When she sits down at the desk once more, Abaitua—knowing that acronyms tend to impress people—tells her she has PMS, and she relaxes, happy that her illness has a name. Premenstrual syndrome is the cyclical reappearance of a combination of psychogenic, physiological, and behavioral changes in the luteal phase of menstruation. Until recently, and taking into account the female condition, even the syndrome’s worst symptoms were accepted with resignation; today, many women of fertile age, if not the majority of them, are usually treated for it as if they were sick. Without thinking about the side effects or, of course, the pharmaceutical companies’ profits. This woman, on the other hand, has clinically significant symptoms. He orders general tests and recommends that she bring her husband to the next appointment if she can.
The next patient is a young, thin woman, born in May of ‘68—this time Abaitua gets it absolutely right. She has soft brown hair and white, drab-looking skin. She’s wearing a casual flowery dress that goes down to her ankles, a thick, loose black sweater, and sandals, as if she were a hippy from her mother’s times. Her mother, though, could hardly have been a hippy; she looks conventional, one of those people who see themselves as a typical Donostian—discreet, stiff-necked, and with a trace of bitterness on her lips. The daughter is extremely nervous, she keeps wringing her hands, and it’s obvious she bites her nails. When he asks her what the problem is, she takes her sweater off, determinedly holding it by each side until her arms cross, as if it were a sudden decision to do something she had wanted to do long ago but not been able to until now. There are traces of dampness on her dress, the size of two-euro coins, at her nipples. “It’s milk,” she says. She says it’s been happening for a couple of months. She kept it quiet at first, because she was afraid it might have something to do with having engaged in intimate relations, although not complete sexual consummation, until her mother—one of those mothers who might examine her own forty-year-old daughter’s closet—found out. They’re worried, because a doctor—a well-known psychiatrist who’s a family friend, the mother says with obvious pride—has told them that galactorrhea could be the result of a brain tumor.
The old woman says it with a sad voice, but the ever-moving eyes in her aloof face show no sorrow. Abaitua is increasingly sure that there are often psychological alterations behind the symptoms that his patients bring to him, and he finds it hard to ignore them and stick to his specialty. Now, when he turns toward his computer to open the file, he almost says to the woman—who seems to him very old even though she isn’t much older than he is—that, in itself, there’s no reason why a hypophyseal tumor should be any worse than a mother from whom one has to hide their galactorrhea. He thinks perhaps he should ask her to leave and speak with the daughter alone. He’s not sure. He feels less and less sure when he comes into contact with certain patients, not knowing how to give them information or how to interpret the data they give him. Over time, he’s confirmed that intuition is overrated and that experience, as well as being an over-tiring way of collecting knowledge, is not always valid. Experience itself has taught him that. He moves around in his chair in order to avoid the mother and look the daughter straight in the eye. He tells her that it is true that around a quarter of the cases of galactorrhea are due to hypophyseal tumors, but most of those are benign. There’s no reason for her to worry.
He mentions other possible causes of galactorrhea, more for the resident doctor’s benefit than for that of the patient, although the man doesn’t seem to be paying much attention and he isn’t taking notes. Others do take notes, particularly women, but although Abaitua likes to see that they’re interested in what he has to say, he doesn’t care if the fat guy’s interested or not. He makes a mental note to give him something to read: a case of galactorrhea without hyperprolactinemia caused by a pathological relationship with the mother. Although he himself is critical of all the psy- fields, he finds the young man’s wholly unholistic point of view insulting—the man’s supposedly scientific mindset classifies everything that isn’t biochemistry as almost esoteric.
He’s used the computer to write up his cases for a long time now, although he’s not sure whether it’s the best way to do it—the noise of the keys, him looking away at the screen—in terms of the patient feeling comfortable and well looked-after. But he does type fast. He asks her for her medical history; it isn’t particularly interesting, but when the old woman says that the girl was treated for depression six or seven months ago, he can’t hide his excitement. He thinks—taking the development of psychopharmacological medications over recent years into account—that they might have prescribed her a first generation tricyclic antidepressant, and if that’s the case, amitriptyline could be the cause of her galactorrhea. Stranger things have happened. He asks them if they remember the name of the medicine—Tryptizol, Anafranil, or Dogmatil, for instance—hoping it’ll be one of those. It’s Tryptizol. The psychiatrist who’s apparently a close family friend, the same one who terrified them with hypophyseal tumors, prescribed it. He knows him by name, he’s quite well known, but he thought he’d be retired by now.
“That’s the key to it.” He’s aware that linking up the increase in prolactin and galactorrhea with Tryptizol isn’t particularly difficult, but even so, after putting forward this hypothesis of cause and effect, he expects to see some sign of admiration from the resident doctor. But there’s none. Nevertheless, he explains the biochemical mechanism that the medicine produces and gives a short explanation, which he tries to make understandable, to the two women. He thinks that if she needs antidepressants, she should start using ones with selective inhibitors, but that’s something for a psychiatrist to say. He says that he will telephone her and that she needs to have some tests done to be on the safe side, and, specifically, so that he can see her again, just in case he has to convince her that she should go to a psychiatrist who isn’t on such intimate terms with the family.
He increasingly prefers treating outpatients to the rest of his work in the hospital. To such an extent that he’s been toying with the idea of retraining and going to work in a health center, in a small town if possible, and starting to work as a family doctor. It seems to him, although it could be no more than a fantasy, that the relationship between patients and their surroundings in such a setting would allow illnesses to be treated in a more contextualized manner, and that it would make it easier to recover the profession’s humanist spirit, which hospital doctors have lost. Because as things are, he has the sensation that he’s working in a large factory, with workers rather than doctors—they’re all alienated, working on a production line. Doctors are no more than that, himself included. The main reason his colleagues are discontent is that they don’t want to resign themselves to being mere technicians toiling away on the pyelonephritis in Room 312 or the lupus erythematosus in Room 42; they want to be treated in all their complexity as suffering human beings. That’s why they have an insatiable appetite for money. Alienated as they are, what they crave is golf, powerful cars, long yachts, or landscaped houses in the south of Spain, and they become envious of their colleagues, and cruel toward them, as well. They are no more than poor devils, at the end of the day, though those who are forced along their production lines are even less fortunate. He likes throwing the young ones into confusion—especially the ones who want a Rolex on their wrists—by bringing out all the anger he has inside.
“María Amor.” This time, the nurse does not need to sing out the last name. María Amor, Mariamor, Mary Love—an unbeatable name for a prostitute. She’s a mulatto from the Dominican Republic. When she comes through the door, Abaitua thinks he sees a tray full of pineapples, bananas, oranges, and lemons on her head. She’s the very model of a tropical woman, although he’s convinced that she tries to play her splendor down, dressing discreetly and not wearing any makeup. When she comes to the hospital, at least; he’s never seen her outside. To greet him, she holds out a hand with over-long fingers, showing the back of her wrist and lif
ting it up toward her head as if she were going to kiss it, and Abaitua takes hold of it, though not wanting to be overly affectionate.
The cry she lets out when he tells her that the results of her AIDS tests are negative is so high and long that it must have been heard everywhere on the floor. She lifts her arms up toward the roof, her hands pressed together. “Gracias, Virgencita de las Mercedes.” She explains that Our Dear Lady of Mercy is the protector of the Dominican Republic. With her hands on the table, she leans toward him until she’s almost touching his nose and asks what she can do to thank him.
It’s tempting for doctors to claim nature’s decisions as their own achievements, they often do, and to an extent, it’s to be expected, and when it comes down to it, the opposite happens, as well, doctors being blamed for nature’s losses. But he doesn’t think it’s right. So he says that all he did was order a few tests, she’s the one who’s healthy and strong. “¿Sana y fuerte?” With her arms akimbo, her eyes wide open and almost rolling back into her head, her accent becomes almost a parody as she asks what the doctor is trying to insinuate by calling her healthy and strong—“¿Qué me quiere decir el doctor con sana y fuerte?”—and now Abaitua sees her with a colorful polka-dotted kerchief tied around her head—“¿que estoy gorda?”—you think I’m fat? And her effusive laughter shakes her whole fine body.
War stories. The woman’s pimp—who died the month before of septic shock—was a small-time drug dealer; they knew him at the hospital, because he had AIDS. The guy himself used to tell the story—without any embarrassment, and proud of his own malice—about how, at a time when ETA was targeting drug pushers, he felt suspicious one day when he got a call from a stranger to do some business. He had a twin brother who looked a lot like him, and who was a sympathizer of the so-called “abertzale left”—the left-leaning Basque nationalist movement—and he decided to ask him to go and meet the guy in his place, at the same place and time as the meeting had been arranged for. Apparently, at the time of the meeting—it was set to take place in Irun, in a plaza with arches around it—he was there, hiding behind a column and watching; he saw a couple of guys go up to his brother from behind and shoot him dead. He would laugh as he told the story.
María Amor always said that he was a hyena, but she was completely dominated by him. He wanted intercourse without protection, and she, against her will, gave way on “special days”: when they made up after a fight, or when he would come back after days or weeks away and—in her words—cling to her like a child, crying and begging for forgiveness. He would beat her, clearly. Occasionally he threatened Abaitua, as well, saying that he was taking advantage of his position of power, interfering in their private life, and trying to convince the woman to leave him. He also accused him of wanting to take his place. There was one especially aggressive moment when he refused to let them join the assisted reproduction program for serodiscordant couples. The guy knew that there was a way of cleaning sperm and demanded the treatment, but Abaitua knew that the girl only wanted a child of his on “special days” and explained to him that they didn’t meet the required conditions for proving they could guarantee a child’s welfare that the program stipulated. He was furious and threatened to report him for discrimination. They said all sorts of things to each other. The pimp said that everyone at the hospital knew that he was in love with María Amor and that he wanted her for himself; Abaitua said that the guy’s sperm was the cleanest thing about him. The hustler held him by his neck and raised his fist at him but unfortunately went no further, so Abaitua wasn’t able to give him a good punch. He was human garbage. He drew a disability pension and, at the current stage of his illness, was costing the public health system twenty thousand euros a year for his retroviral treatment, a lot more than many honest workers make. The infections specialist and he had often said that they’d be doing society a favor if they gave him a continuous perfusion of Midazolam. There was something more than a joke in what they said, but neither of them was daring enough to do anything about it. Abaitua’s often thought about it, though, without reflecting very deeply, just playing around with the idea. Given that the valor normally required to murder someone would not be required, and that there would be almost no risk of getting caught, it was the famous dilemma: If you could kill someone by pressing a button, being completely sure that nobody would ever know, would you do it? Of course, he would need a more enticing motive than saving the community a few thousand euros. That beautiful and agreeable woman, who seemed to be such a good person, would be more of a motivation for him—it would be freeing her from that human trash.
It was a family doctor’s job to give that healthy woman, whose only problem was the risk involved in her job, her routine checkups, or the area gynecologist could do it; Abaitua was keeping her on without any possible justification. He doesn’t know exactly why, and he doesn’t want to think about it. At the end of each appointment, he feels he doesn’t want to send her to another doctor, he wouldn’t want her to think that he’s getting rid of her, or force her to explain her situation to another person; he knows she doesn’t like that. He has to admit he’d be sorry not to see her there, and he has fun scandalizing the nurses; he knows they know he’s in no hurry to get her off his patient roster.
Now María Amor smiles at him in a pitiful way. Few women are comfortable on the gynecologist’s table. He decides to let the resident doctor examine her while he goes to look for the old psychiatrist and talk with him about the galactorrhea case. Does he do that because he wants to make it clear to the gossiping nurse that he has no interest in touching the woman? Probably. As he draws the screen to the examination room closed, he spots the resident doctor holding the speculum in his hand, a hand which seems fatter and hairier to him than ever. “Gloves!” he shouts out, and he startles fatty, who, in his shock, drops the speculum on the floor. A ridiculous situation.
The door to orthopedics room 417 is ajar. He sees mother and son through the gap. The young man is slouched almost horizontally in the chair, reading a book. The old lady’s sitting up in bed and staring at something on the wall in front of her. Abaitua is pleased to see that the people in charge at orthopedics have heeded his request and put her in a room of her own, even though there are two beds in it. Kepa greets him without getting up—“¡Hombre, doctor Abaitua!”—and pushes aside a lock of black curly hair from his forehead. He’s growing a beard, which is also black and curly. Abaitua goes up to the woman and jokes to her in Spanish that they won’t be able to recognize her son pretty soon, he’s gotten so much hair—“A su hijo un día no le vamos a conocer con tanto pelo.” The old lady looks at him carefully, examines his face with no inhibition whatsoever, trying to find out who he is. She looks at things the way disorientated people who’ve lost their minds do. He takes her thin, wrinkled hand, and when he asks her how she is, she lifts her head up, looks at him, and says in a tired voice, with her thick Andalusian accent, that he shouldn’t have bothered coming—“¿Para qué te has molestado en venir, Juan?” Apparently, Kepa doesn’t know what Juan she’s taking him for, either. She had problems knowing where she was before she was hospitalized, but now she’s completely lost and confused. He thinks it’s partly because she isn’t in her usual daily place, but they also give old people Haloperidol and other such psychopharmacological medications, almost systematically, in order to stop them from getting too nervous, and it usually does them harm. Abaitua concedes the son has a legitimate cause for complaint. When his mother fell over and hit herself on the head and lost consciousness, she was hospitalized. They took her to Neurosurgery and found she had a large subdural hematoma, which reabsorbed quite quickly in spite her age and without any need for surgery. But she didn’t want to walk. According to her son, even though she’s not at all the complaining sort, she started screaming when the nurses made her take walks along the hallways. He told the doctors that these walking sessions were torture and his mother really was suffering, but they didn’t pay any attention to
him, taking him to be a strange, problematic person, because they had seen him reading, or so he believes. They told him it was their job to know what was good for the patient, getting her out of bed in the morning and in the afternoon, telling her she was lazy and a complainer, even though she couldn’t stand up and made signs that she was in a lot of pain. Her son, too, made her get up and walk, because they had told him that if she didn’t, she would become disabled, and he dragged her up and down the hallways like a whimpering rag doll. Abaitua didn’t hear about it until he got back from his vacation in Italy, and as soon as he saw her, he guessed that she had a broken hip at least. It was obvious just from her posture, and ninety-five percent of old people who fall over break their hips. A simple X-ray confirmed the diagnosis. That’s why she’s in the orthopedics ward with an artificial hip. And now she’s lost her mind and confuses Abaitua with someone else.
When Kepa said he was thinking of reporting the neurosurgery department, Abaitua told him to go ahead, encouraged him to do it. He certainly complained enough about it, insulting and threatening everyone there, but no more than that. He asked what the point of reporting it was, and it was too late now, anyway. What he’s really worried about is the possibility of them reporting him for the fuss he kicked up, grabbing the department head by the chest and shoving him. He regrets that now, and consoles himself by saying that he’d rather get to say what he said in front of everyone than receive a small indemnity from public funds. Abaitua would have preferred the opposite option; what happened was worth reporting, and he couldn’t stand the department head—his brother-in-law, in fact, Pilar’s sister’s husband, who also happened to be the director of his father’s clinic. Someone knocks on the door and opens it before there’s time to answer. Two auxiliaries wearing pink scrubs come in briskly and purposefully. They greet the woman, whose name is written on a small board over the bed—“¿Qué tal estamos hoy, Eugenia?”—and one of them opens the half-closed roller shutter, letting in a ray of light that hurts their eyes. It’s clear they’re in a hurry, they have to get through a large number of rooms in a certain amount of time, but they treat the woman affectionately, with familiarity, speaking to her with the informal tú form of address, although speaking too loudly for the size of the room, with a forced type of cheerfulness. They ask the men to leave. They’re in a rush. Kepa puts on his blue duffel coat and suggests they go for a coffee. It seems Kepa’s got something important to tell him; his head hangs low, his hands are in his coat pockets, and although his voice is firm, his “I have to tell you something” is like a little boy’s. Abaitua, thinking it’s going to be something to do with money, is on his guard.
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