Читать книгу Hunting for Hippocrates - Warren J. Stucki - Страница 12

Two days later as he checked the day’s patient schedule Moe noted that Howard Swensen was due back at 4:45 p.m. He was the second to the last patient of the day and was coming in to get the results of his prostate biopsy. Moe smiled. His nudging of Catherine had produced results. Howard’s report had arrived a couple days earlier than expected.

Moe’s pulse quickened as he thought of Connie. He wondered if she would accompany her father. Perhaps, he should have Sally call and subtly suggest she come. With a positive biopsy report, Howard might need some moral support and decisions would have to be made. Quickly, Moe gave Sally instructions to call Connie and remind her of today’s appointment, then trudged to the back office to face a sullen Diane and four exam rooms that were already stuffed with patients.

The day went pretty much as expected. Moe had been in the business long enough that he rarely saw any new pathology, any unusual disease, or anything he’d never seen before. Just an endless parade of prostatitis, chronic UTI’s and impotence (now tactfully and forever labeled erectile dysfunction by Bob Dole). And by now, he was pretty much used to Diane’s attitude, though her surliness was getting monotonous. When Howard Swensen finally arrived, Moe was happy for the change of pace.

Moe entered the exam room still feeling tired. Somewhere in his medical studies he had read that depression was a leading cause of fatigue and of course, over work was an obvious major cause as well. He was sure both factors applied to him.

“Hello, Mr. Swensen,” he said wearily, then noticing Connie in the chair in the corner, he continued with a bit more enthusiasm, “Oh, hi Connie. I’m happy you could make it.”

“Well Doc, give us the bad news first, that always makes any good news seem even better,” Howard said, forcing a smile.

“Unfortunately Howard, I’m afraid it is bad news. There is no good way to tell you this, but first let me say, I’m very sorry for having to deliver this kind of news and I apologize to you and Connie for being the bearer of bad tidings.” Moe watched Connie and Howard closely for a reaction.

“Not your fault. I was kinda expecting it, and Doc, you don’t have to apologize. Nowadays, we don’t kill the messenger,” Howard said gamely. In the corner, Connie started crying softly.

Moe melted. He always did when women started crying. “Let me take a few minutes and discuss prostate cancer with you, what it means and what your options are. When we do biopsies of the prostate, we collect little bits of tissue with a needle and send them to specialists called pathologists. The pathologists are the ones who actually make the diagnosis of cancer, and if they find prostate cancer, they grade it from one to five, depending on how mean the cancer cells look under the microscope. Grade I and grade II are the slow growing kind, the type that literally takes years and years to ever amount to anything, if indeed, they ever do. On the other hand, grade IV and V are the fast-growing variety, the type that grows faster and spreads faster in a much shorter period of time. Grade III is in the middle. It is neither fast nor slow growing. Howard, yours was read out as a grade IV, so it falls in the faster growing, more aggressive category.”

“Is that what they call the Gleason Grade?” Howard interrupted.

“I see you’ve been reading,” Moe said.

“Yeah, I get on the internet from time to time,” Howard explained.

“Yes, that’s what we’re taking about,” Moe answered, then continued. “Cancer of the prostate, as you may or may not know, has been a fairly controversial subject in medicine the past few years. Where the controversy comes from, a lot of people think we, as urologists, over-treat this disease. That we’re treating it many times, when men would do just as well if we left them alone. However, some men do die of cancer of the prostate and statistically, it’s the third leading cause of cancer death in men. It ranks behind lung and colon cancer, and accounts for about fifty thousand deaths annually in the United States.

“Unfortunately, one of the jobs we have as urologists, is to try to decide who needs treatment and who might do fine without any treatment. When trying to make this decision, there are two factors that we take into consideration. One is the age of the patient and the other is the grade of the tumor. If you’re eighty-five years of age and have a grade one prostate cancer, I can almost guarantee that it will never bother you in your lifetime. On the other hand, if you’re fifty years of age and have a grade five prostate cancer, I can predict that it will cause you trouble in your lifetime. Howard, let’s apply these criteria to you. You’re a man in your sixties with a high grade tumor. My feeling is that it should be treated.” Moe paused to catch his breath, quickly glancing at Connie. She appeared to be listening intently.

“I agree, Doc. Never been much of a gambler, at least not with my life. How we goin’ to treat it?” Howard asked. Connie had stopped crying, but remained silent.

“In the United States today, there are three major treatments for prostate cancer: surgery, radiation and radiation seeds. They all have their advantages and disadvantages—”

“Sorry to interrupt Doc, but I don’t want no damn radiation. It didn’t do my wife no good. She had breast cancer. And from what I hear, radiation killed half the people in St. George in the sixties and seventies with that goddamn atomic bomb testing.”

“What about radiation seeds?”

“It’s still radiation, isn’t it? I think I’d rather you just cut it out and be done with it,” Howard said flatly, then turned to Connie and added. “What do you think, Connie? You’re the one in the family with the medical training.”

“Dad, I’m a pharmaceutical rep,” Connie protested. “That’s not exactly medical training.”

“But you’re around medicine every day. Considering what happened to your mother, what do you think?”

“Of course, it’s up to you, Dad, but I agree, radiation didn’t seem to help mother, and you’re in relatively good health; I think surgery is the right course for you,” Connie said, then turned to Moe and smiled. “I Ve checked out Dr. Mathis with the other doctors and they consider him the best.”

Moe flushed with embarrassment and hurriedly launched into his speech. “Let me tell you a little bit about the surgery. The incision is made in the midline from just below the belly button to the pubis. Initially, we harvest the lymph nodes around the prostate to make sure not even one cancer cell has escaped, then we remove the entire prostate gland. There is enough give, or play, to the bladder that you can pull the bladder down to make up the distance lost by removing the prostate gland with its portion of the urethra. Then you simply sew the bladder neck back to the transected urethra. There can be a couple side effects to that surgery of which you need to be aware. There is about a fifty to sixty percent chance of becoming impotent. The other potential complication, about a ten to fifteen percent chance of being incontinent. With modern medicine, if either of these occur and you want them corrected, they both can be fixed.”

“Hell, Doc, it doesn’t matter. I’m a widower. I haven’t had a woman in five years.” Howard blurted out, then turned crimson as he remembered Connie was by his side.

Moe lessened the embarrassment by hurrying on. “Also, we often lose a little blood with this surgery, so we encourage patients to donate a couple units of their own blood. That way if you need blood, you will get nobody’s but your own. This is called autologous blood transfusions and makes the odds of getting AIDS or Hepatitis from blood transfusions almost zero. You can only donate one unit a week, and we need two units, so that means we can schedule your surgery in a couple of weeks,” Moe said, his mind starting to drift. Connie, as usual, looked stunning today.

Howard set his jaw. He’d made up his mind. “Let’s go ahead and do it, Doc. The sooner the better.”

“Howard, I almost forgot.” Moe forced his mind back to business. “I can do your surgery two weeks from Tuesday, but the only snag is I’m going on vacation that following Sunday. If we do your surgery then, my partner, Dr. Wright, will be on call in my absence, in case of any emergencies. But, you should be home by then and out of any danger. If you don’t like that idea, we could delay the surgery till I get back. I’ll be gone for ten days.”

“What about recovery time? Will I be able to take care of myself at home?”

“Yes, I’ve done this surgery on single men before, and they’ve done fine at home alone.”

“Well, I can help with his care,” Connie insisted.

“Yes, and we can even have home health nurses come by, if need be. But Howard, it makes no difference to me. We can easily wait till I get back.”

“No Doc, I don’t want to wait. I can almost feel it spreading now. Any little pain, even arthritis, makes me think it’s the cancer. If we’re going to do it, let’s get it done and as soon as possible. I suppose Dr. Wright knows what he’s doing, doesn’t he? I mean, if we need him.”

Moe decided it would be best not to say anything, rather than say what he was thinking. He simply said, “Dr. Wright is a board certified urologist.”

“Doc, this probably sounds silly,” Howard said. “But since I’m going to lose mine, I was just wondering what a prostate does, and what it looks like.”

“Well, when you’re trying to have kids, the prostate furnishes part of the fluid that keeps the sperm alive along enough to fertilize the egg,” Moe said. “Wait just a minute and I’ll grab an actual prostate from my partner’s desk to show you.”

Moe quickly walked to Rusty’s office and retrieved the specimen jar containing a formalin preserved prostate. According to Rusty, during freshman gross anatomy he had absconded with his cadaver’s prostate. Now he used it mainly as a teaching tool, to show patients what a prostate and prostate cancer looked like. Whether it was cancer or not, Moe had no way of knowing, but the pickled prostate did have a whitish nodule off the right lateral wall.

Howard examined the jar closely. Connie only managed a quick peek.

“What’s these squid-looking appendages coming off the back?” Howard asked.

“Seminal vesicals and portions of the ejaculatory ducts,” Moe answered.

“Well,” Howard said, handing the prostate back to Moe. “If mine looks this ugly, I’d be better off without it.”

“Let’s get things scheduled,” Moe said, setting Rusty’s specimen on the desk.

Moe escorted Howard and Connie back to the front desk, where he instructed Sally to schedule the surgery and the autologous blood donations. He then said goodbye to Howard and personally assured Connie everything would be all right, that it was a pretty routine surgery. As he turned to go, out of the corner of his eye Moe saw Connie put her arms around her father’s shoulders as they sat down waiting for Sally to do the paper work. Moe sighed, then grudgingly returned to the back office to face the ice woman, Diane, and of course, there was another patient waiting.

A few minutes later Moe picked up the hall phone and punched the intercom button to talk to Sally. “Hey Sally, the patient in room one, Edwin Kite, had and IVP done yesterday by the ER for flank pain. I need to look at it.”

“You want the films or the report.”

“Come on Sally, you know I don’t trust those reports.”

“I’ll call x-ray, but it’ll be ten or fifteen minutes before I can go get them. I’m still working on scheduling Mr. Swensen’s surgery. You got any more patients to see?”

“No, Mr. Kite is the last. Why?”

“Well, why don’t you just sneak over to radiology and look at them yourself. It’s all of fifty yards,” Sally said sarcastically.

“Oh, all right, but could you call, so they’ll have them ready.”

On his way back to the office after reading the x-rays, Moe saw unmistakable silhouettes of Connie and Howard sitting outside his office on the bench in the foyer. They were facing the opposite direction staring out the large picture window. Connie still had her arm draped around her father’s shoulders.

Though he knew he shouldn’t listen, he couldn’t help it. Moe paused at his office door for a moment. “—that’s why I had you see him. On my rounds, I talk to a lot of different people in doctors’ offices. The nurses really like to gossip. You pretty much get to know the reputation of all the doctors by talking to the nurses. He’s the best.”

“With a town the size of St. George, even in the real estate business I hear things too,” Howard said. “I hear he’s divorced.”

“Well, I hope that doesn’t bother you, as your oldest daughter is too,” Connie said, laughing.

“No, that doesn’t bother me. Anyway, I’m glad you’re done with that womanizer Rigettori and I’m glad you dropped his name. You don’t look like a Rigettori.”

“Me too, dad. But why bring it up? I mean the divorce thing. I hope it’s not because of the Church’s stand.”

“Nah, I don’t much care what the Church says and I have all the confidence in the world in Dr. Mathis. But you’re both divorced. When you first insisted that I see him, I thought it was because you two were romantic, but now I see that’s just not the case. Too bad, you two would make a nice couple.”

“Dad! I can take care of my own love life. To him, I’m just a drug rep and—” Connie sighed and her voice tailed off.

Feeling guilty for eavesdropping, Moe quietly opened his office door, then entered, shutting the door without a sound.

After finishing up with Mr. Kite, dictating a record of each patient’s visit, and making hospital rounds, it was late, as usual, when Moe finally returned his dark silent home. The house was constructed in the pueblo style and projected the illusion of a flat top roof with vegas, log poles, protruding at regular four-foot intervals. The building was covered with tapioca white stucco in the classic Spanish lace pattern. Surrounding the house was a small twenty-acre ranch where Moe grazed his three registered quarter horses, two mares and a stud. Though not ostentatious, the place did give the appearance of a southwest hacienda.

The U-shaped house enclosed a Spanish courtyard containing a small landscaped lagoon was enclosed by the U-shaped house. The open end of the U was abruptly bordered by sheer, black lava cliffs containing several large panels of ancient Anasazi petroglyphs.

While he was building the house, Moe had employed a native-American carpenter, Fergeson Yazzie. One day he had asked Fergie to interpret the writings. Fergie studied the panels for a few minutes then proclaimed he had figured out the timeless message of his ancestors, “Gone to Seven-Eleven to pick up beer; be back in an hour.” Moe still chuckled when he recalled the scene.

Yes, he had enjoyed his home, but what he had not enjoyed was his single life and he especially did not like coming home to a dark, silent house. But that’s what he had done for four years, ever since Annie had run off with that so-called artist from Sedona, Arizona.

Moe parked his Jeep in the garage and flipped on the lights. Immediately, the odor of death, the smell of decomposing flesh, hit him like a blow to the head. For three days he had put off burying Casey because he just could not face it. He’d even been parking outside. Well, the stench in the garage left little doubt. He had to bury little Casey and he had to do it tonight. Grabbing a shovel and the flashlight, Moe purposefully headed for the pasture in front of the house. Dorey was in the south pasture. The ground was soft with the rain and Moe had just irrigated, but still it required a large hole to bury a six-month-old horse.

When the hole appeared large enough, Moe headed back to the garage. Barely, able to contain his emotions he gathered up Casey and carried him back to the pasture. Gently, he lowered the colt into the grave, then with tears in his eyes he stared down at the small corpse. God, how he would miss Casey, prancing around with head held high, showing off for him and his mother.

It was absolutely inconceivable to Moe that anyone would want to kill him. Obviously, it was not that they felt malice for the horse. A horse was not like a wild sheep-killing dog. Someone was trying to get him, not the horse. Who hated him that much? Wiping his tears, Moe started shoveling in the dirt.

After finishing with the grave, Moe plodded back to the house. He really should eat something before giving himself his evening dose of insulin. Absentmindedly, he tore a frozen dinner from its box and shoved it in the microwave. Since his divorce, Moe never cooked. What was the point? When he was a kid, meals were not just for fuel, they were also the family social hour. A chance to get caught up on each other’s lives, to exult in the family triumphs and share the failures and sorrows. Some social hour now, eating alone. Frozen dinners were a perfect commentary for his present life.

No, Moe did not enjoy the bachelor’s life. For a time, he had tried the single bars, what few there were in southern Utah. Soon, he had discovered that he was not very good at the bar scene. He had felt awkward and childish, and he was clumsy with the “one-liners.” Furthermore, he was not all that fond of alcohol. He did drink socially, but even that was becoming a problem, now that he had diabetes.

Moe had considered going to the Mormon Church sponsored singles dances, but didn’t really fit in there either, since he was not a religious person or a church goer. Eventually, he resigned himself to the fact he would remain celibate and companionless. To fill the void, he started devoting more and more time to work. His practice prospered and what spare time he did have, he spent with the horses.

Then, just as he was getting comfortable with his life as a monk, Judy suddenly appeared in one of his operating rooms as a circulating nurse. She had just relocated to St. George, a transplant from Salt Lake City. The apparent reason for her defection: she was trying to get out of a bad relationship. Though she had never said, Moe suspected the bad relationship was with a married man.

Judy was a small, pretty woman in a saucy sort of way, but unfortunately, she was also a tease. She flirted with everyone—all the surgeons, including his pious partner, Rusty. Moe, however, was the only single surgeon on staff. Therefore, at least theoretically, he had the advantage. Even though there was a big difference in their ages, after a few months of working together, Moe had asked Judy to dinner and a movie. Their dating continued and eventually she had stayed at the ranch overnight a couple of times. Moe figured they were an item now, though in the back of his mind he was not sure he could trust her.

When Moe had asked her if she wanted to go to Cozumel with him, Judy had promptly agreed and though she was not a diver, she was willing to learn. Moe explained that after they had arrived in Cozumel, Judy could enroll one of the resort certification courses and be a trained diver in a couple of days.

Throughout their short courtship, the main thing that troubled Moe was Judy’s continual flirting. And even that didn’t bother him all that much, except when she flirted with Rusty. Moe was pretty sure nothing was going on between them. After all, Rusty was a married man and an active Elder in the Mormon Church. The irritating thing, why would she want to flirt with him anyway? Regardless of all that, Moe was very much looking forward to the vacation. Since his divorce four years ago, he really hadn’t had a vacation and it was past due.

The beeping of the microwave broke his train of thought. The Healthy Choice sesame chicken dinner was done. Time to eat, check his blood sugar and time to take his evening dose of humulin. Though he’d been on insulin for over a year, he still hadn’t gotten used to the fact that he was a diabetic.

In his mind, he just did not look like a diabetic. He had always been athletic, played high school and junior college football. And even now, he was still in good health, other than the diabetes. Moe knew he should not have been surprised. He had always known that diabetes was a possibility, it was an inherited disease and his mother had been a diabetic for years. In fact, it was complications of diabetes that caused her death. But it still came as a shock when he was actually diagnosed.

Moe had made the diagnosis himself. Inexplicably, he had started feeling weak and extremely fatigued. Then he began urinating every thirty minutes and gulping water. Being a urologist, he naturally ran a urinalysis. Everything was okay on the dipstick except the ketones were high and the glucose was four plus. He had Diane draw a blood sugar which came back 457. Dr. LaRowe, the internist in the office next to his, had initially tried pills, oral hypoglycemics, but they just did not control the blood sugar level. Unfortunately, that left only insulin as a treatment.

Well, so far the diabetes really hadn’t bothered him that much and hopefully if he kept his blood sugars under control, it never would. He knew a lot of diabetic men became impotent, but if that happened there was always Viagra or implants. It was just the nuisance of the insulin shots and the diet and always having to be on a schedule. Running on a tight schedule was not his nature.

Moe tore off the cellophane wrapper, stared at his piece of processed chicken, then lost his appetite. But there was that damn schedule again. If he didn’t eat, then he would have to adjust his evening dose of insulin, and that would be just a guess. Then in the morning his sugars would undoubtedly be high or low, then he would have to adjust his morning dose of insulin, and so it would go on and on. The dreaded yo-yo effect. It would be far simpler just to eat the goddamn chicken.