The Collectibles (22 page)

J
oe was wheeled into Dr. Gordon's office at 10:55 a.m. It was a large, rectangular, dimly lit room with rosewood paneled walls and no windows. Instead, the wall on the right was lined with diplomas, and the upper half of the wall on the left was illuminated with a soft white light. Dr. Gordon sat behind a large metal desk covered with files, Dr. Burns was in one of two armchairs in front of the desk. He motioned Joe to the other. Dr. Gordon leaned forward on his desk. “How are you feeling today, Commander?” he asked. “Is everybody treating you all right around here?”

“Just fine, sir,” Joe replied.

“Yesterday I spoke with you about the MRI. As you know, the MRI consists of scans, or images, of your brain. Essentially, the MRI is a way of making a picture of the brain using magnetic energy rather than X-rays. In your case, the scans are quite impressive. Let me show you some films.” Dr. Gordon said, getting up and moving from behind his desk to a table on his right. “Most of the pictures that we'll look at today are cross sections through the head, done serially so that they're stacked on top of each other.”

Dr. Gordon pointed to the portions of the MRI study that pictured Joe's nose and ears. As he moved his finger across the brain images, he pointed out a mass higher up in the front of the brain that involved areas known as the frontal lobes and the corpus callosum, or the part of the brain that connects the two sides.

The mass had a different appearance from the other part of the brain, the brain tissue that surrounded it looked swollen. It also extended into the area on the left side known as the basal ganglia. Dr. Gordon then put up another sheet of pictures. “Commander, these pictures show where contrast dye had been given to you. As you can see, the mass is even more obvious here.”

Joe experienced a cool, drawn-down feeling in the back of his neck. His stomach was queasy, his shoulders ached, and his heart was pounding. He felt hot and cold at the same time. He also sensed he was weak, but he was standing in a firm manner and he heard himself ask, “What does this all mean for me, doctor? I understand I have a mass. What I would like to know is, can it be treated? How do we get rid of it? And will I be okay?” What Joe didn't hear was the intense edge to his voice.

Dr. Gordon put his hand on Joe's shoulder and suggested that Joe sit down in front of his desk. He poured a glass of water from a silver water pitcher. Now Joe caught himself observing the water pitcher with too much attention, yet he could not help himself. He did manage not to start a conversation about it. Instead, he realized how good the cool water tasted. Then he found himself dwelling on how important cold water is, and wondering why he did not drink more of it. His mind wanted to follow that course, but, recognizing its absurdity, he decided the only thing he could do was listen to Dr. Gordon some more. He was not sure, however, he wanted to hear anything else Dr. Gordon had to say unless he was going to be told this was not a serious problem and could be taken care of.

At this point, Dr. Burns moved his chair to more directly face Joe. “Do you remember when I asked you to turn away from me yesterday during my physical examination?” he asked. “What I noticed then was that your right arm drifted downward slightly from the original position. When I asked you to stand at the side of the exam table and close your eyes, you seemed a little wobbly.

“We don't have all of the answers today, but we have enough to make us feel, based upon the information we have reviewed, that you have a tumor of the brain that's called a glioblastoma multiforme. It's still possible that something else is producing the findings, such as an infection, but we don't think so.”

Dr. Gordon interjected, “We're going to get you started on Dilantin, to decrease the possibility of a seizure from the irritation of the brain. I'm also going to prescribe a second medicine called Decadron, to reduce the swelling of the brain.”

“Is this tumor malignant?” Joe heard himself ask. He felt as if he were outside the room, looking in at a conversation that he was having. “Do you mind, Doctor, if we bring in Commander Barnes? He was my exec officer on the
Trader
years ago, as you may have read when you reviewed my file. He's here in the hospital; I saw him last night. I'd like him to hear this.”

“He's not only in the hospital, he's right outside the door, practically asking for a court martial trying to get in here. Please ask Mr. Barnes to come in, Dr. Burns.” Sure enough, Red was standing on the other side. Joe looked over at Red, who simply smiled back and didn't say a word.

“Commander Hart tells us that you served with him as his exec on the
Trader
several years ago,” Dr. Gordon said.

“I can't discuss that, sir, but I do know the man,” Red said with a smile.

“I'm sure you do. You both have very impressive records. Let me get to the point. Commander Hart has a brain tumor, which caused him to sustain syncope, which is a loss of consciousness. The tumor is called a glioblastoma multiforme. Commander Hart, may I call you Joe?”

“Yes, sir, please do. And call this guy on my right Red, if you would, so he doesn't get a swelled head.”

“Joe, you asked whether or not the tumor was malignant. We'll need to schedule a CT guided stereotactic biopsy. The neurosurgeon will take a small piece of the tissue in the area of the mass through a twist drill hole in the skull. Although there is risk of causing harm to the brain any time surgery is performed, Dr. Raymond, our chief of neurosurgery, sees the risk as minimal, and the benefit is that we'll know the diagnosis. I'm sure you'll want to ask him questions. Ask him whatever you like. And, Joe, as you well know, you're not married to the opinions of Dr. Raymond, or mine either for that matter. We've been in touch with Dr. Worthington. There's always room for second or third opinions.”

There was silence in the room. No one said a word for quite some time. Dr. Gordon poured another glass of water for Joe, and one for each of the others in the room without asking if they wanted any. They all drank. Joe and Red looked at one another for a long time, neither speaking words, each speaking volumes.

Joe broke the silence. “I would like the biopsy as soon as possible. I would also like to talk to you, Dr. Gordon, alone.”

“Of course. We can talk tomorrow at 0900.”

“With your permission, doctor, I would like to talk with you alone in fifteen minutes, and I would like to be alone from now until then.”

“Fifteen minutes it is,” Dr. Gordon said. “And you can stay right in this office.” With that, he walked out of the room, followed by Dr. Burns. Red waited a moment, looked at Joe, and told him he would be outside the room. With that, he got up and left as well.

Joe rose and poured himself another glass of water, rushed into the bathroom adjoining Dr. Gordon's office, relieved himself, and stood in front of the mirror, splashing cold water on his face and fighting the urge to throw up. He didn't want to leave the bathroom, so he sat down on the toilet, arms resting on his legs, holding his head. His mind was spinning, but he was also organizing, thinking, gaining control. After fifteen minutes, he washed his face again and dried it, came out, and sat back in the chair. Moments later, Dr. Gordon came back into his office, locked the office door, and sat at his desk. He looked at Joe.

“How much do you know about glioblastoma, Dr. Gordon?”

“More than I would like to, in some ways,” Dr. Gordon gently replied. “In addition to neurology, I have been trained in oncology, and while rare, we have seen more of these tumors over the years than we would like.”

“I realize that you don't have the results of the biopsy, but it seems to me that you have reached a diagnosis, tentative at least, of this glioblastoma. What I want to know is, is this tumor malignant?”

“Glioblastoma, if that is what you have, is a malignant tumor of the brain tissue that is a kind of cancer. It can be treated with radiation therapy, which, in some instances, depending on the size and location of the tumor, can induce a phase of remission. The tumor, however, often recurs in a short period of time. It can also be treated with chemotherapy, but unfortunately, this treatment prolongs life only fifteen extra days in a typical case. Surgery is an option in certain cases but is not a cure for these tumors and, because of the location of your tumor, is not viable. There are several other kinds of experimental treatments that have shown some promise. However, it is a very serious tumor problem, and if we are correct, cannot be cured.”

Silence again. Dr. Gordon seemed to wait for the question both he and Joe knew was coming. Finally, Joe asked it.

“Assuming the biopsy is positive, that I have this type of tumor, how much time do I have left?”

Dr. Gordon remained silent for a while and then, walking around his desk and sitting next to Joe, he said, “The average time from diagnosis until death in a patient with a biopsy-proven glioblastoma is a little more than one year, although the time for any given patient can vary significantly from that figure all the way from less than six months to more than two years. I told Dr. Raymond that I had reviewed your record, met you, and told him that you are going to want the facts, all the facts. I asked him specifically, given the location and appearance of your tumor and the brain swelling, what did he truly believe you had left in useful time. Dr. Raymond told me, and I am sure he will tell you, that given your age, good health generally, and the size and location of the tumor, it is likely that you will live approximately six months, assuming the biopsy confirms our impression. Even with radiation and experimental therapies, he could not be optimistic because the tumor involves both sides of the brain, the corpus callosum, and even the basal ganglia on the left.

“Naturally, we will go ahead with further consultation with other neuro-oncologists in our department to be sure we have not overlooked any possibility of new treatment options that might have the potential to prolong your life. And we are only doctors, Joe. We don't make decisions as to when people die. I may be wrong. You may have much longer, and we'll keep working on it.”

More silence.

“Let me ask you three questions, Dr. Gordon: again, assuming the biopsy is positive, the tumor malignant, and that I have approximately six months to live, what will my life be like during these six months? Will I know when the time has come? And how will I know it?”

“It is hard to say with certainty how you will do from this point forward. Given your history of good health and being in good shape, it is not unlikely that you will proceed relatively normally during this period. You may experience headaches, perhaps some constipation, and it is not unlikely that you would have a decrease in your motor response efficiency. Medication will mitigate the likelihood of seizure and abate the swelling in your brain. It's entirely possible that for several months you will feel physically normal, or close to it. Of course, the stress is incalculable. If anyone, however, has a history of handling high stress in an exemplary manner, from what I have read, it is you.

“As to your last two questions, will you know and how will you know it, those are very interesting questions. At the very end, you will clearly know it because you will have an episode something like the one you had on your boat, but one from which you will not wake up. As far as how you will know it, I can tell you that I have observed in some of my patients over the years with this particular disease that towards the end – a day or two – and it's hard to be specific, they smell a very pungent odor, one they clearly recognize, like burning leaves, oil-based paint, ether, but in fact, there is no precipitating agent for the smell.”

“You mean I smell the odor, but it's not there?”

“Exactly,” Dr. Gordon said. “That could happen.”

Joe rose and shook Dr. Gordon's hand. “Thank you, Doctor. I want to share something with you in confidence.”

Dr. Gordon nodded, and Joe continued.

“You know, there were times when we were at sea and down for considerable periods. A submarine is smaller than you think, and the quarters are close. Sometimes the work we did got a little hairy. One of my favorite times would be when the job was completed, our orders successfully carried out, and we would be in a position to surface. Once in a while, under those circumstances, we would surface in time to see a clear, calm ocean with the warm afternoon sun shining on the bridge. I would happen to have a cigar to light up just at those moments. Nothing like a good cigar at a time like that.”

“Did you bring any cigars with you to the hospital?” Dr. Gordon asked.

“As a matter of fact, I did,” Joe replied.

“You know, Commander, sometimes I feel a little closed-in in this office. There's a little balcony that can be accessed by the first door on the left of the entrance to this office. When the weather's decent, sometimes I sit out there, get some fresh air. I believe that door is unlocked.”

Joe shook Dr. Gordon's hand again and walked to the door. When he opened it, he ran into Red.

“Red, we need to go AWOL for an hour. We're going to have a cigar.”

A
fter breakfast, Dr. Raymond came in. About Joe's age, a few inches taller, with a shaved head, the doctor had small bright blue eyes and a cool demeanor. He introduced himself and explained that as a neurosurgeon, he was part of the team evaluating and treating Joe. Mechanically, as if checking off his to-do list, he recited that he had reviewed all of the test results and had conferred with Dr. Burns, Dr. Gordon, and the neuro-oncologist and radiation oncologist assigned to the case. He told Joe that the biopsy had been scheduled for that morning, and explained the procedure, including, in great detail, all the risks. He asked Joe whether he had any questions about the biopsy procedure or otherwise. Joe recognized Raymond's professional skill as a surgeon but, trying to hide his immediate dislike for the man, said, “No, sir. You have my informed consent. I'm ready to proceed.”

“Excellent,” Dr. Raymond replied and left the room.

Shortly, two nurses came in to prepare Joe for the biopsy. He was sedated and taken by a gurney to the surgical wing where he was further prepped, and the procedure performed.

When he was returned to his room and recovered, he noticed Red sitting in the chair. Red gave him a wave and asked him how he was feeling. Joe told him he felt fine, a little dry, and took a sip of water from the tray in front of him.

 

Later that day, Dr. Gordon and Dr. Raymond paid Joe a visit. Dr. Gordon took the lead as they walked in, but Joe beat him to the punch.

“Malignant, correct?”

“Correct,” Dr. Gordon replied. Dr. Raymond stood stoically without saying anything.

Silence for a long moment.

“Well,” Dr. Raymond said, “if you don't have any questions, I have to get back to my wing.”

“No questions, Dr. Raymond,” Joe said, before the surgeon turned and left.

“I'm sorry, Joe,” Dr. Gordon said. “Can I get you anything?”

“Is that door still unlocked?”

“No, but it will be in a minute,” Dr. Gordon replied with a smile. “By the way, I made sure there were two chairs and a table out there this time, and an ashtray as well.”

“Thanks, Dr. Gordon.”

“You're welcome, Joe,” Dr. Gordon said. “And it's Henry. In fact, please call me Hank. You'll be free to leave here soon. Let me know if there's anything you need. And I'm available to talk any time you want.”

“Thanks, Hank,” Joe said. “You deliver a strong pill, but you do it in a nice way.” With that, Dr. Gordon shook Joe's hand, then Red's, and left the room.

 

Red came over and sat on the edge of Joe's bed, carrying a red canvas bag, looking like he was going to the beach.

“What's in the bag, Red?”

“Six bottles of cold Sam Adams just in case I have to go sit with you on that balcony and smoke another one of those lousy Graycliffs.”

“Let's do it now,” Joe said.

“You might be rushing it a bit,” Red replied.

“I intend to, Red. My timetable's a little shorter these days. By the way, any chance you could free yourself up for a boat trip in the immediate future?”

“That would be really difficult,” Red said. “I'd have to make arrangements, get everything lined up, talk with some people, prepare. I don't think I could go before tomorrow morning. Come on, I'll wheel you to the balcony.”

“Sounds good,” Joe said, reaching for two cigars, a cutter, and his favorite lighter.