Dina tried to read the scrawled handwriting, but their swirls were a whirlpool of Yiddish she couldn’t decipher. None of it made much sense. She heard the gate creaking outside as it opened suddenly, her mother’s footsteps coming down the path. Jumping up, she hit her head on a beam. Quickly shoving everything back in place, she climbed out of the wardrobe. Her heart beat wildly as she ran to her room, grabbing a copy of The Secret Seven off the shelf as she dived onto her bed and sprawled out, pretending to read. The words of her father’s letters wound around each other, tangling themselves into a Yiddish Gordian knot that held his secret within its coils.
With all the commotion going on when she got to the clinic, Dina hadn’t bothered reading this morning’s mail. Urgent messages bombard her constantly, overwhelming her some days. Her idea of urgent is not usually the same as her patients’, who think an itchy bum or a rash that has been there for two years is cause for her to drop everything and see them right away. And the laboratory can’t seem to understand that slightly low iron levels on a blood analysis does not require she call an ambulance immediately. She wastes so much time dealing with nonsense, chasing up tests that have been ordered unnecessarily by specialists just to cover their own arses, or returning endless phone calls. Yael jokes about Dina having compassion fatigue. But Dina isn’t laughing.
She is jolted from her thoughts the moment she notices the fax sitting under the apple. Its juice has made the red ink from the stamp run, so the word URGENT now reads URGE. Dina tosses her organic would-be sex aid in the bin and dabs the page dry with a tissue. Sousanne’s name is printed at the top of the page. It’s the report of the ultrasound Dina sent her for last week. She sets it aside and gets up from her desk, edging down the corridor. Expecting Evgeni to pounce on her again, she peeks into the waiting room to find him slumped in a corner, snoring. Careful not to wake him, she motions Sousanne and the girls to follow her. They enter Dina’s room and stand motionless in front of her, as if their feet are chained to the ground.
‘Who’s going first?’ Dina asks the girls.
They both look over at Sousanne. She prods Nadia, the older girl, whispering ‘Yukoon shija’a.’
Be brave. It’s one of the few Arabic phrases Dina knows.
The child trembles, her face turning pale, looking like she is about to be pushed into a ravine. She steps forward slowly, climbing onto the examination couch. Dina draws up the vaccine and places it onto a green, plastic tray. Holding the girl’s arm gently, she swabs it with an alcohol wipe and stabs the needle into her muscle like a dart. The girl barely flinches.
‘Well done,’ Dina says, placing a princess-themed bandaid over the injection site. She offers Nadia some jelly beans from the jar on her desk.
Shlomi was never so stoical when he had his shots. It took both Dina and Eitan to hold him down as he thrashed and screamed, working himself up into a blithering mess of tears and snot.
Nadia’s sister follows suit, standing still as she accepts her fate. It’s all over in a few seconds and Dina gives her some jelly beans too. She clutches them in her palm.
‘Dr Dina. I know you are so busy today, but I just wondered if you got the results of my ultrasound yet,’ Sousanne says nervously.
‘Take a seat for a moment, Sousanne.’ Dina shuffles her papers around, searching for the fax. ‘I think something might have come in this morning. It’s been so frantic today, I haven’t had a chance to look at it yet.’
Sousanne’s daughters fidget with the plastic models of hip joints and knees displayed on the shelf.
‘Hallas, girls. Stop that! We’ll be finished in a minute; I just have to talk to the doctor about something.’ Rubbing her back, Sousanne lowers herself into the chair. ‘You work too hard. You are a doctor and a mother and a wife. How do you do it?’
Dina doesn’t answer. She doesn’t have time this morning to chat.
‘I still don’t understand why you stay in this country. The news is too much for my nerves lately. But I am trapped.’ Sousanne pauses, waiting for Dina to respond. ‘Really. Why would anyone choose to live in a place like this?’ she presses. ‘People are crazy here.’
Dina utters a noncommittal grunt. Here they both are: Sousanne because she has nowhere else to go and Dina because she can’t decide whether to leave.
‘Hallas. It’s enough for me that my baby will be so sweet,’ Sousanne says. ‘And God knows a boy will save our marriage. Poor Basim has been waiting long enough for a son.’ Sousanne always talks a lot when she is nervous. She looks down at her abdomen, resting her hand over it as if to keep this new hope to herself. ‘I can’t wait to hear what you have to tell me. I know it will all be good. It’s destined.’
Dina leans back in her chair, fidgeting with the report on her lap. She reads the first line: A large, partially solid mass in the right ovary.
‘At Nadia’s christening,’ Sousanne continues, ‘Mr Shity from the garage told Basim he should watch me. Right there in front of everyone. “She is trouble, your wife. Keep an eye on her.” He winked at me while he picked his nose. Basim joked with him: “Ah, it is this devil we must watch,” pointing at little Nadia. “She keeps us up all night.” But Mr Shity placed a hand on his shoulder. “The baby doesn’t sleep?” he said. “What do you have a wife for, my boy? A man needs his rest. You can’t keep coming in late to work every day,” Shity warned, that rotten smirk still plastered on his face.’
Sousanne leans back in her chair and sighs. ‘Basim used to be such a gentleman.’
Dina understands how she feels. She remembers how much fun she used to have with Eitan during those first heady days of their relationship. After the first time they made love, they woke in the middle of the afternoon, realising they’d forgotten to eat all day. Dina put on a jacket and wandered into the kitchen, rolling up her sleeves as she flung open the pantry door.
Eitan followed her. ‘You can cook?’
Dina nodded.
‘My life is saved.’ He sidled over to her, whispering almost fearfully, ‘There isn’t much in there.’
He grabbed her from behind, pressing into her. She tried to pull herself away, but knocked her head against the edge of a shelf. Minutes later, they were both sitting cross-legged on the floor, Eitan holding an icepack against Dina’s head. Heavy rain clattered against the kitchen window, torrents of water gushing over gutters. The radio was playing mellow songs for Friday afternoon’s Twilight Time program. John Lennon and the Plastic Ono Band suddenly forced their way in, asking listeners to ‘Give Peace a Chance’ and, before Andy Williams crooned ‘Can’t Get Used to Losing You’, the ice melted and Dina and Eitan had become a contortion of limbs and lips among the spilled lentils.
The slow burn of Friday afternoon, the clock hidden, the day was almost gone. And then along came the ghosts. They appeared as Dina lounged on the bed again. She stroked the hairs on Eitan’s arm, traced the veins on the back of his hand. Uninvited, the ghosts opened the door and filled the room like an empty fog. She was glad for their familiarity. Crammed into Eitan’s one-bedroom apartment, they draped themselves on the sofa, fingering the knick-knacks on the shelf. They would go on to use this place as a laboratory, conducting experiments, researching time.
She was scared of opening up to Eitan, even when he rocked her in his arms, plunging into her with tender need. It was during the moments after that the voices came; the ghosts crawled out from cracks in the wall. Inside Eitan’s bedroom, it didn’t matter whether or not there was a war going on, or ever had been.
Dina stood up, pulled on her jeans, filched Eitan’s sweatshirt and, picking up a ball from the table near the front door, led the dog out into the rain. She bounced the ball and Kelev jumped up to catch it, refusing to give it back, chewing it until he decided he was ready for more. She ran with the dog, up the hill, needing to get away.
She listened to the birds chirp in the rain, the hum of the electricity pole on the corner of the street, the sign shouting Danger of Death as the dog lifted his
leg to pee. They ran past the empty synagogue that was waiting to swallow a handful of Sabbath worshippers, while the rest of the street went home to roast chickens, peel potatoes and drape white cloths over fold-out tables. They strolled past Ilanot supermarket, where the old Moroccan in his butcher’s apron was sliding the metal grate across the entrance, locking up until Sunday morning. The playground stood deserted, as children lounged around at home, watching re-runs of Rechov Sumsum, the Israeli version of Sesame Street. Dina dawdled as she passed the bakery, the barber shop, the trash-and-dime. Her wet hair dripped on her forehead; she saw the pine trees in a wash of pale green. The dog ran ahead through puddles. As he turned the corner, he looped back and bolted in the direction of Eitan’s apartment. She called after him, whistling, bouncing the ball, but the rotten mongrel ignored her, his legs carrying his stocky body home.
A large, partially solid mass in the right ovary. Dina reads the line again to make sure she hasn’t made a mistake. The words roar at her from the page: compatible with the possibility of a malignant teratoma.
Sousanne has been coming to Dina for years, although she hasn’t seen her as much recently. She turned up last week out of the blue.
‘I’ve been so tired lately, Dr Dina,’ she had said. ‘Muna is such a terrible sleeper.’
Dina waited for Sousanne to elaborate. Silence makes people talk.
‘But I feel like throwing up all the time. I think I might be pregnant again.’
Dina asked her to get up on the couch. She checked her blood pressure, took her temperature and listened to her chest. She performed the examination like a professional dance routine – Inspection, Auscultation, Palpation, Percussion – the finale reached as she tapped her fingers on Sousanne’s swollen abdomen. The well-rehearsed drill was designed to uncover clues that Dina hoped she wouldn’t find.
‘You can get dressed now,’ she’d said as she washed her hands.
She returned to her desk and typed some notes into the computer. After a minute, Sousanne came and sat down beside her. Dina handed her a form.
‘What’s this for?’ Sousanne asked.
‘It’s a referral for an ultrasound. Get Yael to book you in to see me again next week for the results.’
Sousanne giggled nervously as she rose from her chair.
‘I think you already know what’s going on, Dr Dina, but you’re just not going to tell me, are you?’
‘It’s just routine,’ Dina had said. She stood up, signalling it was time to see the next patient.
Sousanne takes a large, sealed envelope from her bag and places it on the desk. She sits opposite Dina, an expectant smile on her face.
‘You don’t think it’s another girl, do you, Dr Dina?’
Dina pulls out the ultrasound. She knows Sousanne must already be imagining the fledgling heart beating, the hand pushing out tiny finger buds. Sousanne wants to know if this is going to be her long-awaited son. Will he burst forth from between his mother’s legs at last, brandishing a cast-iron sword, cape fastened around his neck, the saviour of a dreadful marriage? She will bear a prince, arisen from the dead of night, into the hands of the waiting midwife. And Basim will hand out Cuban cigars to all his co-workers at Shity’s garage, in honour of his son. For years Basim’s bones have ached for the strength of a male heir, and Sousanne thinks she will deliver him unto his father this time.
Solid mass.
‘I cannot believe how early I am showing.’ Sousanne sounds like she is calling for help from the bottom of a well. ‘It’s amazing how quickly it happened this time. I thought my eggs wouldn’t be ready yet, especially since I’m still feeding little Muna.’
Dina glances at the fax report, while Sousanne rambles on. She can barely hear her anymore. Dina’s eyes tiptoe over the words she does not want to read: A large, partially solid mass in the right ovary, compatible with the possibility of a malignant teratoma. The irregular collection of fluid in the abdominal cavity is suggestive of metastatic spread. A report announcing death, not life.
Dina looks away from where Sousanne is seated, towards the bookshelf crammed with texts she used to pore over as a medical student. Her eyes rest on a slim, blue volume filled with pictures of giant cysts containing limb buds, teeth and hair; malignant teratoma – a monster, not a fetus. How is she going to tell Sousanne?
Dina has never been taught how to deal with scenarios like this one; not as a medical student, nor as a young doctor. Surely there is training for these things, nowadays. They must read articles and whole chapters of glossy textbooks written by academics, with titles like Breaking Bad News to a Patient. It even has a catchy acronym – BBN. They copy down guidelines from a presentation on the board at the front of the lecture theatre, learning about empathy, compassion and empowering your patient. They will be told to be sensitive, learn to set aside their own baggage, allow for shutdown when the patient turns off and is unable to hear the doctor’s words. Pause so the patient has time to absorb the message. Maintain eye contact. Keep your hands on your knees, using your body language to project a willingness to be open.
Dina can see the students sitting in a circle inside some drab university classroom, chewing spearmint gum, nursing hangovers from the previous night’s pub-crawl. ‘Imagine this scenario,’ the tutor tells them. ‘You have thirty minutes to role-play a woman who does not know she is going to die and leave her children to grow up with their abusive father who has threatened her with a knife on three occasions in the past, tried to drown their third daughter in the bath soon after she was born, told her he would leave if his wife cannot bear him a son and who eats dinner every night at his mother’s place instead of coming home. There is nothing on earth you as her doctor can do, except try to ease the excruciating pain she will feel towards the end of her illness with your bag of tricks – paracetamol, codeine, morphine. You will stand by and watch her slowly dying. So, go ahead let’s role-play this today, students. Try to empathise with the patient sitting opposite you.’
Doctor: Sorry, Sousanne. You are not pregnant after all.
Doctor: I hate to be the one to tell you, but the swelling in your abdomen is cancerous fluid and you probably have three months to live at best.
And after all these years, she wonders if any textbook or number of role-plays prepares you for this moment in another person’s life; this point of no return. The icy chill that runs through your body, the closing off of the iron gate as you read the report, the instantaneous locking away of your own heart. Dina sees people’s lives change in an instant. They whimper their why-me’s. They spend the remaining time holding onto dreams and hopes, as though they are never going to die; as if their bodies aren’t simply rental accommodation and the landlord will one day revoke the lease and throw them out.
And then there is the unmentionable secret excitement Dina feels. It disgusts her, but she finds a smile creeping onto her face. The power she holds to break bad news to someone affords her the illusion of her own magical immunity to illness. Or is it simply a relief it isn’t her this time? She knows too well that mortality lurks, always hiding around the corner, ready to surprise her.
An awkward silence grows, prompting Sousanne to continue.
‘This baby must really want to be born,’ she says eagerly.
Dina turns to face her computer screen. How can she say anything in front of Sousanne’s girls? And there’s not enough time now to cushion the blow. Maybe it’s best not to tell her anything today. Is there really any harm letting her live with false hope for another twenty-four hours; will it make that much difference anyway?
Sousanne looks down at her swollen abdomen, resting her hand over it, as if to keep this new hope to herself. Dina taps her fingers on the keyboard and waits for the printer to spew out a form:
Sousanne Khoury
DOB 31/5/1969
PHx – G3P3, 3 normal pregnancies
Ix – Abdo US – abdominal swelling, ascites, neoplastic ovarian lesion?
Dina hands her the encr
ypted form.
‘What’s this for?’ Sousanne asks.
Dina pulls at a loose strand of hair. How can she confront Sousanne with the grim news, thrust her own fecund belly in between them, like a sordid carnival mirror reflection, accusing Sousanne of false hope? Wouldn’t it seem like Dina was flaunting her own good fortune? She just can’t face Sousanne today. Or any other day, really. She feels pathetic and gutless.
‘It’s a referral to a specialist. Ask Yael to call and book you in with him for tomorrow.’
‘Dina, don’t lie to this poor woman,’ her mother scowls as the baby kicks Dina in the ribs. Both of them seem to be ganging up on her.
‘Is there something you haven’t told me? It’s not another girl, is it?’ Sousanne’s face turns pale. ‘I had to hold myself back from asking the technician the other day. I know they are not supposed to say anything.’
‘It’s far too early to know anything for sure,’ Dina mutters, feeling nauseated. She stands up, signalling to Sousanne like a robot that their consultation has ended.
‘Now,’ her mother says. ‘Tell her now! What are you waiting for?’
‘I can see you are trying hard not to give anything away, Dr Dina,’ Sousanne says, her hands trembling. ‘But I know it in my heart – this time the tiredness is definitely worse, so it must be a boy.’
Dina herds her towards the door.
‘Sousanne, I’m running way behind today. I’ll see you again after you’ve seen the specialist.’
Sousanne turns to leave, the girls trailing behind her, and then looks back at Dina, smiling: ‘You would say if it wasn’t a boy, wouldn’t you?’
Waiting Room, The Page 9
