by Robin Cook
Closing her right eye, Cassi looked at the test tape. There was just a vague sensation of light as if she were looking through a wall of ground glass. She wished that she didn’t have the problem with her eye because the idea of blindness terrified her more, in some ways, than the idea of death. The possibility of death she could deny, just like everyone else. But denying the possibility of blindness was difficult with the condition of her left eye there to remind her each and every day. The problem had happened suddenly. She’d been told that a blood vessel had broken, causing blood to enter into the vitreous cavity.
As she washed her hands, Cassi examined herself in the mirror. The single overhead light was kind, she decided, giving her skin more color than she knew it possessed. She looked at her nose. It was too small for her face. And her eyes: they curved unnaturally upwards at the outer corners as if she had her hair pulled back too tightly. Cassi tried to look at herself without concentrating on any single feature. Was she really as attractive as people said? She’d never felt pretty. She had always thought that diabetes was indelibly stamped in bold letters across her forehead. She was convinced that her disease was a major flaw that everyone could see.
It hadn’t always been that way. In high school Cassi had tried to reduce it to a small aspect of her life. Something she could compartmentalize. And although she was conscientious about her medicine and diet, she did not want to dwell on it.
Yet this approach made her parents, mostly her mother, understandably concerned. They felt that the only way she would be able to maintain the discipline the disease required was to make it her major focus. At least that was the way Mrs. Cassidy had dealt with the problem.
The conflict came to a head at the time of the senior prom.
Cassi came home from school beside herself with excitement and anticipation. The prom was to be held in a fashionable local country club, followed by a breakfast back at the school. Then the entire class was to head down to the New Jersey shore for the rest of the weekend.
Unexpectedly Cassi had been asked to the prom by Tim Bartholomew, one of the more popular boys in the school. He’d talked with Cassi on a number of occasions following a physics class they shared. But he’d never asked Cassi out, so the invitation came as a total surprise. The thrill of going out with a desirable boy to the biggest social event of the year was almost too much for Cassi to bear.
Cassi’s father was the first to hear the good news. As a rather dry professor of geology at Columbia University, he didn’t share the same enthusiasm as Cassi but was pleased she was happy.
Cassi’s mother was less enthusiastic. Coming in from the kitchen, she told Cassi that she could go to the prom but had to come home instead of going to the breakfast.
“They don’t cook for diabetics at such affairs,” said Mrs. Cassidy, “and as far as going to the shore for the weekend, that is completely out of the question.”
Not expecting this negative response, Cassi was ill-prepared to deal with it. She protested through tears that she’d demonstrated adequate responsibility toward her medicine and diet and that she should be allowed to go.
Mrs. Cassidy was adamant, telling Cassi that she was only thinking of her welfare. Then she said that Cassi had to accept the fact that she was not normal.
Cassi screamed that she was normal, having emotionally struggled with that very issue for her entire adolescence.
Mrs. Cassidy grasped Cassi’s shoulders and told her daughter that she had a chronic, life-long disease and that the sooner she accepted the fact the better off she’d be.
Cassandra flew to her room, locking her door. She refused to talk with anyone until the next day. When she did, she informed her mother that she’d called Tim and told him that she couldn’t go to the prom because she was ill. She told her mother that Tim had been surprised because he’d not known she had diabetes.
Staring at her reflection in the hospital mirror, Cassi brought herself back to the present. She wondered to what degree she had overcome her disease intellectually. Oh, she knew a lot about it now and could quote all sorts of facts and figures. But had that knowledge been worth the sacrifices? She didn’t know the answer to that question and probably never would. Her eyes strayed up to her hair, which was a mess.
After taking out her combs and hairpins, Cassi gave her head a shake. Her fine hair tumbled down around her face in a disorganized mop. With practiced hands she carefully put it back up, and when she emerged from the bathroom she felt refreshed.
The few things she’d brought with her for the overnight in the hospital fitted easily into her canvas shoulder bag despite the fact that it already contained a large folder of reprinted medical articles. She’d had the bag since college, and although it was soiled and threadbare in places, it was an old friend. It had a large red heart on one side. Cassi had been given a briefcase on graduation from medical school, but she preferred the canvas bag. The briefcase seemed too pretentious. Besides, she could get more into the bag.
Cassi checked her watch. It was five-thirty, which was just about perfect timing. She knew that Thomas would be heading down the stretch, seeing his last office patients. As Cassi hefted her things, she remarked to herself that the regular schedule was another benefit of psychiatry. As a medical intern or pathology resident, she was never finished much before six-thirty or seven, and at times worked to eight or eight-thirty. On psychiatry she could count on being free after the four to five afternoon team meeting, provided she wasn’t on call.
Stepping into the corridor, Cassi was initially surprised to find it empty. Then she remembered that it was dinner-time for the patients, and as she passed the common room, she could see most of the patients eating from their trays in front of their TV sets. Cassi ducked into her cubbyhole office and collected the charts she’d been extracting. She only had four patients, including Colonel Bentworth, and she’d spent a portion of the afternoon carefully going over their charts and making three-by-five index cards on each case.
With the canvas bag over her shoulder and the charts in her arms, Cassi went down to the nurses’ station. Joel Hartman, who was on call that night, was sitting in the station, talking to the two nurses. Cassi deposited the charts in their respective slots and said good night. Joel told her to have a good weekend and to relax because he’d have her patients cured by Monday. He said he knew just how to handle Bentworth because he had been in ROTC in college.
As she walked down to the first floor, Cassi could feel herself beginning to relax. Her first week on psychiatry had been a trying and difficult period, one that she would not like to relive.
Cassi took the interior pedestrian crosswalk to the Professional Building. Thomas’s office was on the third floor. She paused outside the polished oak door, gazing at the shining brass letters: THOMAS KINGSLEY, M.D., CARDIAC AND THORACIC SURGERY, and felt a thrill of pride.
The waiting room was tastefully decorated with Chippendale reproductions and a large Tabriz rug. The walls were powder blue and hung with original art. The door leading to the inner office was guarded by a mahogany desk occupied by Doris Stratford, Thomas’s nurse-receptionist. As Cassi entered, Doris looked up briefly, then went back to her typing when she recognized who it was.
Cassi approached the desk.
“How’s Thomas doing?”
“Just fine,” said Doris, her eyes on her paper.
Doris never looked Cassandra in the eye. But over the years Cassi had become accustomed to the fact that her illness made some people uncomfortable. Doris was obviously one of them.
“Would you let him know I’m here?” said Cassi.
Cassi got a fleeting glimpse of Doris’s brown eyes. There was an aura of petulance about her expression. Not enough for Cassi to complain about but enough to let her know that Doris did not appreciate the interruption. She didn’t answer Cassi but rather depressed the button on an intercom unit and announced that Dr. Cassidy had arrived. She went directly back to her typing.
Refusing to allow Doris t
o irritate her, Cassi settled herself on the rose-colored couch and pulled out the articles she wanted on borderline personality. She started to read but found herself looking over the top of the paper at Doris.
Cassi wondered why Thomas kept Doris. Granted she was efficient, but she seemed moody and irritable, hardly the qualities one would like in a physician’s office. She was presentable although not overly attractive. She had a broad face with large features and mousy brown hair pulled back in a bun. She did have a good figure; Cassi had to admit that.
Letting her eyes drop back to her paper, Cassi forced herself to concentrate.
Thomas looked across the polished surface of his desk at his last patient of the day, a fifty-two-year-old lawyer named Herbert Lowell. Thomas’s office was decorated like his waiting room, except the walls were a forest green. The other difference was that the furniture was authentic Chippendale. The desk alone was worth a small fortune.
Thomas had examined Mr. Lowell on several occasions and had reviewed the coronary arteriograms done by Mr. Lowell’s cardiologist, Dr. Whiting. To Thomas the situation was clear. Mr. Lowell had anginal chest pain, a history of a mild heart attack, and radiographic evidence of compromised arterial circulation. The man needed an operation, and Thomas had told Mr. Lowell as much. Now Thomas wanted to terminate the visit.
“It’s such an irreversible decision,” Mr. Lowell was saying nervously.
“But still a decision that must be made,” said Thomas, standing up and closing Mr. Lowell’s folder. “Unfortunately I’m on a tight schedule. If you have any further questions you can call.” Thomas started for the door like a clever salesman indicating the issue was beyond further negotiation.
“What about the advisability of a second opinion?” asked Mr. Lowell hesitantly.
“Mr. Lowell,” said Thomas, “you can get as many opinions as you’d like. I will be sending a full consult letter back to Dr. Whiting, and you can discuss the case with him.” Thomas opened the door leading to the waiting room. “In fact, Mr. Lowell, I would encourage you to see another surgeon because, frankly, I do not feel good about working with people with negative attitudes. Now if you’ll excuse me.”
Thomas closed the door behind Mr. Lowell, confident the man would schedule the required operation. Sitting down, he gathered the material he needed for his Grand Rounds presentation the following morning, and then started signing the consultation letters Doris had left for him.
When Thomas emerged with the signed correspondence, he was not surprised to find Mr. Lowell in the waiting room. Thomas glanced at Cassi, acknowledging her with a brief nod, then turned to his patient.
“Dr. Kingsley, I’ve decided to go ahead with the operation.”
“Very well,” said Thomas. “Give Miss Stratford a call next week, and she’ll set it up.”
Mr. Lowell thanked Thomas and left, closing the door quietly behind him.
Holding her reports in front of her as if she were reading, Cassi watched her husband going over some notes with Doris. She’d noticed how well he’d handled Mr. Lowell. He never seemed to hesitate. He knew what should be done and he did it. She’d always admired his composure, a quality she felt she lacked. Cassi smiled as her eyes traced the sharp lines of his profile, his sandy hair, and his athletic body. She found him extraordinarily attractive.
After the insecurities of the day, in fact the entire week, Cassi wanted to rush up and throw her arms around him. But she knew instinctively that he would not care for that kind of show of emotion, especially with Doris there. And Cassi knew he was right. The office was not the place for such behavior. Instead, she put the reprint back into the folder and the folder back into the canvas bag.
Thomas finished with Doris, but it wasn’t until the office door closed behind them that he spoke to Cassi.
“I’ve got to go to the ICU,” he said, his voice flat. “You can come or wait in the lobby. Your choice. I won’t be long.”
“I’ll come,” said Cassi, already guessing that Thomas’s day had not been smooth. She had to quicken her step to keep up with him.
“Was there trouble with your surgery today?” she asked tentatively.
“Surgery went fine.”
Cassi decided against further questioning. It was difficult to talk as they threaded their way back into the Scherington Building. Besides, she’d learned from experience that it was usually better to let Thomas volunteer information when he was upset.
In the elevator she watched while he kept his eyes glued to the floor indicator. He seemed tense and preoccupied.
“I’ll be glad to get home tonight,” said Cassi. “I need a good night’s sleep.”
“The weirdos keep you busy last night?”
“Let’s not have any of your surgeon’s opinions about psychiatry,” said Cassi.
Thomas didn’t respond, but an ironic smile appeared on his face, and he seemed to relax a little.
The elevator doors opened on seventeen, and they got out. Thomas walked swiftly ahead. No matter how many years Cassi had spent in hospitals, she always had the same reaction when she found herself on the surgical floor. If it wasn’t fear, it was close to it. The crisis aspect undermined the elaborate denial she used about the implications of her own illness. What mystified Cassi about the response was that she didn’t feel the same way on the medical floor where there invariably were patients with diabetically induced complications.
As Cassi and Thomas neared the ICU, several waiting relatives recognized Thomas. Like a movie or rock star, he was instantly surrounded. One old woman was intent on touching him as if he were some kind of god. Thomas remained composed, assuring everyone that all the surgery had gone routinely and that they would have to wait for further updates by the nursing personnel. With some difficulty he finally detached himself and entered the ICU where no one dared follow him except Cassi.
With its enormous number of machines, oscilloscope screens, and bandages, it intensified all of Cassi’s unspoken fears. And in fact, the patients themselves seemed all but forgotten, lost as they were in the tangle of equipment. The nurses and doctors seemed to tend the machines first.
Thomas went from bed to bed. Each patient in the ICU had his own specially trained nurse to whom Thomas spoke, hardly looking at the patient unless the nurse called his attention to some abnormality. He visually checked all the vital signs which could be seen on the read-out equipment. He glanced at the fluid balance logs, held portable chest X rays up to the overhead light, and looked at electrolyte and blood gas values. Cassi knew enough to know how much she didn’t know.
As Thomas had promised, he didn’t take long. His patients were all doing well. With Larry Owen in command, the resident staff would deal with all the minor problems that arose during the night. When Thomas and Cassi reemerged, the patients’ families again set upon him. Thomas said that he regretted he didn’t have more time to talk but that everyone was doing well.
“It must be extraordinarily rewarding to get that kind of feedback from families,” said Cassi as they were walking toward the elevator.
Thomas didn’t respond immediately. Cassi’s statement reminded him of the pleasure he had felt years earlier when the Nazzaros had greeted him. Their gratitude had meant something. Then he thought about Mr. Campbell’s daughter. He glanced back down the corridor, realizing that he hadn’t seen her.
“Oh, it’s nice that the relatives are appreciative,” said Thomas without much feeling. “But it’s not that important. It’s certainly not why I do surgery.”
“Of course not,” said Cassi. “I didn’t mean to imply that.”
“For me recognition by my teachers and superiors was always more important,” said Thomas.
The elevator arrived and they got on.
“The trouble is,” continued Thomas, “now I’m the teacher.”
Cassi glanced up. To her surprise his voice had an unexpected and uncharacteristic wistfulness. As she watched him, she could see that he was staring ahead, daydreaming
.
Thomas’s mind flashed back to his thoracic residency, a time of unbelievable excitement and adventure. He remembered that he all but lived in the hospital for three years, going home to his drab two-room apartment only to recharge by sleeping for a few hours. In order to excel he had worked harder than he’d ever thought possible. And in the end he was appointed chief resident. In many respects Thomas felt that event had been the crowning achievement of his life. He’d come out on top of a group of gifted people as committed and competitive as himself. Thomas would never forget the moment that each of his attendings congratulated him. There was no doubt, he thought, that surgery and life in general were more rewarding and more fun then. Thankful relatives were nice, but they were no substitute.
When Cassi and Thomas emerged from the hospital, they were rudely slapped by a wet Boston evening. Gusts of wind lashed the rain in chaotic circles. At six-fifteen it was already dark. The only illumination came from the city lights reflecting off the low, swirling cloud cover. Cassi grasped Thomas about the waist and together they ran for the nearby parking garage.
Once under shelter, they stomped the moisture from their feet and walked more slowly up the concrete ramp. The wet cement had a surprisingly acrid smell. Thomas still wasn’t acting normally, and Cassi tried to guess what was bothering him. She had the uncomfortable feeling that it was something she’d done. But she couldn’t imagine what. They hadn’t seen each other since the ride in to the hospital Thursday morning, and everything had seemed fine at that time.