Читать книгу Fallout - Mark Ethridge - Страница 14

Allison silently cursed medical schools for failing to teach how to deliver bad news.

Medicine could describe the function of almost every organ in the human body and instruct doctors what to do about problems. But courses on how to interact with fellow human beings instead of biological systems weren’t part of the curriculum. State medical boards didn’t test communications skills. It was something she had had to learn on her own.

Many physicians lacked the basic understanding that such communication was important. Allison noticed a correlation with certain specialties. Brain surgeons often saw individuals simply as the product of a series of electrical impulses. Anesthesiologists seemed to prefer dealing with patients who were unconscious. Radiologists generally were more comfortable with pictures, not people. Ob-Gyns and general practitioners tended to be the best at patient communication, although it wasn’t always just about the specialty. She remembered one GP who’d fainted when faced with having to inform a patient he was HIV-positive. And communication wasn’t her father’s strong point, either at the clinic or at home.

Trial and error had taught Allison to have difficult conversations away from her medical office. Everything about it, from the big desk, to the mysterious medical equipment, to her white lab coat, fostered the impression that the doctor was a god delivering a pronouncement of doom to a weak and helpless mortal. Coffee shops, on the other hand, were places where everyone was equal and where friends gathered to share information and solve problems. She’d found nothing in the privacy portions of the Health Insurance Portability and Accountability Act that proscribed private medical discussions in such places—as long as they weren’t overheard.

Ruling out the Koffee Kafe, which she was sure barely squeaked by its yearly health inspection, and the Cluck N’ Cup, which closed at 3 p.m., she had picked the Java Joynt for her conversation with Josh, confident that so late on a Friday she wouldn’t run into her ex, Vince Bludhorn. The overbearing, hardball-playing in-house lawyer and general fixer for the Recovery Metals recycling plant was such a regular patron that the establishment had named coffee with a double-shot of espresso “the Counselor” after him.

She had also observed that whatever attitude she personally adopted during bad news conversations tended to be the attitude that the recipient adopted. If she was scared, the patient was likely to be scared. If she was calm, the patient often would be calm. Today, her emotions were bouncing all over the place. She was worried about what Josh and Katie might be facing. She felt guilty, as if she had let Sharon down. She was sick at the unfairness of it all.

Arriving early, she had chosen an herbal tea to steady her nerves and claimed a quiet table toward the back. As Josh bypassed the barista and bee-lined for her table, she tried for an expression that conveyed: concerned, but not worried.

Unsuccessfully, judging by his face.

Josh scraped a chair across the tile floor and sat. “What’s the headline?”

“I’d like to get some more tests run on Katie. There’s a feature on her x-ray that may relate to the pain in her leg. It may be nothing but it could possibly be serious.”

He stiffened. Anything termed “possibly serious” in Sharon’s case had invariably turned out to be so. He took a deep breath. “How serious?” he asked calmly, thinking that if he limited his panic he could somehow limit the threat.

Allison knew Josh wouldn’t stand for anything but the truth, straight and unvarnished. Even as Sharon faded he had badgered her caregivers to tell him the unknowable: How many weeks? How many days? She took a breath. She couldn’t believe Josh had to hear the word again. “Worst case, I’m somewhat worried about the possibility of cancer.”

Josh deflated into his chair. His eyes closed. His head weaved unsteadily.

“There’s no need for panic. This is a concern, not a diagnosis. It could be nothing. I want someone else to take a look. Coretha’s setting you up for Monday at the hospital in Columbus. There’s a great children’s wing.”

Josh looked stunned.

“Cancer’s not a death sentence.” She regretted the words as soon as they left her mouth. It certainly had been a death sentence for Sharon.

“What kind?” Josh asked numbly.

“A bone cancer, if it is cancer. Osteogenic sarcoma.”

“What stage?”

“If it is cancer, we caught it early.” Josh looked dead. She placed her hand on top of his. “I know how you must feel,” she sympathized. “This can’t be happening again.” Neither moved for a minute. She could see him start to regain his bearings. He withdrew a reporter’s notebook from his pocket and uncapped a pen.

“What makes you think Katie has cancer?” He asked it like he would a question at a press conference, responding as a journalist, creating emotional separation from bad news.

“Might have cancer. She attributed her leg pain to jumping out of a tree. I x-rayed for a stress fracture. There was none. I was looking at the x-rays again this afternoon and I noticed an anomaly I hadn’t seen before. It could be a bone bruise. It could be congenital. It could be a bad x-ray. It could be something else. I’m not a pediatrician, I’m not an orthopod and I’m not a radiologist. That’s why I want someone else to take a look. I do this sort of referral frequently. Often, it’s nothing.”

Josh folded up the notebook. He lived by the mantra of his first great city editor, Walker Burns, who taught him to assume nothing. If your mother says she loves you, check it out, is how Walker had phrased it. “I want to see the x-rays,” Josh said.

“You won’t be able to tell anything.”

“Maybe not. But I need to see.”

Coretha joined them in the examining room at the clinic. Allison slid the three views of Katie’s left leg into the tray and doused the overhead light.

“As you can see, the tibia and fibula show no sign of fracture, even a stress fracture. But look up here, at the bottom of the femur. Right above the knee cap.” Allison touched a spot on the x-ray with a pen. “That’s what I’d like an expert to look at.”

Josh squinted at the x-ray. “Look at what?”

Allison moved to a second x-ray. “It might be easier to spot here.” She circled an area above the knee. “This could be a mass about twenty-five centimeters diameter. See the irregular cloudy area, a denser white than the bone that seems to intrude into the surrounding tissue.”

“No. I think you’re seeing things.”

“Possibly,” Allison conceded.

“We had a problem with some x-rays,” Coretha volunteered.

“What do you mean, ‘problems with the x-rays’?” Josh said sharply.

Allison shot Coretha a look of disapproval. “Some films of a patient’s jaw came out strangely this week. We don’t know why it happened.”

“Your machine is broken,” Josh said calmly. “There’s nothing wrong with Katie.”

Josh was clearly in denial but Allison desperately wanted for him to be right. “I hope so,” she said. “But we had several sets of x-rays taken at about the same time that didn’t have any problem, including Katie’s, as far as we can tell.” She looked to Coretha for confirmation but found she had slipped out of the room.

“So some x-rays are screwed up and some aren’t. I’m betting this whole thing is a mistake. What are the odds?” Josh demanded. He was feeling slightly better.

Allison flicked on the lights. “We don’t know. That’s why you’re going to take her to Columbus.”

Josh pressed close to the x-rays. “So what am I supposed to tell Katie?”

Allison took him by the shoulders and turned him so she could look him in the eye. “Tell her the truth. Tell her the doctor wants to find out what’s causing the pain in her leg and that more tests are needed. That’s all we know.”

Allison summoned Coretha when Josh had gone. “Josh is having to live with this all weekend. Creating uncertainty in his mind about the quality of the x-rays didn’t help.”

Coretha looked downcast. “Sorry. I didn’t even think about that.”

“Well, if there is an x-ray problem, we need to find out.”

“I’ll call the company and get them to send out a tech. With any luck, they can be here Monday.”