Five Days (2 page)

‘But not like I'm burning up.'

‘I can assure you you'll not feel that.'

‘I want my daddy . . .'

‘The sooner we do this, the sooner you'll be with him. Now here's what I want you to do . . . I want you to close your eyes and think of something really wonderful. You have a pet you love, Jessica?'

‘I have a dog.'

‘Eyes closed now, please.'

She did as instructed.

‘What kind of dog is he?'

‘A cocker spaniel. Daddy got him for my birthday.'

I swabbed the crook of her arm with a liquid anesthetic.

‘The needle going in yet?' she asked.

‘Not yet, but you didn't tell me your dog's name.'

‘Tuffy.'

‘And what's the silliest thing Tuffy ever did?'

‘Ate a bowlful of marshmallows.'

‘How did he manage to do that?'

‘Daddy had left them out on the kitchen table, 'cause he loves roasting them in the fireplace during Christmas. And then, out of nowhere, Tuffy showed up and . . .'

Jessica started to giggle. That's when I slipped the needle in her arm. She let out a little cry, but I kept her talking about her dog as I used tape to hold it in place. Then, telling her I was going to step out of the room for a few minutes, I asked:

‘Is the needle still hurting?'

‘Not really, but I can feel it there.'

‘That's normal. Now, I want you to lie very still and take some very deep breaths. And keep your eyes closed and keep thinking about something funny like Tuffy eating those marshmallows. Will you do that for me, Jessica?'

She nodded, her eyes firmly closed. I left the scan room as quietly and quickly as I could, moving into what we call the technical room. It's a booth with a bank of computers and a swivel chair and an extended control panel. Having prepped the patient I was now about to engage in what is always the trickiest aspect of any scan: getting the timing absolutely right. As I programed in the data necessary to start the scan I felt the usual moment of tension that, even after all these years, still accompanies each of these procedures: a tension that is built around the fact that, from this moment on, timing is everything. In a moment I will hit a button. It will trigger the high-speed injection system that will shoot 80 milligrams of high-contrast iodine into Jessica's veins. After that I have less than fifty seconds – more like forty-two seconds, given her small size – to start the scan. The timing here is critical. The iodine creates a contrast that allows the scan to present a full, almost circular image of all bone and soft tissue and internal organs. But the iodine first goes to the heart, then enters the pulmonary arteries and the aorta before being disseminated into the rest of the body. Once it is everywhere you have reached the Venus phase of the procedure – when all veins are freshly enhanced with the contrast. Begin the scan a few critical seconds before the Venus phase and you will be scanning ahead of the contrast – which means you will not get the images that the radiologist needs to make a thorough and accurate diagnosis. Scan too late and the contrast might be too great. If I fail to get the timing right the patient will have to go through the entire procedure again twelve hours later (at the very minimum) – and the radiologist will not be pleased. Which is why there is always a moment of tension and doubt that consumes me in these crucial seconds before every scan. Have I prepped everything correctly? Have I judged the relationship between the diffusion of the iodine and the patient's physique? Have I left anything to chance?

I fear mistakes in my work. Because they count. Because they hurt people who are already frightened and dealing with the great unknown that is potential illness.

I especially fear moments when I have a child on that table, that bier. Because if the news is bad, if the images that emerge on the screen in front of me point up something catastrophic . . .

Well, I always absorb it, always assume a mask of professional neutrality. But children . . . children with cancers . . . it still pierces me. Being a mom makes it ten times worse. Because I am always thinking: Say it was Ben or Sally? Even though they are now both in their teens, both beginning to find their way in the world, they will always remain my kids – and, as such, the permanent open wound. That's the curious thing about my work. Though I present to my patients, my colleagues, my family, an image of professional detachment – Sally once telling a friend who'd come over after school: ‘My mom looks at tumors all day and always keeps smiling . . . how weird is that?' – recently it has all begun to unsettle me. Whereas in the past I could look at every type of internal calamity on my screens and push aside the terribleness that was about to befall the person on the table, over the past few months I've found it has all started to clog up my head. Just last week I ran a mammogram on a local schoolteacher who works at the same middle school that Sally and Ben attended, and who, I know, finally got married a year ago and told me with great excitement how she'd gotten pregnant at the age of forty-one. When I saw that nodule embedded in her left breast and could tell immediately it was Stage Two (something Dr Harrild confirmed later), I found myself driving after work down to Pemaquid Point and heading out to the empty beach, oblivious to the autumn cold, and crying uncontrollably for a good ten minutes, wondering all the time why it was only now so getting to me.

That night, over dinner with Dan, I mentioned that I had run a mammogram on someone my own age today (this being a small town, I am always absolutely scrupulous about never revealing the names of the patients who I've seen). ‘And when I saw the lump on the screen and realized it was cancerous I had to take myself off somewhere because I kind of lost it.'

‘What stage?' he asked.

I told him.

‘Stage Two isn't Stage Four, right?' Dan said.

‘It still might mean a mastectomy, especially the way the tumor is abutting the lymph nodes.'

‘You're quite the doctor,' he said, his tone somewhere between complimentary and ironic.

‘The thing is, this isn't the first time I've lost it recently. Last week there was this sad little woman who works as a waitress up at some diner on Route 1 and who had this malignancy on her liver. And again I just fell apart.'

‘You're being very confessional tonight.'

‘What do you mean by that?'

‘Nothing, nothing,' he said, but again with a tone that – like much to do with Dan right now – was so hard to read.

Dan is Dan Warren. My husband of twenty-one years. A man who has been out of work for the past twenty-one very long months. And someone whose moods now swing wildly. As in, having just made that somewhat catty comment he followed it up with:

‘Hey, even the best fighter pilots lose their nerve from time to time.'

‘I'm hardly a fighter pilot.'

‘But you're the best RT on the staff. Everyone knows that.'

Except me
. And certainly not now, positioning myself in front of the bank of computer screens, staring out at Jessica on the table, her eyes tightly shut, a discernible tremor on her lips, her face wet with tears. A big part of me wanted to run in and comfort her. But I also knew it would just prolong the agony; that it was best to get this behind her. So clicking on the microphone that is connected to a speaker in the scan room, I said:

‘Jessica, I know this is all very spooky and strange. But I promise you that the rest of the procedure will be painless – and it will all be over in just a few minutes. OK?'

She nodded, still crying.

‘Now shut your eyes and think about Tuffy and . . .'

I hit the button that detonated the automatic injection system. As I did so a timer appeared on one of the screens – and I turned my vision immediately to Jessica, her cheeks suddenly very red as the iodine contrast hit her bloodstream and raised her body temperature by two degrees. The scan program now kicked in, as the bed was mechanically raised upwards. Jessica shuddered as this first vertical movement startled her. I grabbed the microphone:

‘Nothing to worry about, Jessica. Just please keep very still.'

To my immense relief she did exactly as instructed. The bed reached a level position with the circular hoop. Twenty-four seconds had elapsed. The bed began to shift backwards into the hoop. Thirty-two seconds when it halted, the hoop encircling her small head.

‘OK, Jessica – you're doing great. Just don't move.'

Thirty-six seconds. Thirty-eight. My finger was on the scan button. I noticed it trembling. Forty-one. And . . .

I pressed it. The scan had started. There was no accompanying noise. It was silent, imperceptible to the patient. Instinctually I shut my eyes, then opened them immediately as the first images appeared on the two screens in front of me, showing the left and right spheres of the brain. Again I snapped my eyes shut, unable to bear the shadow, the discoloration, the knotty tubercle that my far too-trained eye would spot immediately and which would tear me apart.

But professionalism trumped fear. My eyes sprang open. And in front of me I saw . . .

Nothing.

Or, at least, that's what my first agitated glance showed me.

Nothing.

I now began to scrutinize the scan with care – my eyes following every contour and hidden crevasse in both cerebral hemispheres, like a cop scouring all corners of a crime scene, looking for some hidden piece of evidence that might change the forensic picture entirely.

Nothing.

I went over the scan a third time, just to cover my tracks, make certain I hadn't overlooked anything, while simultaneously ensuring that the contrast was the correct level and the imaging of the standard that Dr Harrild required.

Nothing.

I exhaled loudly, burying my face in my hand, noticing for the first time just how rapidly my heart was pounding against my chest. The relief that Jessica's brain showed no signs of anything sinister was enormous. But the very fact that my internal stress meter had shot into the deep red zone . . . this troubled me. Because it made me wonder: Is this what happens when, over the years, you've forced yourself to play a role that you privately know runs contrary to your true nature; when the mask you've worn for so long no longer fits and begins to hang lopsidedly, and you fear people are going to finally glimpse the scared part of you that you have so assiduously kept out of view?

Nothing.

I took another steadying breath, telling myself I had things to be getting on with. So I downloaded this first set of scans to Dr Harrild – whose office was just a few steps away from the CT room. I also simultaneously dispatched them into the PACS system – that's the Picture Archiving and Communication System – which is the central technological storage area in Portland for our region of the state (known by its code name, Maine 1). All scans and X-rays must, by law, be kept in a PACS system for future reference and to ensure they are never mixed up, misplaced, assigned to the wrong patient. It also means that if a radiologist or oncologist needs to call up a specific set of patient scans – or compare them with others on file – they can be accessed with the double-click of a mouse.

The images dispatched, I began running a second set of scans to have as back-up, to compare contrast levels, and to double-check that the imaging hadn't missed anything. Usually, if the scans in the first set are clear, I relax about the second go-around. But today I heard a little voice whispering at me: ‘Say you got it all wrong the first time . . . say you missed the tumor entirely.'

I grabbed the mike.

‘Just a few more minutes, Jessica. And you have been just terrific. So keep lying still and . . .'

The second scan now filled the two screens. I stared ahead, fully expecting to see proof of my corroding professionalism in front of me as a concealed nodule appeared in some ridge of her cerebellum. But again . . .

Nothing.

That's the greatest irony of my work. Good news is all predicated on the discovery of nothing. It must be one of the few jobs in the world where ‘nothing' provides satisfaction, relief, the reassertion of the status quo.

A final scan of the scan.

Nothing.

I hit the ‘send' button. Off went this second set of scans to Dr Harrild and the PACS storage centre. I picked up the mike again and told Jessica we were done, but she would have to remain very still as the bed was brought back to ground level again.

Ten minutes later, dressed again and sucking on a lollipop, Jessica was reunited with her father. As I brought her into the waiting room, where he sat slumped, anxious, he was immediately on his feet, trying to read me the way a man on trial tries to read the faces of the jurors filing back into court with a verdict already cast in stone. Jessica ran over to him, throwing her arms around him.

‘Look, I got four lollipops,' she said, holding up the three untouched ones in her hand and pointing to the one in her mouth.

‘You deserve them,' I said, ‘because you were such a brave, good patient. You would have been proud of her, sir.'

‘I'm always proud of my daughter,' he said, picking her up and putting her on a bench, asking her to sit there for a moment, ‘while this nice lady and I have a talk.'

Motioning for me to follow him outside into the brisk autumn morning, he asked me the question I always know is coming after a scan:

‘Did you see anything?'

‘I'm certain the diagnostic radiologist, Dr Harrild, will be in contact with your primary-care physician this afternoon,' I said, cognizant of the fact that I also sounded like a scripted automaton.

‘But you saw the scans, you know—'

‘Sir, I am not a trained radiologist – so I cannot offer a professional opinion.'

‘And I don't design the ships I work on, but I can tell when something's wrong if I see it in front of me. Because I have years of on-the-job experience. Just like you. So you now know, before anyone, if there is a tumor in my daughter's head.'