Doctored

by Sandeep Jauhar

  “Your mother killed herself all week,” he groused. “I mean, chicken, fish, gulab jamun, ras malai. It was a bit ridiculous.”

  “She hasn’t seen me in almost a year, Dad.”

  “Drive with two hands,” he ordered. I grudgingly placed my right hand on the steering wheel. My father looked back at my mother. “He still acts like a kid,” he said. “He still drives like it’s a game.”

  At the house, I noticed there was rust on the garage girders. Lightbulbs needed to be replaced. One of the kitchen tiles was cracked, and soap dispensers were empty. The house, like my parents, was in a state of subtle decay.

  I unpacked my suitcase in the guest room. On the bedside table were some pictures of me from high school, along with a couple of old tennis trophies and my tattered copy of Zen and the Art of Motorcycle Maintenance. Inside the closet I noticed the world globe I had used in middle school, as well as my dad’s old Petri camera. Each object was heavily laden with memories: the lemon drops my father offered whenever he drove me to school board meetings; the tennis racket I played with when my father forced me to give up my spot on the local team going to the California Interscholastic Federation tennis tournament because Rajiv, whom I had beaten in the qualifying match, was a senior and it was his last opportunity to play CIF. Despite the ambivalent remembrances, the room had a cobbled-together quality, as if it were being used for storage.

  Downstairs, my father was sitting at the dining table, sorting through bills. He seemed blank, anxious, worked up. We quietly ate the meal my mother had prepared. My father asked how my work with Chaudhry was going. I hadn’t told him much about what had transpired, other than that Chaudhry had cut back on some of my hours. “Sometimes he doesn’t give me work, and then I’m short paying my bills,” I said offhandedly.

  “Does he pay you on time?”

  “Yes, he pays,” I said, trying to squelch the conversation. “He’s not that bad, just a bit stingy with the work.”

  After dinner we lit candles and cut a small cake. Mohan belted out “Happy Birthday,” trying to infuse some celebration into the proceedings. While I went upstairs to put him to bed, my parents cleaned up. Coming back downstairs, I spied my father fishing a birthday envelope out of the trash bin. It was covered in grease and cream. He passed it to my mother. “Keep it,” he said. “For a memory.”

  My sister and her kids arrived the following day. The cousins played hide-and-seek in the backyard. We went go-karting at an amusement park. Every evening after dinner we’d go for ice cream. One evening we went to my father’s lab to check out his new microscope. Afterward, in the greenhouse where he grew his wheat hybrids, he tried to explain genetics to Mohan. “What’s inside cells?” my father asked him.

  “Genes,” Mohan replied proudly, as I’d taught him.

  “No, chromosomes,” my father said sharply. Mohan looked at me, deflated. “You have forty-six chromosomes,” my father said.

  “Chromosomes have genes in them,” I gently explained to Mohan.

  “A cell doesn’t have genes?” Mohan asked.

  “No!” my father barked. “Well, it does, but you can’t see them.”

  Now Mohan was really confused. “The genes are inside chromosomes,” I explained. I picked him up. “Do you have to make it so difficult?” I snapped at my father. Turning to Mohan, I said, “Every cell in the body has forty-six chromosomes. Nana has forty-six, Mama has forty-six, you have forty-six, I have forty-six—”

  “If you have more or less—forty-five or forty-seven—you will be abnormal!” my father boomed.

  My father got increasingly testy as the week wore on. “I don’t know what will happen to us,” he said in one especially malevolent altercation at the kitchen table. “When you get old, you lose your importance.”

  “That’s the way of the world, Dad,” I said evenly, refusing to be emotionally manipulated. “What makes you think our family is any different?”

  “I took care of my mother. She died in my arms.”

  “She died in a nursing home!”

  “We visited her three times a day!”

  I laughed mirthlessly. I didn’t want to continue the argument, but I couldn’t stop it either.

  “You people don’t respect your parents. When we are old…” His voice trailed off. “I don’t want to see it.” He looked sharply at my mother. “I can’t believe these kids. I never yelled at my father.”

  “That’s because he died when you were thirteen years old,” I said viciously.

  Though seventy years old now, he was still the same: inflexible, restless, a victim of his own expectations. There was no question in my mind that he’d wanted us to come for his birthday, and he was probably touched by the gesture, too—even if he couldn’t show it—but I couldn’t help but think that for him it was more about the ritual of the visit than the sentiment. We were following the same old script from when I was growing up, unable to modify it to cope with the changing times.

  “Things are never perfect,” I said to my sister when we took a walk around the neighborhood one evening. The air was warm and stale; the sidewalks were empty. Fireflies were starting to light up in the dusky haze. “I was so looking forward to this trip, but things are never perfect.”

  She strolled beside me but didn’t say anything.

  “I get so irritated,” I said. “I know I shouldn’t. I hate myself for it. But if I don’t react, it’s like I’ve given up.”

  “Our parents are probably only going to be around for a few more years,” she said softly. “We keep forgetting that.”

  “I know,” I said. I remembered what a doctor friend had told me at the funeral of a colleague’s mother. “It’s really something to lose your parents,” he’d said. “You grow up after you lose your parents.” I shook my head to banish the thought. Then I said defiantly to my sister: “I know he’s never going to change. But neither am I.”

  * * *

  Back in New York, I was feeling increasingly weighed down by my bland responsibilities. Everything I was doing—as a doctor, husband, or father—seemed a crude and subpar approximation of what was good and ideal. I kept telling myself to be a witness and observe it all. But experiences refract aberrantly through the haze of gloom. A stick underwater gives the illusion of being bent.

  In the fall I impulsively wrote an essay for The New York Times about the problem of overtesting in medicine that predictably created a backlash. After the article was published, a group of private cardiologists wrote a letter to my division chief saying they were “outraged … We take great offense to the portrayal of medicine on Long Island … as being driven solely by money,” they wrote. “Although you can argue that there are a few bad apples in the bunch, nevertheless the great majority of physicians that we associate with put the care, safety and concerns of our patients first and monetary issues second.” They said the article was “disingenuous and counterproductive … It would be impossible for our group to support any physician who spouts such self-destructive, one-sided opinions. If this is the opinion of the Department of Cardiology, support of such a department would also become more problematic.”

  Though I believed in what I had written, I was still nervous. One can never underestimate how hard people will fight to protect their turf. And although my chief was generally supportive of my journalism, I couldn’t help thinking of what Santo Russo, my Columbia mentor, had told me in my first year as an attending: “If you mess up relations with a referrer, you can get fired.”

  One morning, several days after the article was published, Rajiv found me in my office. He closed the door. “No one loves you more than I do,” he said, sitting down, “so I have to tell you that you are fucking up.” I stared at him but didn’t say anything. “You sit in this office all day. You keep the fellows and your patients waiting. I know how smart you are, but you are just so … disengaged. And then you write these goddamned articles for the paper! Get it together. People are watching. Don’t wait for a crisis to change.”


  No question, I was in a rut. The strain at home and at work had taken its toll. “You always look so pensive,” a colleague told me, and undoubtedly I had, for months. I had accomplished few of the goals I’d set for myself when I started my heart failure program four years earlier. Though I’d helped reduce length of stay and readmissions and had written an admission order set that was being used throughout the hospital, most of my good intentions remained unfulfilled. I knew I couldn’t go on like this for much longer. I’d experienced periods of depression before—most recently during internship, when I was exhausted and sleep-deprived for the better part of a year—but this was different, a murkier feeling, as if there were something I was supposed to be worried about but I didn’t know what it was, as if I were waiting for something to happen that wasn’t happening, so I kept waiting and waiting, sort of hoping it would happen—whatever it was—and be done with.

  One day I received an unexpected phone call. Chester Thomas, a young patient of mine, had died suddenly.

  Chester was diagnosed with heart failure when he was eighteen years old, but as is so often the case with this disease of manifold etiologies, we never figured out how he got it. He was a student at a community college in Brooklyn when I met him, though he dropped out when his condition worsened. He had short, curly hair and gold wire-framed glasses that rested on the bridge of a wide nose. Despite the setbacks, he was a model patient, coming in diligently with his mother for weekly appointments, eliminating salt from his diet, taking his medications regularly. “May God bless you,” his mother often said to me. “You are doing such a wonderful thing for my son. You will be rewarded.”

  As Chester’s condition deteriorated, he started going frequently to the emergency room with abdominal pain. “I was having the dry heaves,” he once explained when I admitted him to the hospital. “Sometimes I wonder whether it’s psychological. My stomach gets full, the whole abdomen gets hard, like I had nine meals,” a result, no doubt, of fluid buildup caused by his weakened heart.

  Eventually I referred Chester to a transplant center in Manhattan, where he went for evaluation and frequent follow-up visits. He had to lose weight to qualify for a heart transplant, and by the time he did, his lungs had become so waterlogged that he was suffering from severe fatigue and shortness of breath.

  Two weeks before his twentieth birthday, Chester attended a weeklong religious retreat with friends in Kentucky. His doctors, including a transplant cardiologist, had strongly discouraged him from going, but he had insisted. He left by car on a Sunday. The following Friday, he died alone in a hotel room in Lexington.

  His mother called to tell me the news. Voice breaking, she thanked John and me for treating him over so many months. She invited us to the funeral.

  The church, in Jamaica, Queens, resounded with lilting hymns as we arrived. Inside, men were dressed in cream-colored suits and women in Sunday finery. An organ was playing eerie music in the high-ceilinged chamber. Two men stood in front of the coffin, which carried a portrait of Chester wearing a pinstriped suit, looking debonair, unlike the debilitated state in which I remembered him. As we took our seats, a man in a yellow suit got up and started tap dancing, exhorting the crowd to come up and dance with him. A woman carried a shrieking toddler to the back of the room.

  Soon people were clapping on tambourines and playing harmonicas in fast, crazy rhythms. Men came up to praise Chester. “He walked with God … He is in a better place … He never did nothing the wrong way.” One person confirmed what I’d always known about Chester: “He believed in order and had no tolerance for cutting corners.” A few folks were dancing wildly as Gospels were shouted. “Speak praise of the Lord,” someone bellowed. “You can hear me say it now: the Almighty himself will lead you down the path of the true and the righteous.”

  Chester’s uncle, a bishop, stood up and delivered the main eulogy. In soaring oratory he declared that Chester had had an unshakable conviction that God would save him. “Even in his worst sickness, when he had to tell his brothers to give him a few minutes because he could not get up from a chair—even then he had faith.” The audience roared its approval.

  “Ticktock!” he screamed into a microphone, which reverberated in dissonant feedback. “Your time is coming, too. Keep on with the insults, the small-minded bruises and disputes. Ticktock! Your time is coming, too.” Murmurings swelled to shouts of support. Someone opened the coffin. Chester lay in repose, his skin gray, his eyes closed. A shiver spread across my chest.

  “Ticktock!” Again and again he shouted these words as I sat transfixed, my eyes filling with tears at the spectacle. I thought of my trip to Fargo and all the silly acrimony with my father. What was the point of it when our time together was going to end anyway? How strange this existence, I told myself. It is the finitude of life that keeps us going, and yet it saps meaning from our lives if this is all there is.

  The sermon then took on a more subdued tone. The uncle recalled how Chester had been adopted as an infant. (I had not known.) He said Chester had taught himself Hebrew and liked being called T.R., for Temple Rabbi. (Another thing I hadn’t known.) Then he said, “Forgive me, but I want to focus on the lighter side of my nephew.” He told how Chester enjoyed wearing stylish clothes. He recalled Chester’s youthful indiscretions. “Chester loved White Castle cheeseburgers.” I did a double take: Cheeseburgers loaded with sodium? Chester had always denied such improprieties to us. “And chicken rolls with soy sauce. Whenever he was with me, we would always stop for takeout.”

  I looked at John. He had the same disbelieving look I must have had.

  “Chester did not like taking his medications,” his uncle went on, as if speaking to me. “I’d remind him to do it, force him to, but he would avoid it because they didn’t make him feel good.” I shifted uncomfortably in my seat. “And you all know he never wanted a heart transplant. He never would have accepted one.” (That was news to me, too.)

  Afterward, John and I were asked to say a few words. John recalled how much Chester loved pens, how John always gave him a fancy pen when he came to see us. (I’d had no idea.) He said he believed that God had put us on this earth for a reason and that Chester had fulfilled his purpose in this world. Then it was my turn. As I walked up, I thought about the signs I’d missed while taking care of Chester. I thought about how easy it is to ignore social milieu, habits, the sorts of things that make a patient into a real person—and vice versa. Undoubtedly, such information would have helped me treat Chester while he was alive. Standing behind the podium, I told the crowd that Chester was brave and vibrant. I called his death a tragedy. Then I thanked his adoptive mother for inviting me. I had learned so much that day.

  After the service, John and I went to a nearby deli for lunch. “There is always someone who has it worse than you,” John said after we sat down. “No matter how bad things get.”

  I nodded and took a bite of my pastrami sandwich. I was hungry.

  “People don’t take the long view,” John went on, uncharacteristically philosophical. “We worry about so much trivial stuff.”

  I smiled at John’s gravity, but he was right, of course. We so often waste our borrowed time. I had seen so much death the past four years, seen so many patients come and go. A few weeks prior, when I had been in line at the hospital deli to buy an iced coffee, a woman in front of me paid for her drink, picked up a laptop computer and a sheaf of papers, and turned to me in my white coat and said, “He’s probably dead by now, my husband,” and walked out. It had been overwhelming at times—I could never forget the horrible ways by which Joseph Cimino and Lily Dunhill had died—but I had become almost inured to it, and I didn’t feel so afraid of it anymore. I often thought of a letter I’d received from the mother of another young patient of mine, a man in his early twenties who’d been born with severe congenital heart defects—a large hole between the upper cardiac chambers, an incompletely formed left ventricle—requiring multiple surgeries. She’d written:

 
All of life is snatched from death. Our responsibility is to fully taste it. I believe that we each live many lifetimes, that none of us is a stranger to the other. I believe that temporal time, as we perceive it, is an illusion. And so the part of me that is not the grieving mother knows deeply in her heart that the duration of this lifetime of Jack’s is not what really matters. And that any attempt to cling to it only ends in despair.

  It was impossible, with all the death I had witnessed, not to think about how I was eventually going to die. Was I going to cling to life in desperation? Would death happen suddenly, as for my grandfather? Would it drag out, with me helpless at the epicenter, like Lily Dunhill? Or would I accept it with equanimity like Leonard Sullivan? Sullivan, a patient I took care of for almost three years, loved the sea, loved to sail his little catboat on Long Island Sound. “I must go down to the seas again” is the beginning of “Sea Fever,” a poem his son, a college professor, told me he recited countless times, sometimes to express his sense of awe about the sea and sailing ships, sometimes to express his frustration that he was living in a home in suburbia rather than leading the sailor’s “vagrant gypsy life.” When he entered the terminal phase of his disease, his wife insisted on the most aggressive treatment possible, but Sullivan rejected it. After he died, his son wrote this letter:

  Near the end of his life, when he was no longer responsive, when the “death rattle” began in his breathing, I read “Sea Fever” to him. As soon as I started reading the poem he rose up in bed and started turning his head from side to side and up and down. What I witnessed I will never forget. We had been talking to him for the last several hours but he seemed not to hear us. But I know he heard that poem, something familiar, something from his past, something etched in his memory and dear to his heart. What I believe, what I want to believe and yet, what I do believe, is that hearing this poem took away my father’s fear of death, and that this is the reason why, just five minutes after reading him the poem, he passed away. And what I want to believe is that he passed away, beyond the horizon, on a tall sailing ship, listening to the song of the wind, the seagulls crying, amused by a merry yarn from a laughing fellow rover, feeling the kick of the wheel and the shaking of the sails, living at last that vagrant gypsy life for which he longed so intensely his entire life, and finding, at the end of life’s long trick, a quiet sleep and a sweet dream.