The Patient (10 page)

‘Did you know that Michael retired today?' Michael was one of the hospital's urologists.

‘No, I did not,' I replied.

‘We'll be advertising his place shortly, but it will be a mixture of an academic position and private practice. Do you think you'd be interested?' he asked, knowing the answer.

‘Absolutely!' I replied.

‘What about Switzerland? Didn't you have a job lined up there?'

‘It was tentative at best.'

Virginia came running towards me in the corridor. ‘Do you think you could please come back and write up Mr Zudarsky's notes? He needs to be pronounced dead.'

‘You go on. I'll be fine on my own,' said Jacob. ‘I just have one patient to see.'

I returned with the nurse and wrote in the notes of the dead man, because without me writing, he was not officially dead. My thoughts were full of hopes for what lay ahead. Becoming an academic and a consultant at the Victoria Hospital would be a major achievement. How fantastic it would be to achieve my life's ambition. I wrote the words quickly: ‘Respiratory arrest. No heart sounds. No response. No pulses. Patient expired 7.18 pm.'

Life, death, hope and failure: this was the human condition.

When Jonathan went home the next day, he was immediately comforted to be in his own space and to see his own bed, with his own sheets. The girls were at school, and Tracy was running errands, so he was at home alone.

He pressed the button on the answering machine and held his pen ready to take down numbers and messages.

The first message was from Jake: Jonathan was to worry about nothing; everything was under control in the office; just relax and get better. Jonathan had a sinking feeling in the pit of his stomach. Evil was afoot. His job was under threat.

Ill at ease, he walked over to the door that led to the garden, passing various luxuries and chattels he and Tracy had bought during their married life together – a spending orgy that had accelerated when his income had increased and then again when his promotion had come through. He felt a deep paranoia about the possibility of losing it all. Jake's tone on the answering machine was one of triumph. Jonathan walked outside to get some air and have a quiet smoke.

Tracy had employed a gardener, an Indian-or Pakistani-looking man, who was raking leaves into a pile.

‘Good morning, sir. I am Ahmed, the gardener,' the man said, clasping his hands together in a praying pose above his head. Jonathan felt an obligation to clasp his hands together too. ‘I'm very sorry to hear your news. I hope you're well now.'

‘Yeah, yeah, I'm fine, thanks.' After his days in the public hospital, he was touched by the man's compassion; they'd never even met before.

‘Allah takes care of all,' replied the gardener softly and went back to his raking.

It was the kind of thing his father might say – ‘God takes care of all'. Jonathan had always rejected his father's view that Christianity was the only truth, the only way. He had always believed that maybe the wisdom contained in the Bible was no different from that in any other holy book, no matter the religion or the language it was written in. Perhaps there was only one essential truth – such as love, for instance. The love this gardener felt for his children – was it any different to the love Jonathan felt for his girls? He guessed not.

Now that he had been forced to stop, forced to think about things, Emma and Kate were much on Jonathan's mind: he couldn't help but feel he could've played a bigger role in their lives, and he found himself wondering what kind of a legacy he was leaving them.

He sat down. He looked at the set of eight white designer outdoor chairs and remembered the day that he and Tracy had put them on their credit card.

What was his life all about? He'd helped Tracy create
Vogue Living
right here in the house, but if he died tomorrow,
what memories would he leave his kids with, what lessons? They deserved the wisdom and strength of a father who could see further than they could … and though he hated to admit it, maybe further than he himself could. ‘This house, this land, it's all just stuff,' he whispered to himself. What he really needed was wisdom – wisdom to hand down to his girls for when he wasn't here any longer.

Jonathan gathered his thoughts and looked behind him to make sure no one had heard him. He was deeply embarrassed to be thinking such airy-fairy and morbid thoughts. It wasn't as if he'd just been handed a verdict of certain death, after all.

As if to wash away his discomfort, Jonathan went back inside and took a shower. He stood under the stream feeling the healing warmth of the water all over his body. He placed both hands up on the wall and let the water blast onto his head. Even that couldn't stop thoughts of the gardener, his hands raised in prayer, thoughts of his father, his mother slowly dying in a nursing home, God, Allah, Jake, the operation he'd just had, the threat of cancer, his daughters, whom he hadn't seen for a week or more, the fact that he hadn't made love to his wife for over a month, his maxed-out credit cards, his used-up sick leave, Tracy's lack of clients.

When he stepped out of the shower, just as deeply troubled as he was before, he heard the phone ring.

‘I'll get it!' yelled his eldest daughter, Emma. The girls must have just got home from school.

‘Dad, are you home? It's the doctor,' she shouted up the stairs.

‘Thanks, sweetheart. Can you take a message? I'll be down in a sec,' he shouted through the en suite door.

Jonathan dried himself, put on his tracksuit and found Emma and Kate in the kitchen having a snack. He squeezed first Kate then Emma in a hug, and then both of them together. Emma said matter-of-factly, ‘The lady at the doctor's says you have to call urgently to make an appointment to come back and see him.'

He went to the study and dialled the urologist's number. ‘Hello, it's Jonathan Brewster here. I have a message to call and make an appointment.' Jonathan was breathless.

‘Can you hold the line?' the secretary said and then put him on hold without waiting for his answer. She returned a couple of minutes later.

‘Yes, doctor would like to see you about the results of your surgery. Could you come in on Tuesday morning at nine forty-five?'

‘That's nearly a week away! Is there nothing sooner?' Jonathan was beside himself with impatience and anticipation.

‘No, Mr Brewster. If there was something sooner, I would have told you about it. Doctor is operating all day tomorrow, and he is away for two days after that. The earliest is Tuesday. Can you make it, or do you need me to find a time later that week?' she asked.

‘No, no. That's fine. I'll be there.' Jonathan hung up; he'd given up on the niceties of ‘please' and ‘thank you' with the doctor's secretary, as there didn't seem much point.

When Tracy came home minutes later, he immediately told her the doctor wanted to see him on Tuesday about the results of the operation. Jonathan was walking down the stairs towards the kitchen, a zombie-like absence to his gaze.

‘Did he say anything?' Tracy was anxious to know. She clearly dreaded the worst.

‘No. It was just the secretary,' said Jonathan.

‘So, your test results aren't coming in till next week?' asked Tracy, confused about the wait.

‘I think he's got them already – it's just that he's not available to see me any sooner.'

‘God, doesn't he know how desperate we are to find out what's going on? Why is he making us wait? What's the point?' There was an edge of hysteria to her voice.

‘I don't know … the secretary said he was away for a couple of days.'

‘Yeah, it's OK for him to take holidays while we sit here sweating blood for the results. One minute, they say it's an infection or a stone, then maybe it's a tumour … oh, but they're not sure what kind. We still don't know anything!'

‘It's OK, Tracy. We'll make it through. We will make it through.' He was hugging her now; her head was on his chest as she sobbed.

Emma and Kate began crying too, and they came up and put their arms around both their parents.

Through the lounge-room window, the gardener looked in at the scene and with deep compassion in his heart said a prayer for the family.

The phone rang again. It was Jonathan's boss, Paul Carter. ‘How're you going, mate? Do you think you'll be back to work this week? Take as much time as you like, though. Everything's under control,' he said reassuringly.

‘I'll be in tomorrow, but I'll have to duck out for a bit next Tuesday.'

Everyone at work was treating Jonathan differently. Gossip and speculation had been rife in the office for days about how serious his condition was; they were amazed to see him back at work so soon.

He himself was more impatient than normal. Uncharacteristically, he snapped at his secretary for failing to send some memos, the state of his desk, a few unanswered emails. At a meeting that morning, he found himself doodling, absent in thought and disengaged from the now seemingly trivial expectations placed upon him at work.

‘Sorry, I was just somewhere else. Could you repeat that?'

Carter had a caring and benign, almost priestly, look on his face as he repeated his assertion that profits were descending and that Sales and Marketing had to pull something impressive out of the hat if the end-of-year forecasts were to be met.

‘Any suggestions, Jonathan?'

‘Uh, let me take it on board, and I'll get back to you with some suggestions this afternoon,' said Jonathan, without
the slightest idea what he would get back to him with this afternoon.

‘With Jonathan's permission, I suggest we take another look at TV advertising,' piped up Jake. ‘I've been doing the numbers on it. I really think it would suit this product, and I did a bit of arm-twisting and managed to screw the networks down on price so it fits within the budget.' He was right on top of this stuff. Jonathan was deeply embarrassed that his junior had taken control. Since when had Jake turned into a TV expert?

‘What do you think, Jonathan? Do you think it could work?' Carter was trying to appear to involve Jonathan.

‘I suppose so. I really thought it was too expensive, but if Jake has managed to get the price down, then we should look at it, and soon.' He tried to sound like he was cool, but inwardly he was stumbling.

Later that day, he was keenly aware of mumblings in the corridors. His colleagues would suddenly go silent when he walked into the room. Most of his workmates had the same benign look on their face that he had seen that morning on his boss's, but they also had an awkward nervousness that reminded him of Rowan Atkinson's bumbling priest in the film
Four Weddings and a Funeral
.

‘We thought you'd take more time off.'

‘Is Tracy … OK? How are the kids handling it?'

‘My cousin had blood in his urine – turned out to be a strange infection. Anyway, a few days of antibiotics and that was all there was to it. He had an operation and everything – you know, where they look up his spout – just like you have had. It is going to be fine.'

Jonathan was suddenly embarrassed that people knew the
details of his operation. He blushed. One of his co-workers noticed and tried to make him feel better. ‘We heard about the operation, mate. I'm sure it's going to be OK. Do the doctors know what it is yet?'

And, finally, the words he had feared: ‘Watch your back with that Jake.'

Jonathan just smiled, thanked everyone for their concern and reassured them that it was all going to be OK. He was fine, thank you.

He wanted them all to go away. He wanted them to either talk to him genuinely or just be quiet and ignore the situation. Since the beginning of this whole thing, no one had really asked him about his feelings. No one broached that subject.

His feeling of isolation was only accentuated by a phone call from Tracy that afternoon. ‘What are we going to do if this is something serious, Jonathan?' she asked him. She was at home sorting out the monthly bills and was getting anxious. ‘How are we going to survive? We don't have anything put away.'

‘I'm well insured, Tracy,' he said. ‘We may not have health insurance, but we certainly have life insurance. You and the girls will be well looked after if I die.'

‘Don't say that! You're not going to die, Jon. Why would you say something like that? I'm just trying to work out how we'll get by if you need some more time off.'

‘I don't know, Trace. I just don't know.'

‘Maybe I can forget changing careers and starting my business and go back to being a temp – but, even then, it'll be hard to make ends meet on the kind of salary I can get. I wish that damned doctor had told you whether you
were going to need any more treatment. Are you sure he didn't say anything on the phone the other day?' Tracy was desperately seeking answers that were not there.

Finally, Tuesday came.

‘So, how have you been?' said Derek.

Jonathan and Tracy took no comfort from the concerned look on the doctor's face.

‘Fine. What was the result of the pathology?' Jonathan's apprehension was making him so nauseous that he wanted the truth immediately.

‘Well, we have indeed received the pathology results, and I'm afraid the news is not good.' Derek paused to see the couple's reaction. They glanced at each other and then looked back at him, nodding expectantly for him to continue.

‘The pathology shows you have a T1 carcinoma of the bladder with CIS in the random biopsies we took.'

‘What? T1? CIS?' Though Tracy was struggling to comprehend the doctor's jargon, from her tone it was clear she understood the gravity of his pronouncement.

Derek directed his explanation to Jonathan. ‘In the right side of the bladder, you have a tumour, a cancer. We removed the protruding growth, but it has also burrowed slightly down into the bladder wall. It does not look like it has invaded into muscle. If it had, then you would probably be looking at a cystectomy – that is, removal of the bladder.' Derek held up a diagram of a bladder and started pointing at the various parts. ‘At this stage, the cancer is in the superficial layers of the bladder. In addition, there are cancer
cells over on the other side of the bladder. They are also superficial.'

‘So, there's a cancer in my bladder, but it hasn't spread?' said Jonathan.

‘Well, we know it is quite superficial. We don't yet know if it has spread to other parts of your body. You will need to have a bone scan and a CT scan – which is like an X-ray – to help us determine if it has spread or not. In addition, you will need to have some blood tests, and then we'll need to see you again next week to start treatment.' Derek had a room full of patients. He really wanted to make this as brief as he could.

Tracy started crying, and, ironically, Jonathan comforted her, putting his arm around her shoulder. Derek wrote up the various forms required to put Jonathan through the next lot of tests and handed them to him. The tests would be done in the private radiology suites down the road, and Derek marked the request forms urgent so that there would be no unnecessary delays in getting the results.

‘OK, my secretary will make the various appointments and we will see you again next week. Any questions?' The doctor had already risen up out of his chair. In an instinctive response, Jonathan and Tracy got up as well. Jonathan clutched his forms – his passport through the health system – and they left the room.

Minutes later, at the front desk, they had their diaries out, cancelling this event, that dinner, their attendance at a school concert, while the secretary made the appointments.

When they pulled into the driveway, Jonathan's father was waiting on the doorstep.

‘Oh, Tracy, I don't know if I can handle him today,' mumbled Jonathan.

‘What did the doctor say?' was his father's greeting.

Jonathan unlocked the door and let him in. ‘Have a seat, Dad. The doctor reckons that they found a cancer in my bladder. It hasn't taken hold yet, but I need to have more tests before they can decide exactly what to do.'

His father sat silently for a moment, trying to absorb what his only child had just told him.

‘Please, let us pray together, son.' He held out his hand.

‘Not now, Dad.' Jonathan stood up and went over to the bottom of the stairs. ‘Please, not
now
!'

As he went up the stairs to his study, he could hear his father shouting after him. ‘If not now, then when? When, Jonathan?'

‘
Never!
' Jonathan shouted back.

Tracy came in with two cups of tea and handed one to her father-in-law.

‘You need to talk to him, Tracy. He needs God more than ever now. He needs Him.'

‘You need to give him a bit of space. He's not concentrating on work, on the girls, on anything in his life.' Tracy was pleading as much for herself as for Jonathan.

‘That's exactly why he needs to make contact with the Lord. This illness he's gotten, this is not random. God has caused it to teach him lessons about life and about mortality. I know I haven't always got on with him, but you, Tracy, you have his ear and his heart. Please tell him to look beyond his present suffering to the glory that awaits.'

Tracy stared pitifully at him. There was no question
that he loved Jonathan with all of his heart; his son was the blood that coursed through his veins, the breath that gave him life each day. For this man, God was so real. He saw Him; he talked with Him; he read words that he believed with absolute certainty God had written. But Tracy's view of religion was that it was not so much about God, about truth, about knowledge, as it was about clinging to a rigid belief and creating an ‘us' – the believers, who deserve saving – and a ‘them' – everyone else. Like Jonathan, she found her father-in-law's Bible-thumping hard to take. Yet she had sympathy for the man, especially on a day of bad news such as this. Tracy sometimes felt there was something insincere about his absolute conviction. It was almost like he was shouting loudly so that the demons within him could hear. She had no evidence for this. It was simply a hunch, an intuition. She dismissed the thought.

‘Would you like to stay for some lunch?' she asked.

‘Thanks, love, but no. I'm going up to see Mary.' Mary was his wife, Jonathan's mother, who had suffered a stroke about three years earlier and was living in a nursing home. One tiny clot – measuring only about four millimetres in diameter – had travelled a distance of about six centimetres from her neck to one of the end arteries in her brain. End arteries have no other tributaries to feed them in case of blockage, so the clot blocked blood supply to part of her brain. Once a part of the brain gets no blood – no oxygen – it only takes about three minutes for irreversible damage to occur. In Mary's case, over the course of about ten minutes, she was converted from an elegant, well-spoken, intelligent and beautiful woman into a body that lay in a bed unable to move.

Her nutrients came by way of a tube down her nose into her stomach. Every three hours, she was turned to avoid pressure sores. She recognised no one; her eyes were able only to open and stare. She did not move, did not speak, did not interact, did not react. The only noise that came from her was an almost constant groaning sound, and her face was contorted in a permanent wince. The nurses had to keep her in a nappy. Every now and then, she would get so constipated that a nurse had to manually remove the impaction. She needed 24-hour nursing care.

Mr Brewster visited almost every day, catching the bus from his house to the nursing home to sit with his wife. Whenever she had an infection, he gave orders for it to be treated. When her heart had started failing about a year ago, he gave orders for the tablets to be crushed and injected down the tube to her stomach. Many a time, the doctors and nurses raised the topic of ‘being kind', of ‘letting her go', of ‘allowing nature to take its course'. Mr Brewster's answer was always, ‘I want everything possible done to help her live out her life.' He would not allow any talk of passive euthanasia. Every sore was treated to its fullest. At one stage, she suffered bowel obstruction and would have died had it not been for Mr Brewster's insistence that she be transferred to the Victoria Hospital to be operated on. He still nearly cried each time he remembered overhearing one of the thrusting young surgical trainees saying, ‘I have no idea why they don't just let this old biddy die. But if the husband insists we operate, then who are we to say no? If they're cactus, they're good for practice!' Mr Brewster had put in a complaint and took satisfaction in having received a written apology from the resident.

Tracy visited every now and then, but Jonathan had long-since given up visiting. His view was that the doctors and nurses who kept her alive were inhuman monsters. He found the smells and sights of the nursing home so overwhelming that it was a struggle for him to breathe whenever he was there. There were rows and rows of patients exactly like his mother. Some, the better ones, sat in wheelchairs in the television room for part of the day. They would be hunched over, held in the chair only by a seat belt, their eyes gazing at their lap. Perhaps they were listening to the morning shows, which were turned up to maximum volume to cater for the majority of patients whose hearing had long departed this earth, waiting for the rest of their bodily functions to catch up.

After Mr Brewster had gone to the bus stop, Tracy went up to see Jonathan, who was checking his emails.