When Sarah opens her eyes again, she is tangled in her sheets and a Toronto dawn is setting her bedroom alight.
chapter seven
Rebecca pulled her Jaguar coupe out of the staff parking garage behind Mount Sinai Hospital. She could do this route with her eyes closed. The night-like chill from the covered garage gave way to the sudden warmth of day on Murray Street. The patients she had just visited that morning were doing fine. Two had had troublesome organs removed (one gall bladder, one appendix), one was recovering from a mild stroke, and one had delivered a baby. Everything was fine.
Natalka would be her first appointment of the day. She had scheduled forty-five minutes for her so she could do a thorough examination. Rebecca wasn’t looking forward to it. She had seen her share of terminal illness and preferred treatable diseases. Something she could prescribe a drug for: high blood pressure, bronchitis, an overactive thyroid. She was grateful that the rest of her day would be taken up with sore throats and stomach upsets and scripts for birth control pills. That would do nicely. Iris would have everything organized for her, bless her. Only first she had to examine Natalka and hope that her condition was still in the early stages. Thank heavens a specialist would take over her treatment.
She drove south down University Avenue, the showcase of Toronto, its six lanes of traffic divided by sculpted stone monuments planted with impatiens and marigold. She turned right onto Dundas. On the outer edge of Chinatown people were already threading their way through stalls of fruit and vegetables and souvenir T-shirts that spilled onto sidewalks. The crowds and the splash of primary colours always cheered her.
A traffic report came on the radio: “Avoid Bay Street at Wellington if you can. Motorists are slowing down to take a look at the strikers carrying signs…”
She switched stations. A man’s voice shouted over the din. “For the first time in history a wildcat strike has shut down the uranium mine at Bear Lake. These men have come down in their work clothes — some are at the Legislature hoping to get the attention of Premier Bill Davis, and some are here, in front of the offices of Baron Mines. The strikers are slowly marching around in a circle, carrying handmade signs. Here’s one that says, ‘We want fresh air.’ Another one: ‘Baron Mines Death Trap.’ I’m going to wade in and speak to this fellow. What is your name, sir?”
“Bill Roberts.”
“Mr. Roberts, you’re the union rep, could you tell our listeners, what does this sign mean, ‘We want fresh air’?”
Some static crackled. “We work in Baron’s uranium mines in conditions you wouldn’t want for your dog. The ore’s filled with silica dust and gives off these radioactive gases. It’s poison. Our men are dying of lung cancer and what they call silicosis. We think it’s the conditions in the mines, but the company won’t talk to us. We want some straight answers. We’ve got the right to know if our work is killing us.”
“Why do you think they won’t meet with you?”
“John Baron’s only interested in his profits. We dynamite the ore down there — that gives off tons of poison silica dust — and we do it in the same shaft we breathe in. Other companies build hard rock mines with two shafts, one for bringing up the ore, the other for ventilation so people can breathe. John Baron only built one shaft ’cause he didn’t give a damn if we could breathe or not.” The man’s voice cracked with emotion. “He didn’t want to spend the bucks, and what with the radiation down there, we’re dying of cancer at four times the average.”
“What do you want Baron Mines to do?” asked the interviewer.
“They got to dig down that other shaft, give us proper air while we’re down there working — we’re bringing up the ore that’s making them rich.”
Rebecca drove up Beverley Street then turned left on D’Arcy. In spite of the morning sun warming her through the window, she shivered as she pulled into the small lot behind the medical building. John Baron had appeared only crude and selfish during their brief meeting; now it seemed he was also avaricious and cruel.
Iris sat at her desk behind the counter in the waiting room, checking over lab and x-ray reports that had come that morning. She looked up at Rebecca over her spectacles. “Good morning, love.”
Iris was elegant, as usual, in a grey silk suit despite the large curves of size-twenty breasts and hips. Her short hair swept up from her neck in blond wings. What a comfort she was. Rebecca would be lost without her.
The phone rang. Iris answered, “Dr. Temple’s office.”
Rebecca took up her usual position behind the counter, in a chair off to the side where she could look at reports.
“No, that’s all right, Mrs. Mullins,” Iris said into the phone while handing Rebecca some lab results. “I know you’re concerned for the baby. Come in at one o’clock.”
After Iris had hung up, Rebecca raised an eyebrow at her.
“She’s got a sore throat,” Iris said, “but she doesn’t want to take antibiotics because of the baby.”
“I’ll wait for a culture before putting her on anything,” Rebecca said. “But she’s in her third trimester. She can take some penicillin if she needs to.”
They worked quietly for a few minutes.
“Is Nesha coming for Rosh Hoshanah?” Iris asked. Rebecca didn’t look up from the report she was reading. “No,” she said. “His son has a new girlfriend and they’re invited to her parents.”
Rebecca continued to check over the blood tests and consult reports in front of her. Nesha had been flying in from his home in San Francisco once a month since they had met in the spring. Though she looked forward to Nesha’s visits, this month would be different. This month she would light a yahrzeit candle to mark the first anniversary of David’s death.
Nesha knew all about death, having witnessed the destruction of most of his family in the war. But she couldn’t share this with him. She couldn’t share it with anyone, not even Sarah, her mother-in-law, who yearned to share it with her, who would have to mourn alone. She loved Sarah in her own way and felt guilty for neglecting her, but it was all Rebecca could do to force herself to call on Sundays and pretend she’d like to talk to her more often but had no time.
The phone rang and Iris began a dialogue with a drug rep. She wheeled her chair off to the side cabinet where they stored the little boxes and tubes of medication samples the salesmen dropped off. She unlocked the cabinet door. Which samples did they want this month? More sulpha? More diuretics? More birth control pills? Yes, yes, and yes.
With Iris’s attention engaged elsewhere, Rebecca opened the drawer of the desk and felt deep inside with her hand. She had given Iris instructions to remove all photos of David from the office. His artwork had gone first. All his paintings and sketches had been replaced by reproductions of Van Gogh, Monet, and Pisarro. But Rebecca still kept the small, framed photo of them taken by a stranger in the Tuilleries garden. It was 1976 and they were in Paris on a pilgrimage for David’s art. Three years ago. Rebecca prodded the picture to the edge of the drawer and sneaked a look.
It had been taken shortly before they’d discovered the diabetes, before her world had fallen apart. They’d been married for five years then; were thinking of having children. Their arms were wound around each other’s shoulders as they grinned into the camera. They looked so young then, so happy. She hardly recognized herself. Not that she had changed so much, physically. Still the same dark bushy hair, the prominent cheekbones. But the expression of joy on her face — that was something she could only recognize from the distance.
“Try around lunchtime,” Iris said to the drug rep on the phone. “She may have a few minutes then.”
Rebecca quietly closed the drawer. She didn’t mind talking to the men who came round with their oversized cases filled with sample goodies. It was an easy way to find out about new drugs. And her patients benefitted from the free medication supplied by the supposed largesse of the drug companies. A working symbiosis.
Iris stepped over to the wall of colour-coded files a
nd began to retrieve the folders of patients who had appointments that morning.
“My kids have put in their order for Rosh Hashanah,” she said, continuing to work. “They’re tired of turkey, so I’m going to make a brisket. Oh, and you won’t believe this: Martha’s bringing a friend. A man. It must be serious if she’s bringing him for the holiday.”
“You must be pleased,” Rebecca said.
“I’m terrified. What if he hates my cooking? What if he hates my house? I could be starting off on the wrong foot with my future son-in-law.”
Rebecca smiled.
“You’re lucky with Sarah,” Iris said. “She’s a good mother-in-law. She doesn’t push herself on you, and she’s an exceptional woman.”
Iris and Sarah had gotten to know each other during David’s illness. Each spoke glowingly of the other.
“Still, it’s nice you’re doing her this favour.”
Rebecca winced with guilt. She could hardly have refused. Yet now that she had met Natalka, she was eager to help in any way she could. Halina had called Sarah out of the blue after a very spare correspondence of not more than four letters over thirty-five years. She was desperate to get treatment for her daughter’s illness and hoped Sarah could help her. She knew Sarah’s daughter-in-law was a physician and had asked her whether Rebecca could examine Natalka and recommend a specialist to see her. Natalka seemed to have chronic leukemia, better than the acute kind, but not by much. In both cases the bone marrow produced too many white blood cells, a process that devastated the body rather quickly in the acute disease, but took a bit more time to wreak its havoc in the chronic version. With standard medical treatment she might survive three years. Her Polish doctor had told her he could do nothing more for her, but her chances would be better if she could get to the West, where they were experimenting with new drugs and treatment.
Rebecca remembered Janek’s disinterest in Natalka. Perhaps it wasn’t disinterest. Perhaps it was anger. Her illness was going to cost him a fortune. Rebecca, herself, was happy to examine Natalka without payment. And under the circumstances, the surgeon might waive his usual fee for services. But the lion’s share of the cost was hospital-related. Operating room expenses, including anaesthetic and the specialist who would administer it, lab tests, radiation, chemotherapy, hospital stay, nurses, and on and on. None of it would be covered under the province’s socialized medical insurance since they were foreign visitors.
Footsteps sounded on the stairs leading to the second floor office. Rebecca heard low voices on the landing. Sarah stepped through the doorway first, followed by Natalka and Halina.
Iris immediately came around the counter into the waiting room and warmly embraced Sarah. Rebecca followed two steps behind, noting the outlandish difference in the size of the two women: Iris, tall and broad in her grey suit, Sarah just five feet two and slender, a blue-patterned blouse tucked into a matching skirt.
“It’s so nice to see you again!” Iris said, beaming at Sarah.
Rebecca pressed her cheek to Sarah’s in greeting. She looked tired, Rebecca thought. Probably still agitated about the break-in.
Sarah introduced the other two women to Iris. After inquiring about their stay in Toronto, Iris engaged Halina and Sarah in conversation. Meanwhile, Rebecca detached Natalka from the group and ushered her into an examining room. Natalka wore a loose mauve shift dress that barely disguised the protrusion of her abdomen when she moved.
Rebecca spent twenty minutes asking her questions to get a complete medical history. She had been in good health until four months earlier, when she had begun to feel excessively tired. The only time she had ever been hospitalized was when she had delivered her daughter, Anya, fifteen years before. Rebecca underlined “fifteen,” glad that the daughter was old enough to be a candidate for a tissue match if Natalka needed a bone marrow transplant.
Rebecca was listening to Natalka’s answers, writing short notes in her file, when the woman’s voice shifted from matter-of-fact to personal.
“I am very embarrassed, I must tell you something. Mama did not tell even Sarah.” She paused, swallowed, then continued. “Doctor in Poland — he was not sure about the leukemia. Blood tests not clear. He said it could be, but it could be something else. He does not know what. He only knows I can die from it. He wrote letter that I have leukemia so I can leave Poland for treatment. Mama helped one from his relatives with visa.”
Rebecca was taken aback at first, but realized that nothing much would change in the way of her examination or the tests she ordered. Their methods were questionable, this mother and daughter, but what would she have done in the same circumstances?
Rebecca continued her questions. There was no cancer, kidney disease, or lung disease in her family. Halina’s father had died of heart disease, her mother, old age. Rebecca found nothing in her patient’s background that connected her to leukemia, no exposure to radiation or to the chemical benzol. Her only symptoms, apart from the extreme fatigue, were anemia and a dull ache on her left side that wouldn’t go away. And nosebleeds. Spontaneous nosebleeds that were hard to stop.
Rebecca took her temperature and looked into her eyes to see if there were any hemorrhages in the retina. Both were normal. An encouraging sign. She had Natalka sit on a chair while she stood behind and gently moved her fingertips over her entire throat, checking the lymph nodes.
“Tilt your head to the right, please,” she said. She felt for the cervical nodes beneath the relaxed neck muscle. “Now to the left.”
She pressed her fingers delicately around the lymph nodes, feeling whether they moved freely or were fixed to one spot.
“Is it tender here?” she asked.
“No.”
The nodes were firm and slightly enlarged, but discrete. They weren’t fused together like they would be in Hodgkin’s disease. Rebecca knew enlargement was slow to develop in leukemia.
She patted the examining table. “Please lift up your dress and lie down. I’m going to check your abdomen.”
Natalka lifted the mauve cotton fabric, draped it across her chest, and lay down, her head on a small pillow.
As Rebecca had already noted, the left side of the woman’s abdomen was swollen.
“Put your arms at your sides” Rebecca said, “and bend your knees up. It relaxes your stomach muscles.”
Rebecca rubbed her hands together briskly. “I don’t want to touch you with cold hands.”
At first, Rebecca moved one hand very lightly over the area to get a general picture of her abdomen.
“Now breathe deeply.”
She slid her hand an inch at a time from one quadrant to another. Natalka lay without a sound until Rebecca moved her fingers to the bloated left side below her ribcage. Then she winced.
“It’s tender there?” Rebecca asked.
The patient nodded.
There were many reasons why her spleen might be enlarged, ranging from infection to metabolic disorders. And then there was leukemia. The out-of-whack bone marrow filled the spleen with white blood cells, making the area ache, a common complaint of leukemia patients. The Polish doctor had given Natalka the opportunity of knowledge. Western doctors could get to the bottom of her illness. Whether the prognosis would change depended entirely on the nature of her affliction.
Rebecca continued her examination. To palpate the liver and kidneys she tilted her hand slightly with her fingers depressing the abdominal wall further to the right so that she could feel the edges of the organs. Both were the right shape and size and where they were supposed to be. It was a little tricky feeling the liver around the spleen, but at least Natalka was slender. Rebecca had several obese patients whose liver and kidneys were well hidden beneath a layer of fat and refused to reveal themselves under her hand.
Unlike the liver and kidneys, the spleen could not be outlined unless it was diseased or abnormally enlarged.
“Could you please place your left arm under your lower back?” she said.
Natalka obliged
. This position helped lift and displace the spleen forward. Rebecca reached over and placed her right hand under Natalka’s left side, forcing the spleen forward even further, while the fingers of her left hand gently pressed down, searching for an edge.
Natalka groaned quietly.
“I’m sorry,” Rebecca said. “Almost done. Another deep breath.”
Rebecca moved her fingers along the edge of the largest spleen she had ever felt — all the way down to the pelvic brim and over to the right side of the abdomen. Her hopes diminished. She refused to be optimistic and then face the worst. The world was a strange and terrible place. She had already found that out the hard way. Why did she keep hoping for better?
After Natalka left, Rebecca stepped into the little corner of the office where they collected blood and urine samples. A cupboard above the counter was filled with large glass jars that held dipsticks, gauze pads, disposable lancets, disposable gloves, sterile sample bottles. On one side of the counter stood a microscope and glass slides.
Rebecca used a dropper to remove a droplet of blood from the sample she had taken from Natalka. She touched the bead of blood to a glass slide, then took another slide and, angling it against the first one, moved it slowly along the glass to draw the blood flat across it. She let it dry, then fixed it with a stain. After diluting it with water and letting it dry again, she examined it under the microscope. She didn’t often go through this procedure, mostly when an immediate decision had to be made about treatment and she needed information before lab results would come back.
This was different. She doubted there was anything she could do that would dramatically alter the course of Natalka’s illness. She could call it scientific curiosity, but she knew better. She had gotten involved, and that was always dangerous emotionally.
She squinted into the microscope. She understood the confusion of Natalka’s Polish doctor. Among the red and white blood cells and platelets there were none of the blast cells associated with leukemia. And when she put another drop of blood into the counting slide, she found Natalka’s white blood cells were below normal. Not the astronomical count usually found in leukemia. That didn’t rule out the diagnosis, however. She knew better than to hope for that. Before her next patient, she looked up “Splenomegaly” in her pathology textbook.
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