there, down under there."
Benign prostate hyperplasia less likely, malignancy more so, she thought. PSA test. New inflammation test. Eliminate false positive. Biopsy probable. "Pain all the time?"
The question triggered alarm in Connie's beautiful face. "Maybe, but I think yes, all the time!" she whispered.
"Between his anus and scrotum. Sensitive to touch?"
"Well—" Connie drew a breath of surprise at the sudden clinical frankness of this question. And made a quick check that no one was listening to them from behind the lilies. "Well, yes. It worries me so much!"
Ann wondered if she had seen Connie's face before somewhere, an advertisement, perhaps. "He should see a urologist as soon as possible—I mean tomorrow—and get a digital exam."
"That's what he doesn't want . . ."
"He's going to have to get over that."
Connie was nodding frantically, eyes wet, apparently having forgotten the party.
"It's no big deal, frankly. As a woman, you know that, the way gynecologists poke into us."
"I've told him."
"He's never had one?"
"No."
Ann nodded. "Afraid?"
"Yes."
"You really should have a talk with him."
"Yes. He's so very tender down there."
"He needs an exam tomorrow."
Connie became tearful. "Doctor, do you—do you do them?"
"Almost every day."
"And the men—do they mind the fact that—"
"I'm a woman? No. They accept it."
Connie looked at her, a question seeming to tremble in her big beautiful eyes. "Would—would you, would you do it for him?"
"Of course, he can call my—"
"No, no, he's going to Germany tomorrow for four days, he's being picked up at six . . . no, no, I mean would you, could you now? Here?"
Here. Now. Not what she wanted to do but it was her duty, always her duty to help. Connie led her down a hallway to a sumptuous bedroom filled with Picassos on every wall, Manhattan sprawling below from two sides. This is real money, Ann breathed to herself. This is what Tom wants.
"Do you need anything?"
Yes, Ann said. Connie nodded. She picked up the phone, pushed one button. A servant was dispatched to an all-night pharmacy for rubber examination gloves and K-Y Jelly.
"I'll go get him," Connie called. "Please just wait—"
More than a few minutes went by. Was Tom wondering where she was? Not necessarily. He could easily be locked in a conversation on the far side of the room. She sat perched on an upholstered bench with her purse, which had a very small doctor's bag in it.
"—to do it, Bill, I absolutely insist."
Connie appeared at the door. "He thinks he's humoring me."
Martz stepped into the room, glowering. "I am."
"I said it would only take a minute."
Connie handed Ann a white bag from the pharmacy and pulled the door shut.
"Well, Doctor—"
"Please call me Ann," she said, "given that I am your guest."
Martz nodded obligatorily, his expression indicating he had no idea who she was. "Where do you practice?"
"I have my own office practice and I have privileges at Beth Israel."
"How many exams of this nature have you performed?"
"I don't know. Several thousand, perhaps."
Martz's eyes, yellowed by decades of golf, hung open as he stared at her. She could not decide if he found her attractive or whether his interest lay elsewhere. Maybe he hated his wife for asking him do this, maybe he hated Ann for agreeing to do so. Most likely he was examining her for signs that might tell him what she was learning about him. This was typical of patients; they studied the doctor who studied them. Up close she saw that he'd had dozens of tiny skin cancers removed, including on the outer edge of his lower lip. The divot in his lip suggested a healed knife wound, even a disregard for danger.
"I told your wife I'd do this," Ann said, "but of course, it's your decision."
"Let's do it. Then she'll let me alone."
Martz dropped his pants.
"Bend over, put your hands on the table," she instructed.
"How did she find you?"
"We got to talking."
"What a topic of conversation."
"Well, you know women," she said, lubing her fingers. "We do talk about everything."
"I didn't meet everyone," he growled, being polite, making conversation. "You came with—?"
She went in with the forefinger and middle finger together in one firm motion. He grunted. They all grunted, except the men who'd had anal sex; they anticipated the sensation and evaluated it. She moved her fingers up the inside of his rectum and felt the lateral and posterior walls for any rectal masses. Then she identified the prostate on the anterior wall and swept her fingers from side to side, noting smoothness, consistency, lumps, asymmetry, and size.
There was a lot of swelling, bad swelling.
"Excuse me," she responded, "what? Oh, I came with Tom Reilly. I'm his wife."
"Aah, I see." Martz stiffened, actually tightened his asshole. "Good to know that, Doctor. That is, aah, informative. I want you to know exactly what would make me . . . better, would reduce my difficulties."
In general she preferred that patients not self-diagnose. They were inevitably wrong, usually erring on the most dramatic side. She'd once had a woman come in with numb feet and insist she be tested for multiple sclerosis, when in fact the problem was that her shoes were too tight.
". . . the change in my life that would be most prophylactic would be if your—"
She paid little attention to what he was saying, instead carefully feathering her fingers against the lumpy surface of the prostate, probing softly, seeing if she caused pain. The basic rule was that you pressed no harder than you would push against an eyeball. She arced her fingers back to the edge of the prostate to see if she could feel the shape of the swelling better, whether it involved one lobe of the prostate or both.
"Dr. Reilly?"
"Yes?" she answered.
"I said, if your husband—"
Martz's hand shot back and grabbed her own, pulling it out of his rectum, making a wet sucking sound. He turned toward her, underpants still at his knees, shirt and tie hanging down, and drew close, uncomfortably close to her. His large, loose-skinned hand lifted her smelly, gloved fingers up between them as his eyes stared into her face. "If Tom would do me the courtesy of telling me—" She fought Martz and tried to pull away, but his big hand held her fist tight, her authority as a physician gone. "—what the fuck is going on at Good Pharma." He saw her confused reaction. "Oh, your bright, ambitious husband knows something, Doctor. But he isn't telling me. Tried to pretend nothing is going on. Tried tonight, to my face, lied directly to my face, Doctor Reilly. Isn't telling me or anyone else, as far as I can see. I have hundreds of millions of dollars invested in his company. Do you understand? That is a lot of money, even for me. Other people's money, Doctor. The stock was going up. But now it is not. There's a piece of information I don't have! Tom has it, Doctor! Tom knows it! And I want him—" Now Martz was crushing her hand in his, leaning into her with the color rising in his face, his lip curled in anger, a primate showing his old teeth, her fingers with his blood-streaked shit on them an inch from her nose. "—to tell me!"
10
The pain woke him. As always at this time of night, just a few minutes before the machine sent a shot of lovely wonderful morphine through the tube in his arm. He loved the drug more than he could say, craved it, yes, of course—no wonder people destroyed themselves fo
r it. I'm addicted. But these minutes were when he was most clear, the pain rising quickly yet bearable, the veil of the morphine pulled away just far enough to let his mind work. Precious seconds to him. Precious time to think, think about the only thing he had left now: his son. All else was lost to him—his body, failing further every day; his spirit, which needed a body to be manifest; his physical belongings, which he could no longer use or even see from where he lay; and his memory, weakened by suffering, medication, and time. And of course he had lost his wife, Mary, years ago, he had lost the fellowship of his brother detectives when he retired, he had lost so much, nearly everything now.
And yet, he knew, this was in the way of things. Everyone lost everything at the end. You became unified with every human being who had ever lived and who ever would live, including his parents, his brother and sister, Mary, of course, and even Ray. Perhaps that was consoling. You know again the people who have died and you feel they know you now. Dying slowly, you think about death, you study its approach. You imagine the world after you are gone, you see the enormity of time, the final privacy of consciousness. He'd sat with Mary in the last weeks of her life, her mouth pulling back day by day into an emaciated mask, her breath fouler each day, too, and he had gazed into her dull eyes and spoken to her and she to him and he knew now that he had no idea then what she was thinking. She had tried to share it but known she could not. They'd held hands for hours and that had been everything. Worlds within worlds. He saw that no one alive knew what he was thinking. Even the nurses, the lovely professional death watchers.
But he was not dead yet. Not quite. He turned his head to see that it was just after two a.m. Ray was upstairs. The night nurse slept in the next room. Sometimes he heard her talk in her sleep, which made him smile. Such an intimate thing, a sweetness.
Now he lifted the sheet to examine the long incision where the doctors had cut him open trying to find out what was wrong with him. Right through the stomach muscles. They had closed him up, knowing there was no hope. The incision had not healed well and kept getting infected. The nurses left the wound unbandaged with the wish that the air would help. How it hurt to lift his head, but he did, just to see the giant cut, which ran from his breastbone to the top of his public hair. The edges of the incision did not meet, had dried and puckered back from each other. Beyond that lay his penis in a nest of gray hair, a white plastic catheter stuck in it to drain any incidental urine that dribbled through his blocked kidneys. He could barely feel the catheter anymore. He had stopped missing his penis, years earlier, in fact. It had become a mere hose. Old men didn't talk about this, not even to each other. Just bore the truth of it, the change of life. You learned something about the world when you lost your sexual desire, you saw things differently, how tormented young men were, how stupid and out of control.
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