So Much for That (47 page)

“It’s called peritoxamil,” said Goldman, “also known as—”

“Cortomalaphrine,” Shep said sourly.

“Come again?”

“Never mind. In-joke.”

“It’s in phase-three trials, and is showing a lot of promise. Not for mesothelioma, but there could be some crossover effect from therapy for colon cancer. Now, I’m afraid that your wife is—isn’t qualified right now to participate in the clinical trials themselves, but—”

“You mean she’s too sick,” Shep interrupted again. “Since she’s a goner anyway, she’d drag down the cheerful statistics.”

“That’s a harsh way of putting it, but—”

“I like a harsh way of putting it. Let’s put it that way, then.”

Goldman eyed his patient’s husband with a nervous side glance. Shep Knacker had always been so docile, so cooperative. But the doctor would have seen all manner of reactions to extreme medical circumstances, and maybe belligerence was a standard variation.

“The point is,” said Goldman, “we can appeal for the drug’s release for compassionate use. Explain that we’ve depleted the traditional arsenal at our disposal. I grant it’s a long shot, but it’s all we’ve got. Frankly, at this juncture there’s not much to lose. One small downside, however.”

“It makes your head fall off.”

Goldman’s half smile was unamused. “Not a side effect—except for you. Since peritoxamil isn’t FDA-approved, it’s not going to be covered by your insurer.”

“Uh-huh. And how much does this new snake oil cost?”

“For a course? In the area of a hundred thousand dollars. Fortunately, it’s in capsule form, so Mrs. Knacker wouldn’t have to come in for treatments.”

“A hundred grand. There’s ‘not much to lose’? I guess I’m not in your income bracket. Since that strikes me as losing a whole lot.”

Goldman seemed taken aback. “We’re talking about your wife’s life here—”

“Jim!”

The doctor shot him a worried look. “I have to assume that money is a secondary issue at best, if it’s an issue at all.”

“So if I say it is an issue, I’m an animal, right? But even if I fall in line and say, by all means, doctor, do anything you can, throw the kitchen sink at that cancer—a gold-plated kitchen sink—because I love my wife and
money is no object.
Why do you assume I’ve
got
a hundred grand?”

“It’s often possible to take out a personal loan in such cases. Mr. Knacker, I know you’re under stress, but I’m concerned about your combative tone. You don’t seem to appreciate that we’re on the same side here. You, Mrs. Knacker, and everyone in this hospital are united in a common cause.”

“Are we? So what are you trying to achieve?”

“Obviously, I’m trying to extend your wife’s life for as long as possible.”

“Then we’re not on the same side.”

“Oh? What’s your objective, then?”

“To end her suffering as soon as possible.”

“It’s really Mrs. Knacker’s decision, when she wants to call off further treatments. But when I spoke to her about peritoxamil, she sounded keen to try it. Obviously, we’ll make every effort to keep her comfortable. But to talk about…Well, simply planning to ‘end her suffering’ once and for all is defeatist.”

“Fine. I am defeatist,” Shep announced. “I have been defeated. I admit it: mesothelioma is too big for me. If this really has been a battle,”
with weather,
he thought, “maybe it’s time to lay down our arms. As for that being my wife’s decision, I realize she’ll try anything. But it is not my wife’s decision if she’s not the one who’s going to pay for it.”

Goldman was overtly discomfited by this kind of talk. He kept averting his gaze, working his face without concealing his disapproval, and edgily hitting his keyboard’s space bar. Shep got the impression that making a medical decision of any magnitude in consideration of how much a treatment
cost
, in mere money—“only money,” as his father would say—was crude, foreign, and offensive. “I want to be very clear, Mr. Knacker. This drug is our last hope.”

“I was fired yesterday, Dr. Goldman. I just lost my job.”

It was interesting, the subtle but discernible change in the internist’s demeanor, once he registered the implications. “I’m sorry to hear that.”

“I bet you are. But I’d been repeatedly absent and late for work. My wife’s illness alone has substantially raised the health insurance premiums for my employer. As the former custodian of that company, I applaud my being dropped from its workforce as an astute business decision.”

“That’s an awfully understanding spin to put on your own misfortune.”

“I am known,” said Shep, “for my
understanding.
But as a result of my early retirement, the World Wellness Group will not only neglect to
pay a hundred K for pterodactyl, or whatever it’s called, but it won’t be paying your bills, either.”

“I see,” said Goldman. “And I infer that your personal resources are somewhat depleted.”

“
Somewhat
? You could say that.”

“With what you just informed me, I can see why you might be feeling a little angry.”

“No, you do not see. Getting fired was the nicest thing that’s happened to me in over a year. But you’re right that I’m ‘a little’ angry. I realize this is just what you people do. It’s the way you’re programmed. You just keep plowing through the drugs, working down the list, keeping everyone’s chin up, looking on the bright side,
never saying die
. My wife, for example, never says die. Honestly, I can’t remember the last time I heard her use the
d
-word. Nobody in this biz is ever supposed to throw up their hands and call it quits, so long as there’s any last teensy-weensy, teeny-tiny smidgeon of a chance that some new therapy will eke out a few extra days. So you’ve just been following the script. But can we, for once, with Glynis not here, drop the pretense? This ‘experimental drug’—you don’t
really
believe it would make any difference, do you?”

“I did say it was a long shot.”

“What are the odds? Fifty-to-one? Willing to put any of your own money on that?”

“It’s hard to put a number on. Let’s just say the chances are
distant.
”

“Me, I wouldn’t put a hundred grand on ‘distant’ even if I were a betting man. Would you?”

Goldman declined to answer.

“Secondly, let’s skip the ‘I don’t believe in making prognoses’ thing. You’ve been around the block. You know more about mesothelioma than anyone in the country, you’re an expert. So tell me: how long has she got?”

The expression on Goldman’s face reminded Shep of wrestling as a boy in Berlin, when sitting on Jeb’s chest and pinning each wrist to the ground he finally got his friend to cry
uncle!

“Maybe a month? Possibly more like three weeks.”

Shep crimped forward, as if from a gut punch.

“I realize that’s difficult to hear,” Goldman continued softly. “And I’m very, very sorry.”

Three weeks was within the range that Shep had forecast himself, but it was different hearing the bleak estimate from a doctor. It wasn’t possible to keep being pugnacious, aggressive, and hostile, although as the humor slipped he knew he would miss it. This appointment excepted, the amount of his life that Shep Knacker had spent being pugnacious, aggressive, and hostile probably totaled under five minutes.

As Shep recovered himself, the doctor filled the silence. “I think of all the patients I’ve ever had, your wife may have shown the most tremendous spirit. She’s put up a remarkable, a truly admirable struggle.”

“That’s nice of you to say, and I realize you’re trying to pay her a big compliment, but…this way of thinking…”

Shep stood up, and paced the small patch of carpet before the door. “
Struggle
.
Surmounting
the odds. Like, the online support group that Glynis joined for a while was always talking up
hanging tough. Refusing to let go. Not giving up. Going the last mile.
You’d think they were organizing a grammar-school sports day. Dr. Goldman, my wife is very competitive! She’s a high achiever, a perfectionist—which is why, though it doesn’t seem to make sense, she hasn’t been as professionally productive as she would have been with lower standards. A striver like that—how’s she not going to rise to this stuff? And then you guys jack up the stakes even more. It’s not just a potato-sack race, it’s a war. The
battle
against cancer. The
arsenal
at our disposal…You make her think that there’s something she has to do, to be a
good soldier
, a
trooper.
So if she deteriorates anyway, then there’s something she didn’t do: she didn’t show courage under fire. I know you mean well, but after all this military talk she now equates—dying—with dishonor. With failure. With personal failure.” It was the first time that Shep had put it together for himself.

“The military language is just a metaphor,” said Goldman. “A way of talking about medical issues that laymen understand. It’s not meant to hold the patient accountable for a therapy’s results.”

“But for Glynis, when you ‘admire her struggle’ she thinks you blame her when it doesn’t do any good, don’t you see? That’s why she won’t quit. That’s why she and I can’t talk about…well, anything.”

“I see no reason for her to ‘quit.’ Glynis—Mrs. Knacker takes heart from her tenacity. Since I’ve come to know her somewhat, I think I’d counsel you to keep my prognosis to yourself.”

“What’s one more secret?” Shep said morosely, plopping back in his chair. “Though that’s a fucking big secret.”

“I’m only thinking of preserving the quality of the time she has left. Keeping her upbeat.”

“But won’t she know? What’s going on in her own body?”

“You’d be surprised. Not necessarily. Still, I’d advise you to contact her family and friends. Underscore that we’re talking days or weeks but not months, and they mustn’t delay a last visit. So they can say goodbye.”

“What good is saying goodbye when you can’t say goodbye?”

“Pardon?”

“If we’re not telling Glynis, nobody can say goodbye. Not even I can say goodbye.”

“Well, sometimes
hasta la vista
is just as warm, but it’s easier to hear, isn’t it? And we say, ‘See you later,’ to all kinds of people whom we’ll never meet again, really.”

“I guess,” Shep said reluctantly. “Maybe you’re right, Glynis doesn’t want to hear it. She sure hasn’t wanted to hear anything else.”

“I suppose I can see why you might want to pass on the peritoxamil. But she was very eager to take it. If you want to keep her on an even keel I could prescribe a placebo.”

Which really would entail treating Glynis like a twelve-year-old on “cortomalaphrine.” His wife’s final days being webbed in a skein of deceit depressed Shep more than he could say. “Maybe. I’ll let you know.”

“Meanwhile, keep me apprised of her condition, and contact me if you need any advice about how to keep her comfortable.”

“There is something you can do,” said Shep, looking at his lap. “I really don’t want her to die in a hospital. But also I don’t want her to
experience any more pain than she has to. I’d like something to—ease the end.”

“There’s nothing easy about the end. It can be very unpleasant. Professionals have a better chance of keeping her comfortable.”

Repeated at least three times now, the set phrase jarred. Shep suspected that the medical establishment’s usage of
comfortable
strained the definition of the word.

“Are you sure you don’t want to reconsider, about the hospital?” the doctor pressed. “You feel strongly about this?”

“I do. And I honestly think that if Glynis ever faces up to what’s happening she’ll feel the same way, too.”

“Painkillers are controlled substances. We’re closely watched by the FDA. I can’t hand out capsules willy-nilly, because of the danger of addiction.”

“The government is afraid that my wife will become a drug addict when she’s
dying
?”

Goldman sighed. “I grant it’s not all that rational…” He bit his lip. “This is a little risky…But I suppose I can give you a prescription for liquid morphine. It’s not complicated. Just a few drops on her tongue when she seems—”

“
Uncomfortable
,” said Shep, with a trace of his earlier sourness. He stood up. “Thank you. And what I said before, you know, my ‘tone’—I didn’t mean that I’m not grateful.”

“I know you’re grateful, Mr. Knacker. And I’m sorry I haven’t been able to do more for your wife. We’ve tried everything we could—as you observed. But mesothelioma is a virulent, deadly disease. It’s not for nothing that
asbestos
means ‘inextinguishable’ in Greek. And you’re a repairman, so you understand: there are only so many tools in the toolbox.”

After they’d shaken hands and he was leaving, Shep turned back in the doorway. “One last thing. The surgery, all the chemo. The blood transfusions, the chest drains, the MRIs? According to my calculations, Glynis’s medical bills for all these treatments already come to over two million dollars. That sound about right to you?”

“It’s plausible,” the doctor conceded.

If in a moment of idle perversity Shep had worked out that so far they’d paid over $2,700 per day, he’d also estimated that Glynis would often have paid that much to skip one. Of course, he couldn’t vouch for the comparative awfulness of her disease left alone to its evil devices, but as for whether the cure or the cancer had been worse it was at least a contest. “So what exactly did we buy? How much time?”

“Oh, I bet we’ve probably extended her life a good three months.”

“No, I’m sorry, Dr. Goldman,” Shep said on the way out. “They were not a good three months.”

B
ack in Elmsford, Zach had left a message from Rick Mystic, leaving the lawyer’s home number. Since Carol and the girls would be arriving in an hour or so, Shep returned the call in his study right away, closing the door.

Rick got straight to the point. “They want to settle.”

They did not, for once,
sort of
want to settle. “That was quick.”

“These kind of cases can drag out for years, but when they move they can change your life in an afternoon. I bet Forge Craft’s people were kind of impressed by your wife’s deposition. But they were also kind of impressed by her—condition.”