“It’s too bad,” he says, watching me carefully to gauge my reaction.
I nod and continue looking down at the book. Ulcerative colitis: Ulcers, Large intestine, Continuous, Colorectal cancer, Crypt abscesses, Extends proximally, Red diarrhea, Sclerosing cholangitis (ULCCCERS).
“They’re idiots,” he says.
I don’t respond. I don’t ask him why he’s Googling this subject.
“You’d be more careful,” he says.
I put my headphones in to watch a lecture, but the earbuds act like stoppers, keeping the sentence replaying over and over in my ears.
I’m good at interpreting things, I believe. There are always multiple interpretations. You have such a pretty face. Interpretations: 1. The sentence ends with a period. 2. The sentence ends with a silent “but…” Choose the former, every time. Know it’s the latter, but choose to appear as if you believe it’s the former. Choosing the latter reveals a weakness synonymous with malleability. You’d be more careful. Interpretations: 1. As a physician, I would be careful not to obtain illegal prescription drugs. 2. As a physician, I would be careful when obtaining illegal prescription drugs for my brother.
Victoria, who is gunning for a derm residency and generally acts as if she is in a private, post-coital conversation with whoever is the most powerful person in the room, shoots her hand up. “When I was really little, I really wanted a puppy,” she begins, maintaining eye contact with the professor and biting the side of lower lip while she pauses. Her makeup is ringed around her eyes; her hair oily but curled. She’s talking about how she got the puppy she wanted, but it ran away. I remind myself not to compare her pain to the world’s pain, which we learned in Humanity in the Medical Arts is called “minimizing.” It is neither respectful nor beneficial for the physician-patient relationship. Everyone has their own pain and their right to feel that pain. It is our job to Name that pain, Understand that pain, Respect that pain, and Support that pain (NURS).
“Any thoughts?” the teacher says when Victoria is finished. Her eyes are shining and she is looking around expectantly for feedback. Medical students love feedback.
“What I appreciate about this assignment,” says Adek, “is that just as patients are forced to share their most vulnerable moments with us, even when they don’t want to, so we are being forced to share our most vulnerable moments with the class, even though we don’t want to.” I like Adek. I admire the way she has mastered the feeble, passive-aggressive rebellions that pop from us second-year medical students like the last couple of air bubbles from a drowning man.
“Would you like to go next?” the teacher asks.
Adek shakes her head no without looking up from her computer. The kid next to me, James, quietly clears his throat before speaking in his even, low tone. James rarely talks, and when he does, he clears his throat first, like the small fluttering of a stage curtain just before it opens. He’s from some very small Appalachian town that seems like it would make very good reality TV: barefoot kids in overalls and grannies with no teeth, arguing and carrying on, kegs being tapped at the happy weddings of first cousins. James always has something interesting to say, such as that he used to work in a mine. That he is 24 and has two babies with two women. That he majored in fine arts at community college. And, most interestingly, that he is here, somehow, this little medical school filled with future second-, third-, fourth-generation doctors, and that he is doing quite well.
James is cheating by telling a story that is about someone else’s vulnerability, but because it is a sensitive topic, no one calls him out. He is talking about his girlfriend’s struggle with an eating disorder. I find myself wondering: Did she make herself feel Sick because she felt uncomfortably ill? Did she worry that she lost Control over how much she ate? Did she ever lose more than One stone in three months? Did she believe herself to be too Fat when others said she was thin? Did she find that Food dominated her life? (SCOFF.) Then I wonder how much one stone is.
On my computer, a message comes through on Facebook from my friend Anne. “Do we have to write a note after the prostate exam today?” she writes. Fuck. Somehow, I had forgotten that was this week. I had been telling myself for so long that it was so far away.
I quickly check the online schedule for our clinical skills class, where we dress up in our short white coats and pretend to be doctors with people who are paid to let us examine their bodies. I’m scheduled to perform the practice prostate exam today. But I see there’s another session tomorrow—I can delay it for another day. “Idk,” I write back to her. “Mine’s tomorrow.” I can see the bubble of her text starting and stopping, starting and stopping. “I thought you were today with me?” she finally sends.
I close the chat window, annoyed. I’m annoyed that she knows I’m lying about the schedule. I’m annoyed that she knows I don’t want to do the stupid rectal exam on a fake patient. I’m annoyed that she knows anything about me. I download the form to request a reschedule and write that I have a migraine.
My teacher can see that I’m not paying attention, so he calls on me. “Lindsey?” he says. “Care to share?”
I don’t mean to say it. Maybe it’s because I’m writing the word on the rescheduling request form when he calls on me. Maybe it’s because the phrase has been pressing against my lips all semester, rattling around in my head every afternoon as we dissect dead bodies in anatomy class, burning there when we learn about empathy in classes like Intro to Dying. Maybe it’s because I need Anne to stop thinking that she needs to take care of me because she’s the only person at school who I once, accidentally, drunkenly, orientation-weekend-ly, told. I don’t know why I do it, but I do: “My dad died of prostate cancer.”
There is a moment of silence in which I see everything in extreme detail. I can hear blood rushing in my ears. Victoria’s eyes are wide, her eyeliner making them look panicked. Adek’s head is sympathetically tilted in a way that seems genuine. James is staring at his computer. I see the results of the latest Medscape Physician Compensation Survey on his screen.
Tears are welling up in my eyes, and when I realize this, the flash of anger is so strong that I feel heat radiating from my face.
Finally, Victoria, beautiful, future dermatologist Victoria, saves me. “Well, actually...you don’t really die from prostate cancer,” she starts with polite hesitation. She begins to recite from memory: “The vast majority of prostate adenocarcinomas are indolent lesions that will never cause harm. In fact, overtreatment of prostate cancer adversely affects patients’ quality of life and exacerbates the financial burden of our national health care needs.” She looks to the teacher for feedback with wide eyes, like the little puppy that ran away from her.
I love this response. I love all of this. I smile, and then laugh, and the movement of my face makes my tears fall, but more do not come. This is what I need: this space, full of facts and big words, a space as thick as the textbook Robbins and Cotran Pathologic Basis of Disease between me and my pain.
You’re right, I want to tell Victoria. My dad is at home. He’s working on a car with my brother. My brother is sober. He’s still thinking about taking computer classes to make a website for my dad’s auto shop. He’s still thinking of ways to make my dad proud. My mom is making dinner. I come into the kitchen to help her and she kisses my forehead. You look pretty, she says. Is that the sweater I got you? she says. I want to tell Victoria this so bad. The scene is so real, I wonder if I’ve seen it in a sitcom, or if it’s a wisp of some childhood dream still trapped in my hippocampus.
The teacher looks at me with real concern. I look away. “I’m sorry to hear that,” he says.
The room is too silent. I wish I could change the subject. I try to think. I feel so nauseated.
I see a Google chat message from Adek pop up on my computer. “I’m so sorry about your dad,” she writes. “That sucks so bad. What was his PSA level?”
Etiologies of nausea: Anticipatory/anxiety, Vestibular, Obstructive, Metabolic/Medication, Infection/Inflammation, Toxin/Tumor (A VOMIT).
The Humanity teacher looks at the other students. “Let’s use this as a learning moment,” he says. “If you had a patient who just shared something very personal with you, what would you do?”
“NURS!” Victoria says immediately.
That sounds like pain. We understand your pain. We respect your pain. We support your pain.
When I get home, I see he is passed out on the couch. Looking at him, the long, spindly body of my little brother, whatever restlessness has been beating against my ribcage all day seems to slip into resignation. His pill grinder sits on the glass coffee table, next to a credit card and a length of hollow white plastic that he sawed off of a Bic pen tube to use as a straw. There’s a little empty orange bottle with a bit of red liquid residue—the methadone he buys from addicts outside of the clinic. I brush fine white pill dust off the table and confirm the jump of the jugular venous pulsations in his neck and ensure that his chest is expanding and recoiling and note the flutter of his eyes tracking beneath his eyelids in REM, all the while telling myself that that’s not what I’m doing. I’m just tidying up.
There is an envelope on the counter from yesterday’s mail that I haven’t opened yet. It’s the same envelope that comes every month: white, business-sized, blue marbling printed inside, Florida return address, nothing inside except a check signed by my mother for the house payment and the utilities. She left a long time ago, before my dad got sick. She said she was going to visit her mom. Her own father had just died. She didn’t come back. I was young. I remember being confused. I remember no one mentioning it. One day, she was gone. I don’t remember the exact day, even. It was probably different in real life, but in my memory, there was a growing awareness that she had not been around for a while, and then a growing awareness that she was not coming back.
I asked my dad about it only once as an adult. He was sitting in his brown recliner by the window, where he sat all day and night toward the end, his bones too pained to move. He was very sick, but it was a good day. Austin was gone. I was desperate. I kept wringing my hands, wishing time was a thing I could grab and fasten around us both like a safety belt. As he spoke, I tried to describe his voice in my head, tried to transduce it into words I could hold on to. But every time he paused, I lost all memory of his voice, all sense of its fabric and tone. I felt panic. His eyes were closed and it made him feel so far from me. I asked about her without meaning to, while I was thinking about how I could get him to open his eyes and look at me.
His head dropped and lolled to one side at the question. I felt what it was to heap pain on a broken person, and my initial sensation of shriveling in shame was followed by the feeling of something leaving my body. I looked out the window, newly empty. “She was very young. Seventeen when she had Austin. She was a baby,” he said, finally. “She needed her mother for a while longer.”
I nodded. I knew that feeling.
My dad had always had a bad back. He blamed it on the hours he spent lying on a thin layer of foam underneath the classic cars he fixed up in his workshop. Most of the conversations I remember having with him were between me and his Caterpillar work boots as they stuck out from under a ‘67 Chevy or a Model T. Whenever he stood up and groaned, he said to Austin: “You’re looking at your future, boy.” Austin was in vo-ed classes then; his plan was to take over our dad’s car restoration shop. He was taking business classes, too. He wanted to expand the business by making a website to sell and trade parts across the country. Our dad, who didn’t understand the internet, told him it was a dying business. He scoffed at Austin’s plans to expand. He told him to do something useful with his life.
When I began thinking about applying to medical school, I knew it made no sense. There was no real reason—I liked television medical dramas, really, was the only reason. I knew my dad would think it was ridiculous. It took many nights of staring in the mirror at myself while I mouthed the words before I finally worked up the nerve to tell him my big plan. He was working on a lavender Studebaker that night. I became shy right before I was about to say it. I told myself I could tell him I was just kidding after I said it.
I was too quiet at first. “Huh?” he said from under the Studebaker. “What’s that now?”
“I was thinking about being a doctor.”
He stopped ratcheting the bolt he was tightening. I watched the steel toes of his boots, trying to get a read on his reaction. Suddenly he scooted out from under the car and peered out at me from under the light he wore strapped to his forehead.
“A doctor?” he said. His face was scrunched as if he were trying to see in the dark.
“And how you figure on doing that?” he said.
“I Googled it.” I felt a small, embarrassed smile on my face. “I just have to finish college and then you apply to medical school. They’re opening one here. Down across from Bronson. I don’t know if you heard. You have to, like, volunteer and stuff. And there’s a test you take.”
His face stayed scrunched, his eyes flickering with thoughts. I heard the snapping of the woodstove behind me and took a breath to say I was just joking, ha-ha, medical school, not me.
“Well I’ll be,” he said finally. “A doctor in the family!” He grinned before disappearing back under the Studebaker. “Welp, you’d make a good one,” he called out from under the hood. And then I thought: Maybe I would.
It was a few months, not until after Christmas I think, before Austin and I finally convinced him to see someone about his back. He hadn’t been a complainer before, but he couldn’t stop muttering about the pain. When he finally did see someone, he stopped complaining. He stopped speaking much in general. There were tests and more tests. The subject of Doctor Visits was avoided. Austin and I began talking more, but saying less. The silence had to be filled. If we were tired, we kept the TV on. When I try to remember those months, the scenes from our house weave together with scenes from The Wonder Years.
At dinner one night, he looked even more tired than usual. “They want to cut off my balls,” he said suddenly.
Austin and I stopped eating. It felt like it had been a very long time since I had heard his voice. It was different. I wondered for a second if I had heard a line spoken on the TV and had mistaken it as coming from my dad
“You ok, Dad?” Austin asked.
He looked at his plate for a few seconds. “They’re going to make me take something, and it’s going to cut off my balls.”
We all kept eating and let the TV fill our silence. I wondered if he was losing his mind.
It was leuprorelin. We learned about it last month, during the cancer unit. It causes your body to stop making one of the hormones that act in your prostate and your testicles. While I listened to our lecture about it, I thought of my dad at his doctor’s appointment that day.
“Typically, advanced, metastatic carcinoma is treated with androgen deprivation therapy,” I imagined the doctor saying.
My dad would have nodded. He would not have looked away from the doctor’s eyes. He had steady, unreadable, dark brown eyes. The doctor would have been the one to first look away.
My dad used to brag that he made more money with his auto shop than his high school class president ever ended up making, all without ever having read a book in his life.
My dad had once called me just to ask how to spell “nuisance.”
My dad used to write my name on a banana before work and leave it on the counter for me to take to school—sometimes Lindsey Lyn, sometimes Lindsay Linn, sometimes just Linsey. But always followed by “xo Dad.”
My dad would have nodded as the doctor spoke.
My dad would not have looked away.
“So we can do that, androgen deprivation, either by surgical orchiectomy, or pharmacological orchiectomy,” the doctor might have continued. “That last one, the pharmacological route, we give you a synthetic analog of LHRH—that’s kind of like, your sex stimulating hormone—leuprorelin, it’s called. This synthetic analog, how it works is, it’s tonic instead of pulsatile, right? So that’s going to suppress your normal LHRH, and then, basically, it’ll starve your tumor of androgens. You follow?”
My dad would have nodded again. He would have asked how to spell it. He would have written it down, carefully, making sure not to switch the i and the e. He would have gone home. He would have turned on the computer. He would have used his two pointer fingers to type the word into Google. He would have read: “or·chi·ec·to·my (ôrkēˈektəmē/) noun 1. Surgical removal of one or both testicles.”
Or my dad would have asked how to spell the drug, would have written it letter by letter. He would have gone home, pecked in into Google, clicked on the Wikipedia article, and read: “Leuprorelin has been used to reduce sexual urges in pedophiles. Leuprorelin is under investigation for treatment of mild to moderate Alzheimer’s. Leuprorelin is often used to delay puberty in transgender youth.”
My dad, too, would have wondered if he was losing his mind.
When it got bad, it was Austin who took care of him. The whole time. It was Austin before I noticed that he needed to be taken care of, and it was Austin who took care of him at the end, when I made an effort to avoid noticing.
Austin took notes on our father’s condition during the week and recited them to the hospice nurse when she arrived on Thursdays. The nurse gave him a small, white box, and told him to keep it in the very back of the fridge. She called it the Comfort Kit. It was full of things that must have sounded exotic to him at the time: lorazepam, Roxanol, promethazine. She told Austin to call her if our father was ever in great pain, and she would tell him what to take from the box and how to use it. But he was worried that he wouldn’t get through to her in time, or that he would make a mistake, and that our father would suffer. So he made a list of everything in the box, and he made her sit with him and explain when and how to use each and every drug.
Austin kept the Comfort Kit on his lap at first as he sat across from our father. At any groan, he anxiously offered him something from the box. Anything that might help. If he was awake at all, our dad would wave him away with an irritated hand whenever he offered him something from the box. He rarely spoke, as if he felt he might run out of words if he didn’t ration his last remaining ones.
When I was done with my pre-med classes, I would linger at the library. I really, really need to study, I’d convince myself. I would finish my homework and start the next exam’s material. When I was too exhausted to stay at the library any longer, I’d finally go home. I’d park on the street instead of the driveway, telling myself I didn’t want to wake up anyone in the house because I didn’t want to disturb them.
I would find my brother sitting next to my dad’s hospital bed in the living room, wearing the same clothes as the day before. There was always a buffet of juices: orange juice, Hawaiian punch, apple juice, plain water, anything he might suddenly have a desire for, all mixed with Thick-It powder so he wouldn’t choke as he sucked on the straws in the bed. There would be small plates of crushed saltines, bread soaked in milk, applesauce mixed with sugar, things the hospice nurse told Austin to try. My brother would look up when I got home, his eyes dark and red and big. Sometimes he was playing a game on his phone. Other times he was just looking at our father, his face tense as if trying to solve something in his head. He looked so different then, my brother. I think of him now, with his plastic pill crusher full of Percocet, his vials of bitter red methadone, his nostrils ringed with blue Adderall dust, and I think of him back then, with the little notebook where he neatly and exactly copied down the nurse’s instructions for timing and dosing of the Comfort Kit contents or the amount and color of the urine that collected in our father’s catheter bag or the millimeters of juice drunk from the glasses. Those months are the last time that my little brother looked younger than me.
My dad always woke up when I got home, no matter how late I returned or how quietly I opened the door. It was as if he waited for me. He would try to smile and say my name. “Studying?” he would say, phlegm making the edges of the word ragged. And I would walk over to his bed, nausea twisting my insides, and take his papery hand in mine. “Proud of you,” he would say. Every time. “‘Doctor Linds,’” he would force out, his lips sticking to his teeth as he attempted his old grin. And Austin would turn away from us to stare out the window, the glass of thickened cranberry juice sparkling in his hand, waiting for our father to want it.
“What’s up?” she says, finally.
I can’t tell if this meant to be normal small talk or a more significant inquiry. “I’m fine,” I squawk—I’m surprised and embarrassed to hear my voice. It’s devoid of its icy irony, newly friable with emotion.
I wish I were Catholic, so I could wear one of those saints around my neck and believe in its power. I would hold it between my two fingers and I would think: I’m not alone.
I’m fine, I repeat in my head.
I’m fine. I’m fine. I look around the room: the plastic clock on the wall, the concrete walls painted gray, the young, healthy bodies of Adek and Victoria. I’m looking for something of my dad. Just this once? I ask him. Don’t be gone?
But there is just the heavy metal door keeping us in the waiting room, the glow of Victoria’s iPhone, the voices in the exam room as they finish up and prepare to call me in.
I wish I were one of those girls you used to see on daytime talk shows who believed they were witches. I wish I believed I could speak to him beyond the grave. I wish the phrase “beyond the grave” didn’t make me roll my eyes.
I think of his smile when I came home from studying on those late nights. He saved his energy by ignoring Austin’s fussing, and he spent it on me. His mouth sticking to his dry teeth: “Doctor Linds.” Even when he couldn’t smile anymore, his voice still had that shell of amused pride.
I wrap my arms around my stomach as if to hold this memory in, rocking forward.
The truth—I can remember his face, his mouth, his skeletal hands reaching for me, because I have remembered them so many times before.
I can’t remember his voice. Not his exact voice.
If I try too hard, the sounds dissolve like sugar in scalding water. My mind fills in the blanks with the voices of celebrities or operators or cashiers.
I wonder what it is that Austin sees when he’s high. Is our father there in the warm haze? Am I missing out on being with him again? Making the same mistake of spending my time behind books because I don’t know how to tell him that he is everything, that I need him, that he can’t leave?
I wish I were like the African people I once read about, the Malagasy, who exhumed their dead every few years just to say hello.
Nothing inside of me makes sense, but the clock on the wall does: gently, calmly, knowingly, it ticks.
I sit with my arms wrapped around myself, waiting for the voice on the other side of the exam room to call my name.