The Yale Journal for Humanities in Medicine

Laocoön

Jeff Seymour
jeffseymour@aya.yale.edu

“You said how many days?” Dr. Hank Agnew asked.

“At least a week.” Mrs. Claudia Raines shifted on the examination table. The paper sheet beneath her thighs clung to her skin and crinkled as she fidgeted.

“Dull pain in your lower back,” he said.

“But inside.”

“Right. Inside.”

The young doctor turned the sheet of his clipboard and scribbled. His pencil scratched in the white light’s buzz and behind him the sanitary paper crackled.

“Well, Mrs. Raines,” the doctor said, “I had a patient earlier this week with similar symptoms.”

“Something must be going around,” she said.

Dr. Agnew looked at her through his oval rims. His eyes seemed to gaze at his own lenses. Claudia turned her face to the left and right. Then, as if suddenly bored, she tilted her eyes up to the doctor, open for inspection.

“Oh, I don’t– Sorry,” the doctor said. “I was just thinking. I gave my other patient some samples…”

He turned back to the counter. The white linoleum offered cylinders of sterile swabs and tongue depressors, a box of rubber gloves. Dr. Agnew rummaged through the drawers and cabinets while Mrs. Raines dangled her feet above the floor.

Claudia Raines was a grown woman and married–a full member of a rational society that holds doctors in the highest regard but no longer finds the aura of medicine enchanting. When the doctor spun around clutching a fistful of little blue cartons, Mrs. Raines remained unmoved. She was used to getting something from nothing.

“Here,” the doctor said. “Panaxetrone. Our new wonder drug.”

“What does it do?”

“Frankly,” Dr. Agnew said, “they’re not entirely sure how it works. But it will help ease your pain and promote your body’s natural healing. And,” he said, shaking one of the boxes, “no side-effects.”

“Is it antibiotics?” she asked. She believed in her own knowledge and knew to look a gift horse in the mouth.

The doctor concentrated on his clipboard. He shook his head.

“You may get dressed, now.”

Dr. Agnew scribbled away as Mrs. Raines rose from the table. The paper stuck to her skin; she blushed as she pinned it down behind her.

“Well, do I need a prescription?” she asked.

“Those samples should be enough. Two a day until you’re out.” He looked up and said with a smile, “But do give me a call in a couple of days.”

“Okay, then,” she said. “Thank you, Dr. Agnew.”

“No problem. I hope you feel better.”

Dr. Hank Agnew lifted his glasses and pinched the bridge of his nose. Focus washed from his eyes. A weary soldier in the middle of a tired war. Patients like Mrs. Raines made Hank question his work. And in the affluent Connecticut suburb, there wasn’t often another kind.

Holding up a box of Panaxetrone, Hank shook his head. The ethics were easily parried. How many people would have died had they not begun using penicillin until its chemistry was completely understood? If it worked and had no side effects, surely withholding it would be unethical. Only, Hank knew exactly what Panaxetrone would chemically do for Mrs. Raines: nothing.

That night, Hank took his wife, Sarah, and their two children, Daryn and Paul, to their favorite Sicilian pizza joint. Before each meal, the waiters tore rough brown sheets from a roll and spread them across the dining tables. A plastic cup of broken crayons stood beside the salt and pepper. It was great for the kids. The pizza had less crust. And Hank could talk with his wife while the kids drew on the dinner table. They deserved this.

“Hank,” Sarah said, cutting a wedge from the square slice on her plate. “If it works, then it doesn’t do ‘nothing.’”

“Maybe,” Hank replied. “But what am I doing?”

He stared in that way of his, watching his own eyes reflect in his lenses. 

“Nothing,” he answered.

A glob of tomato sauce escaped the corner of his mouth and plopped onto his khaki pants: a liquid period.

“Come on. You’re a doctor. What are you, fishing for compliments? Doesn’t TV deify you enough, already?”

Sarah dabbed a napkin in her water glass and wiped away the blob of sauce.

“You help people,” she said.

“What do I do, Sarah?” he protested. “If they have a real problem I just send them to a specialist. ‘Hi, nice to see you again, how are you, oh, your throat? I’m sorry. Here’s the number of a great ear-nose-and-throat guy.”

“Oh come on.”

“Stomach pains? I know this wonderful gastroenterologist. Really, top of the field.”

Sarah rolled her eyes.

“Infection? Take this to the pharmacy.’ Jesus, Sarah, I’m a middle man!”

“Don’t be insane,” Sarah said, with a tight smile.

“A glorified paper shuffler– ”

Sarah cut him off.

“The wives of middle men didn’t work their asses off to put their husbands through medical school.”

“A-a patient shuffler,” Hank said, quietly.

 “Is this your mid-life crisis?” Sarah asked. “Because, you’re early. Put it off a couple years; maybe it won’t be so pathetic.”

But after a moment she gripped his shoulder.

“Hank, you’ve devoted your life to helping people. Where is this coming from?”

“I don’t know.”

“Look, daddy.” Their daughter, Daryn, tugged at his sleeve. Beside her napkin, she had rubbed a thick streak of green crayon onto the paper-covered table and decorated it with a rough red spiral.

“It’s beautiful, honey. What is it?”

“A ca-du-ceus.”

Hank and Sarah looked at each other, incredulous, and laughed.

At home, the kids were wired from dessert. The parents waited for the sugar to fade, for the kids to crash, before putting them to bed. “No point fighting chemistry,” Hank would say. Better to let chemistry do your work for you. Even if it was just sugar.

Sarah called him into the kitchen. She held out a square piece torn from the restaurant’s disposable tablecloth. It was Daryn’s drawing. Had his three-year-old known she was drawing a snake? She was terrified of them.

“I’ll put it on the fridge,” Hank said.

“Wait.” Sarah took a pen from a drawer and wrote “caduceus” in block letters below the picture. The word transformed the green and red crayon into a rod wrapped in a snake, the symbol of Hank’s profession. Why snakes?

“Here,” Hank said. He took the pen and scrawled “by Daryn.” He pinned it to the refrigerator and stepped back. Hank’s letters ran across a dark oil stain that rendered the last three letters illegible.

“By Da,” Sarah read.

“God I hope she doesn’t become a doctor,” Hank said.

Socked feet stomped into the kitchen behind them. Husband and wife came to attention. Paul stood, silent, his face a pantomime of agony.

“My tummy hurts,” he said, holding his belly. The boy could twist his features into the most repulsive pleas for sympathy.

“Well you shouldn’t have been so greedy at dessert,” Hank said. “I warned you what would happen.”

“Hank,” Sarah admonished. “We said they could.”

“Hey, if he wants to know why his tummy aches…?”

“I don’t think he cares,” Sarah said. “Just make it better.”

Hank sighed.

“All right, sport, come on.” He lifted his son into his arms. “Let’s see what magic daddy can do.”

The next morning, Hank sat in Dr. Rosenbaum’s office for their weekly chat. Rosenbaum had raised a number of young doctors in his twenty-year-old clinic. He enjoyed working with those fresh with passion for medicine. It was still a mission, a crusade. Although he continued to work everyday, the seventy-one-year-old Rosenbaum considered himself, in some ways, to be retired. At least from medicine in the abstract.

“So, what’s up, doc?” asked Rosenbaum.

“My blood pressure,” Hank said.

“Well, Hank, guess what?” Rosenbaum rose to survey the suburban town outside his window. “You’re coming up on five years.”

“Is it? Already?”

“Yup. Next week marks your fifth year with the company.”

“The company,” Hank repeated. “Right. Do I get a plaque?”

“That’s ten years. After five, they usually buy themselves a Mercedes. And start thinking about their own practice.”

Hank tried to view his mentor’s features in the reflection of the window.

“So, you don’t have to buy many plaques, then,” Hank said.

“That’s the idea.”

Rosenbaum turned and faced the young doctor.

“You know, Mrs. Raines called this morning, quite upset.”

“Really?” Hank said, surprised. “The lower back pain?”

“Did you know that Mr. Raines is a cardiologist?”

“Oh, Christ,” Hank said. “Fuck.”

Dr. Rosenbaum looked up. Their eyes met through layers of spectacles.

“I gave her Panaxetrone,” Hank said.

“This isn’t a large town, Hank. Mrs. Raines’s opinion means something to a lot of people. Other clients.”

Hank left in a flurry of apologies and rushed to his own office. He pressed the intercom button on his phone.

“Helen,” he shouted, “hold my patients. And get me Mrs. Raines’s file.”  

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