The Yale Journal for Humanities in Medicine
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Laocoön
(continued)
Jeff Seymour
jeffseymour@aya.yale.edu
The doctor flung his long white coat onto a chair and sat at his desk, thinking about what to say. He began scribbling a script on a pad of paper, testing ways of explaining himself. But the imagined conversation kept twisting in contractile entanglements. He crumpled the script and tossed it in the trash. As he started again, his nurse, Helen, knocked and entered with the file.
“Look!” Hank said, having flipped through the folder. “She put down “Mr.” See?! What kind of woman doesn’t want you to know her husband’s a doctor?!”
The nurse returned Hank’s exasperation with a shrug.
“The nerve,” she said. “Now, if he was a lawyer, I could understand.”
Pained eyes studied the nurse.
“Helen,” Hank said. “Do you take pride in your job?”
The nurse stopped in the doorway and looked back with a raised eyebrow.
“I don’t mean being a nurse,” Hank said. “I mean, working for me.”
“I don’t work for you. I work for Dr. Rosenbaum.” She smiled and shut the door behind her.
Hank waited through what seemed a deliberate number of rings. Then he heard the receiver lift without haste. Mrs. Raines answered, her voice low and level.
“Hi, Mrs. Raines. It’s Dr. Agnew,” Hank said.
He fiddled with his pen, tapping his script. The pen’s cap bore a little ornament: a golden rod, overwrought by a serpent. Hank cursed the presence of such duplicity at the heart of medicine.
“I have to apologize, Mrs. Raines. I really wasn’t trying to deceive you.”
“You know,” Mrs. Raines interrupted. “I can’t believe in this century that you would practice such patriarchal crap. Why didn’t you just order me to stay in bed for six months?”
“Mrs. Raines,” Hank said, “I wasn’t ignoring your pain.”
“What do you call giving me a calcium supplement? Did you think I’d be fooled by the fancy name?”
“I really apologize,” he pleaded. “But it wouldn’t have worked if I told you.”
“That’s what my tax attorney should say. Not my doctor.”
“I was trying to ease your pain. I just thought we could do it without painkillers. They’re not always the best thing. And the placebo effect works.”
“By making me look like a fool?”
Hank’s pale fingers clenched the pen. He wanted to hurl it across the room like a dart. In the earpiece, his patient drew a deep breath. When she spoke again, her voice was quiet, controlled. Hank began winding the telephone cord about the pen and his finger.
“I happened to have brunch yesterday with some friends. We talk about our health, you know.”
She was quiet, then, as if to herself, Mrs. Raines continued.
“They probably think I’m a hypochondriac. Panaxetrone,” she said with disgust. “No wonder they never heard of it.”
“I can give you information to prove it. Your husband can tell you,” Hank insisted. He wound the cord tighter, now wrapping it around his hand.
“It’s the secret shame of medical science,” he said. “A double-blind test for a new drug yields a seventy-eight percent success rate, but they have to ignore the sixty percent of placebo patients who got better just as quick. It happens all the time. In 1956, in trials, the FDA…”
And Hank released a flood of knowledge–facts, numbers, dates, and a roll call of chemicals. It flowed from a dusty closet in his mind, packed with scores of late nights studying. Knowledge culled from dense volumes that would be impenetrable to Mrs. Raines. Precedents tumbled out, expanding like sweaters from an overstuffed suitcase. Hank transformed them into glittering proofs. The earpiece was silent as the doctor laid bare the mechanics of his art.
Or so Hank made it seem. His brain held hundreds of these closets, each similarly cluttered. Mrs. Raines could never have sorted out the whole truth from such a mess. But, Hank hoped, it was the illusion of truth that would set them free.
“Incredible,” said a voice in Hank’s ear.
He paused midway in the relation of a 1994 case where a patient’s liver was destroyed from unnecessary pain medications.
“I’m sorry?” Hank asked.
“You
hear about all these drugs flying around, but no one really knows
who’s giving what to whom. Or what it does. We all just want a
cure.”
“Sometimes there is no cure, Mrs. Raines. Panaxetrone
wouldn’t cure you, but I wasn’t lying. It does work wonders. As a
placebo. There’s just no real explanation why. ”
The line was quiet. Hank bit the pen that was now pinned to his hand in phone cord.
“So,” Mrs. Raines said. “Like usual, it was my husband who screwed things up.”
“Yeah,” Hank replied. “You should sue him for malpractice.”
The patient laughed, uneasily at first. She was still unsure. But she let go.
“Take care of yourself, doctor.”
“You too, Mrs. Raines.”
Hank hung up the phone.
He stood triumphant, arms raised in victory. The telephone cord, wrapped about his hand, tugged the phone from his desk. It crashed to the floor, striking the intercom button. Helen’s voice rose above the clatter.
“Your patient’s waiting in room 2, doctor.”
Rosenbaum visited later that day. Hank was doing paperwork, keeping his patient records in order. Today he’d begun to keep personal notes, little factoids about his patients–jobs, names of children, whether they loved their spouses. The fact that a patient played racquetball now seemed more important than the resulting tennis elbow. “Curing,” Hank formulated, “is less about the cure and more about the –ing.”
As Rosenbaum sat, Hank made a final mark and closed one of the folders piled on his desk. He patted them together into a flush and orderly stack.
“Saved the day?” Rosenbaum asked.
“I guess so.” Hank replaced the cap on his pen and lifted it to his lips. He kissed the inextricably snake-wrapped rod.
“What you mentioned earlier, about starting my own practice?” he began, meeting the elder doctor’s eyes. “What did you mean? It wasn’t Mrs. Raines. You would have done the same thing, right?”
“Absolutely,” Rosenbaum answered. “Panaxetrone’s become the cornerstone of this practice. But I think I’ll have Helen get rid of the packaging, put them in anonymous bottles.”
“Name brand recognition sort of defeats the purpose,” Hank said. “I don’t think I could bullshit my way through placebos again.”
“It’s not what you want to do,” the elder doctor said, raising one bushy eyebrow.
Hank didn’t know what his mentor was saying or asking.
“You know, I should be retired,” Dr. Rosenbaum said. “I’m lucky I’m still able to practice medicine. But, that’s not why I still do it. Not the medicine.”
“Why then?” Hank asked.
“It sounds cheesy but it’s the people. The patients.”
“Curing,” Hank said in what he considered to be his “New Age” voice, “Curing is also about caring.”
Hank wanted his mentor to chuckle. There was something morbid in his elder’s voice, something old in his speech. Hank saw Rosenbaum as a mentor. Never as an old man.
“But that’s not why you got into medicine, is it, Hank?”
“Well, after the money…”.
“Look. I used to leave the house each morning, shouting, ‘Time to stamp out disease!’ I was only half joking. I did want to cure people. That’s why you became a doctor, isn’t it? To struggle with disease? Cure people at one blow?”
Hank nodded wearily.
“I wasn’t telling you to leave my practice. But if you’re like I was at your age, you’re probably thinking about it.”
“I’ve thought about it,” Hank said. “Just thought I’d take over when you kick off.”
“Why? So you can take care of Mrs. Raines for the rest of your life?”
The older man’s reply came harsh, like a cuff to Hank’s ears.
“You’ve got to be your own triage, Hank. There are people who need you to cure them, and others who just need a doctor to help them through. You’ve got to decide who it is you want to help.”
At
the end of the day, Hank stood in the examination room finishing
paperwork. Helen entered to tidy up. She removed the length of
sanitary paper from the exam table. The paper crinkled as she balled
it up and pushed it into the wastebasket. The basket overflowed with
the stuff. Helen unrolled
another length of paper and laid it over the table, tucking it under a
plastic strap that held it in place.
“This stuff really do anything?” Helen asked.
“It keeps the surface sanitary,” he said.
“Makes a hell of a lot of trash,” the nurse rejoined.
Hank nodded. The crumpled paper Helen had squeezed into the trash had expanded, pushed back up, out, and had fallen to the floor. So thin, the paper could have been scraped from a tremendous python; the wastebasket a heap of reptilian skin. Hank imagined a giant caduceus, the snake uncurling and slithering off its wand. He remembered now why the snake was originally associated with medicine. It was because the snake was believed to live forever. By performing secret rejuvenating rites. It was because the snake sheds its skin.
Published: November 2, 2003