“Come on,” he said. “Let’s go in.”
A hand-scrawled sign in the nurses’ office said “Welcome
to Space Age Medasin.”
The bulletin board was tacked with layers of paper—shift
schedules, cartoons cut out of magazines, chemotherapy dosage charts, and an
autographed picture of a famous Dodger with a young bald boy in a wheelchair.
The child held a bat with both hands and gazed up at the baseball player, who
looked slightly ill at ease among the I.V. lines.
Raoul picked a medical chart out of a bin and flipped
through it. He grunted and pushed a button on a panel above the desk. Seconds
later a heavyset woman dressed in white stuck her head in.
“Yes—oh, hi, Doctor Melendez.” She saw me and gave a
nod with a question mark stuck to the end of it.
Raoul introduced me to the nurse, whose name was Ellen
Beck-with.
“Good,” she said, “we could use you around here.”
“Dr. Delaware used to coordinate psychosocial care on
this unit. He’s an international expert on the psychological effects of reverse
isolation.”
“Oh. Great. Pleased to meet you.”
I took the proferred fleshy hand.
“Ellen,” said Raoul, “when are Mr. and Mrs. Swope due
back on the unit?”
“Gee, I dunno, Doctor. They were here all last night
and then they left. They usually come in every day, so they should be around
sometime.”
He clenched his teeth.
“That’s very helpful, Ellen,” he said sharply.
The nurse grew flustered and her meaty face took on
the look of an animal corralled in an unfamiliar pen. “I’m sorry, Doctor, it’s
just that they’re not required to tell us—”
“Never mind. Is there anything new with the boy that
hasn’t been charted?”
“No sir, we’re just waiting for—” she saw the look on
his face and stopped herself. “Uh, I was just going to change the linens in
unit three, Doctor, so if you have nothing more—”
“Go. But first get Beverly Lucas over here.”
She glanced at a chalkboard across the room.
“She’s signed out to page, sir.”
Raoul looked up and stroked his mustache. The only
evidence of his agony was the slight tremble beneath the bristly hairs.
“Then
page
her, for God’s sake.”
She hurried off.
“And they want to be professionals,” he said. “Working
hand in hand with the doctor as equal partners. Ludicrous.”
“Do you use anything for the pain?” I asked.
The question threw him.
“What—oh, it’s not so bad,” he lied, and forced a
smile. “Once in a while I take something.”
“Ever tried biofeedback or hypnosis?”
He shook his head.
“You should. It works. You can learn to vaso-dilate
and constrict at will.”
“No time to learn.”
“It doesn’t take long if the patient’s motivated.”
“Yes, well—” he was interrupted by the phone. He
answered it, barked orders into the receiver, and hung up.
“That was Beverly Lucas, the social worker. She’ll be
here shortly to fill you in.”
“I know Bev. She was a student here when I was an
intern.”
He held out his hand palm down and moved it side to
side. “Soso, eh?”
“I always thought she was pretty sharp.”
“If you say so.” He looked doubtful. “She wasn’t much
use with this family.”
“That may be true of me as well, Raoul.”
“You’re different, Alex. You think like a scientist
but can relate to patients like a humanist. It’s a rare combination. That’s why
I chose you, my friend.”
He’d never chosen me but I didn’t argue. Maybe he’d
forgotten the way it really started.
Several years back, he was awarded a government grant
to study the medical value of isolating children with cancer in germ-free
environments. The “environments” came from NASA—plastic modules used to prevent
returned astronauts from infecting the rest of us with cosmic pathogens. The
modules were filtered continuously and flooded with air blown out rapidly and
smoothly in laminar flow. Such smooth flow was important because it prevented
pockets of turbulence where germs collected and bred.
The value of an effective way to protect cancer
patients from microbes was obvious if you understood a little about chemotherapy.
Many of the drugs used to kill tumors also knock out the body’s immune system.
It was as common for patients to die of infection brought about by treatment as
to perish from the disease itself.
Raoul’s reputation as a researcher was impeccable and
the government sent him four modules and lots of money to play with. He
constructed a randomized study, dividing the children into experimental and
control groups, the latter treated in regular hospital rooms using conventional
isolation procedures such as masks and gowns. He hired microbiologists to
monitor the germ count. He gained access to a computer at Cal Tech to analyze
the data. He was ready to go.
Then someone raised the issue of psychological damage.
Raoul pooh-poohed the risk, but others weren’t
convinced. After all, they reasoned, the plans were to subject children as
young as two to what could only be termed sensory deprivation—months in a
plastic room, no skin to skin contact with other human beings, segregation from
normal life activities. A protective environment, to be sure, but one that
could be harmful. It needed to be looked into.
At the time I was a junior level psychologist and was
offered the job because none of the other therapists wanted anything to do with
cancer. And none of them wanted to work with Raoul Melendez-Lynch.
I saw it as an opportunity to do some fascinating
research and prevent emotional catastrophe. The first time I met Raoul and
tried to tell him about my ideas, he gave me a cursory glance, returned his
attention to the
New England Journal
, and nodded absently.
When I finished my pitch he looked up and said, “I
suppose you’ll be needing an office.”
It wasn’t an auspicious beginning, but gradually his
eyes were opened to the value of psychological consultation. I badgered him
into building the unit so that each module had access to a window and a clock.
I nagged him until he obtained funds for a full-time play therapist and a
social worker for the families. I cadged a healthy chunk of computer time for
psychological data. In the end it paid off. Other hospitals were having to
release patients from isolation because of psychological problems but our
children adjusted well. I collected mountains of data and published several
articles and a monograph with Raoul as co-author. The psychological findings
received more scientific attention than the medical articles, and by the end of
three years he was an enthusiastic supporter of psychosocial care and somewhat
humanized.
We grew friendly, though on a relatively superficial
level. Sometimes he talked about his childhood. His family, originally
Argentinian, had escaped from Havana in a fishing boat after Castro
nationalized their plantation and most of their wealth. He was proud of a
family tradition of physician-businessmen. All of his uncles and most of his
cousins, he explained, were doctors, many of them professors of medicine. (All
were fine gentlemen except Cousin Ernesto, who was a scum-sucking Communist
pig. Ernesto had been a doctor, too, but he’d abandoned his family and his
profession for the life of a radical murderer. No matter that thousands of
fools worshipped him as Ché Guevara. To Raoul he’d always be despicable Cousin
Ernesto, the black sheep of the family.)
As successful as he was in medicine, his personal life
was a disaster. Women were fascinated by him but ultimately repelled by his
obsessive character. Four of them endured marriage with him and he sired eleven
children, most of whom he never saw.
A complex and difficult man.
Now he sat in a plastic chair in a drab little office
and tried to be macho about the buzz saw ripping through his skull.
“I’d like to meet the boy,” I said.
“Of course. I can introduce you now, if you’d like.”
Beverly Lucas came in just as he was about to get up.
“Good morning, gentlemen,” she said. “Alex—how nice to
see you.”
“Hi, Bev.”
I rose and we embraced briefly.
She looked good, though considerably thinner than I
remembered. Years ago, she’d been a cheerful, rather innocent trainee, full of
enthusiasm. The kind voted Miss Bubbly in high school. She had to be thirty by
now, and some of the pixie cuteness had turned to womanly determination. She
was petite and fair, with rosy cheeks and straw-colored hair worn in a long
soft perm. Her round open face was dominated by hazel saucer eyes and untouched
by makeup. She wore no jewelry and her clothes were simple—knee-length navy
skirt, short-sleeved blue-and-red plaid blouse, penny loafers. She carried an
oversized purse, which she swung up on the desk.
“You look svelte,” I said.
“Running. I’m doing long distance, now.” She flexed a
muscle and laughed.
“Very impressive.”
“It helps center me.” She sat on the edge of the desk.
“What brings you around here after all this time?”
“Raoul wants me to help out with the Swopes.”
Her expression changed without warning, the features
hardening and gaining a few years. With forced amiability she said, “Good luck.”
Raoul stood up and started to lecture.
“Alex Delaware is an expert in the psychosocial care
of children with malignant—”
“Raoul,” I interrupted, “why don’t you let Beverly
fill me in on the case. There’s no need for you to spend any more time at this
point.”
He looked at his watch.
“Yes. Of course.” To Beverly: “You’ll give him a
comprehensive rundown?”
“Of course, Dr. Melendez-Lynch,” she said sweetly.
“You want me to introduce you to Woody?”
“Don’t bother. Bev will handle it.”
His eyes darted from me to her and then back to his
watch.
“All right. I’m off. Call if you need me.”
He removed the stethoscope from around his neck and
swung it at his side as he left.
“I’m sorry,” I said to her when we were alone.
“Forget it, it’s not your fault. He’s such an asshole.”
“You’re the second person he’s riled this morning.”
“There’ll be plenty of others before the day’s up. Who
was the first?”
“Nona Swope.”
“Oh. Her. She’s angry at the world.”
“It must be rough for her,” I said.
“I’m sure,” she agreed, “but I think she was an angry
young lady long before her brother got cancer. I tried to develop a rapport
with her—with all of them—but they shut me out. Of course,” she added,
bitterly,
“you
may do much better.”
“Bev, I’ve got no stake in being a miracle worker.
Raoul called me in a panic, gave me no background, and I tried to do a friend a
favor, okay?”
“You should pick your friends with greater care.”
I said nothing, just let her listen to the echoes of
her own words.
It worked.
“Okay, Alex, I’m sorry for being such a bitch. It’s
just that he’s impossible to work for, gives no credit when you do a good job,
and throws these incredible tantrums when things go wrong. I’ve put in for a
transfer, but until they find a sucker to replace me, I’m stuck.”
“No one can do this type of work for very long,” I
said.
“Don’t I know it! Life’s too short. That’s why I got
into running—I come home all burnt out and after a couple of hours of pushing
my body to the limit I’m renewed.”
“You look great.”
“Do I? I was starting to worry about getting too thin.
Lately I’ve been losing my appetite—oh, hell, I must sound like a real
egomaniac, griping like this when I’m surrounded by people in real crises.”
“Griping is a God-given right.”
“I’ll try to look at it that way.” She smiled and
pulled out a notebook. “I suppose you want a psychosocial rundown on the
Swopes.”
“It would help.”
“The name of the game is
weird
—these are
strange people, Alex. The mother never talks, the father talks all the time,
and the sister can’t stand either of them.”
“Why do you say that?”
“The way she looks at them. And the fact that she’s
never around when they are. It’s like she feels out of place. She doesn’t pay
much attention to Woody when she’s here, keeps strange hours—shows up late at
night, or really early in the morning. The night staff says she mostly sits and
stares at him—usually he’s asleep, anyway. Once in a while she’ll go in the
unit and read him a book, but that’s about it. The father doesn’t do much in
the way of stimulation, either. He likes to flirt with the nurses, acts like he
knows it all.”
“Raoul told me the same thing.”