Sensing Light

by Mark A. Jacobson

  “Sure. Want some help?”

  “Just set the table. I’m almost done. Oh, Allison got an A on her English paper.”

  “Great!” he said, feigning delight.

  He found his ten-year-old daughter sitting next to her younger brother at the top of the stairs.

  “Good work, Allison,” Herb called out from the landing below. “I told you it was a great essay.”

  Allison ignored him. She and Martin had their attention focused on a pair of Slinkys perched at the precipice of the landing.

  Martin, eight years old and small for his age, counted backwards, “Ten, nine, eight…”

  At zero, each tipped their coil forward.

  “Go! Go!” they yelled.

  Martin’s champion made it to the next step and slumped over where it lay quivering. Allison’s toppled two steps further.

  “Two points for me,” she shouted gleefully.

  Only when Allison played games with her younger brother, games they had both outgrown, did Herb ever see her animated by joy. Otherwise, she was relentlessly serious. Allison wasn’t depressed. They had taken her to a child psychiatrist who confidently dismissed that possibility. She simply had little interest in friends and none in activities that weren’t goal-oriented. She approached those that were, such as school, with grave intensity. Cecilia, by dint of more dedicated effort than Herb could apply, had found other topics of conversation—mostly clothes and hair products. Persistently hoping for more emotional currency, Cecilia refused to be disappointed. Herb had already given up. He was certain Allison’s austere nature came from his side of the family. He felt all he could manage was to keep it at bay in himself and avoid contaminating his wife and son.

  Martin, discouraged by his toy’s poor performance, sighed, “Hi, Dad.”

  Herb bounded up the stairs and tickled him in the ribs.

  “No!” his son laughed, scuttling away.

  Herb caught him again. Martin collapsed in waves of giggles, punctuated by half-sincere pleas to stop. Herb relented and embraced him in a bear hug.

  On his way downstairs, Herb placed a hand on Allison’s shoulder. She flinched at his touch. He began praising her essay.

  “It was an A-minus.” she said with a scowl. “It should have been A-plus.”

  “You’re too hard on yourself. A-minus is fine.”

  She rolled her eyes and went to her room.

  After dinner, as soon as the children deposited their plates in the sink and left the kitchen, Cecilia closed the door behind them. She confronted Herb with a worried frown.

  “The MacIntyre execs are unhappy. Their sales have dropped by a third this last quarter.”

  He stopped loading the dishwasher and sat down. Cecilia was a partner in a downtown advertising firm. MacIntyre was her client, a major source of the revenue she generated for the business.

  “There’s an emergency meeting tomorrow morning at eight. We need a new marketing strategy, like yesterday. I’ve got to be there. Six people I supervise, their jobs are on the line.”

  Although Wednesday was Cecilia’s day to drive the kids to school, Winton was his only bronchoscopy case. He could do it at nine instead of eight o’clock.

  “Not a problem, honey. I can take the kids to school.”

  Herb’s lack of annoyance was genuine. He felt fortunate, astonishingly lucky, to have Cecilia, a woman so comfortable with herself and others. He believed she was far more than he deserved. But then he had never fully believed he deserved to exist at all.

  Herb was born in the spring of 1938. It should have been in Shanghai during the Japanese invasion that laid waste to China. Except his father, a lawyer and diplomat, had been sent to assist the ambassador in Washington DC a few months beforehand. He brought his pregnant wife along and after the war was hired as an immigration specialist by the newly formed United Nations. U.S. citizenship came with the position. Herb grew up in placid, suburban Long Island rather than amid starvation and epidemic cholera.

  “It’s not just school, Herb. Allison has an orthodontist appointment at nine-thirty. Did you forget she’s been complaining her braces hurt?”

  “Nine-thirty?” he asked uneasily.

  “Yes, nine-thirty.”

  He squirmed.

  “I have a bronch to do, a really sick patient with no diagnosis. I can drop off Martin at school, but I’d have to push back the bronch to eleven if I take Allison to her appointment. Can’t your mother take her or one of your sisters?”

  “Herb, we’re talking about Allison, not Martin. What if she gets into a stubborn snit? She’ll refuse to open her mouth if one of us isn’t there to talk her down.”

  “Come on, Cecilia.”

  “I hate that you have that free pass,” she seethed. “Somebody might die if I’m not there. It isn’t fair.”

  He was trapped. The only way out was to concede. Yet Herb wasn’t angry. He knew how lonely life could be, how much Cecilia’s love sustained him. What he resented was having to choose between his daughter, who gave him no emotional return, and his responsibility for sick patients. He supposed he could do the bronch at eleven. He’d have to page Kevin and the pulmonary fellow first thing in the morning and let them know.

  “All right, all right. I’ll reschedule the bronch. She’ll have to go to the hospital with me after the orthodontist and wait in my office. I’ll take her to school when I’m done.”

  He watched Cecilia relax, her hostility dissipate.

  Thank God, he thought, détente at last. Herb was relieved, briefly. With a sinking sensation, he remembered that if the bronchoscopy specimens didn’t get to pathology by ten in the morning at the latest, the special stains he planned to request couldn’t be completed until the following day, which could delay making a diagnosis for another twenty-four hours. That raised a very disturbing question—whether to tell Kevin to blindly give his patient a steroid infusion. Depending on the type of lung disease, a one day delay in starting steroid treatment might be too long. He had seen someone die from an autoimmune inflammatory condition while waiting for a bronchoscopy result. On the other hand, if an infection was causing the man’s deterioration, administering steroids might compromise his immune system enough to kill him.

  Herb knew where this was going. He would get no sleep tonight unless he stopped ruminating about the case. He forced himself to think of something else and latched on to Kevin’s uncharacteristic behavior that afternoon. Although easily the most thoughtful of all the senior residents and surely the most even-tempered, Kevin had been on edge today. Herb recognized the signs—the lips parted with anticipation, the pressure of speech and gesticulation.

  This case had lit a fire in Kevin’s belly. To quench it, he would have to find out what was causing Winton’s respiratory failure. Herb now had a window of opportunity to sell Kevin on his own career pathway, clinical research. If the bronchoscopy specimens didn’t reveal a diagnosis and the patient didn’t make it, he would push the pathologists to do an autopsy. Kevin would have to know the cause, with absolute certainty. Then the hypotheses could emerge, and he would be off and running. Herb savored the idea until aware he was still thinking about the specimens that wouldn’t get to pathology by ten in the morning.

  VI

  LARRY AWOKE TO DISCOVER he had been moved again, this time to a bed in a private room. Sweat ran down his forehead, burning his eyes. Despite the oxygen pouring into a plastic shell fitted snugly over his mouth and nose, any physical effort made him gasp for air. He felt a catheter inside his penis and saw electrical wires taped to his chest.

  The room’s window gave Larry his first view of the outside world since coming to City Hospital. He guessed it was early morning. On the opposite side of the cubicle was a glass wall. Through it, he saw blue-pajama-clad nurses and white-jacketed doctors at work. I’m on display, he thought, like a mannequin in some S&M shop.

  He was drifting back to sleep when awoken by a voice softly calling his name. Kevin was sitting next to him on a st
ool. Larry realized that every doctor, so far, had stood looking down at him. He prepared to receive bad news.

  “How’s the breathing?” Kevin asked.

  “Worse.” Larry said and pointed to the oxygen mask. “This contraption is damn uncomfortable.”

  “Sorry. It’s the best we can do right now to get enough oxygen into your lungs. The nasal prongs weren’t doing the job.”

  “And what happens if I don’t get enough oxygen into my lungs?”

  Kevin sighed.

  “Be square with me, doc.”

  He searched Kevin’s face for signs of evasion.

  “Your heart and your brain,” Kevin embarked cautiously, “need to get enough oxygen for you to make it. We’re losing ground.”

  Larry cut the redneck jive.

  “There must be something you can do to fix me!”

  “I’m sure there will be, once we have results from the bronchoscopy, once we understand what’s causing this. That’ll be soon, very soon.”

  “Yeah, I hope so too, doc. Well, thanks for trying.”

  Larry extended his hand. Kevin clasped it and gave an encouraging pump.

  As he got up to leave, Kevin took a card out of his pocket and examined it. Larry saw his own name printed on the back.

  “Is there any family member, any friend you want me to contact?” Kevin asked.

  Larry closed his eyes and turned his head away.

  VII

  AT TEN IN THE morning, Gwen Howard was lucky enough to find a parking spot just four blocks from City Hospital. Walking toward the main entrance, she thought about Kevin Bartholomew, how engaging and appealing he had been on the phone yesterday. Had they been flirting?

  Stop it, Gwen ordered herself. He’s got to be at least four years younger than me.

  Since her divorce, she had dated enough to learn the hard way that men could handle being with a woman who was two, maybe three years older. Any more was inevitably a deal-breaker. Gwen concentrated on the building she was entering.

  Though she had already been inside several times to check on sick clinic patients, the place still unnerved her. This modern version of City Hospital with its closed wards and individual rooms was nothing like the brick towers that stood here when she was an intern. The house staff and nurses seemed to work in isolation. It was too white, too bright, too silent for her. Nothing like the old hospital’s raucous open wards where she had become adept at sticking intravenous catheters, spinal needles, and bone marrow trephines into desperately ill people. The constant, colorful chatter, even the patients’ complaints, had been public reassurance that she was doing her best, all that anyone in her position could be expected to accomplish.

  But will my best meet the bar here? Poor Larry Winton was a case in point. Being purely objective, she had to conclude he was in the ICU with respiratory failure because a few weeks earlier, when she saw a tinge of blue in his nail beds and considered calling an ambulance, she had also imagined an emergency room physician complaining about yet another patient unnecessarily sent over by an idiot clinic doc who didn’t know what real cyanosis looks like.

  “Christ,” she said aloud in the empty elevator. “I should have just bit the bullet and called 911. The sub-specialists here would have had plenty of time to figure it out by now.”

  Gwen hadn’t gone into the new ICU on her previous visits. Her self-confidence sunk lower as she looked at the modern equipment. It was all foreign, from intravenous pumps to wall-mounted oxygen valves and chest tube drainage systems. The ventilators had dials to control parameters she had never heard of. It made her re-think applying. How long would it take her to come up to speed? The patients she cared for rarely had anything worse than a bad cold or a sexually transmitted disease. And if she was accepted into the residency, it would mean being here triple the hours she now worked, so much time away from Eva.

  Yet Eva did seem to need her less. She was thriving in fourth grade and happy to play in an after-school program until six on the days Gwen worked. And Gwen knew she could find a college girl with a car to cover the nights and weekends on call. It wouldn’t be that expensive. Parenting certainly wouldn’t get easier once Eva started adolescence. In any case, Gwen’s days at the Haight-Ashbury clinic were numbered if she didn’t acquire a specialty credential. Health department doctors like her would soon be required to be boarded, and eligibility for a board exam required completing two additional years of hospital training after internship. The clincher was Proctor, the private school Eva attended. Its tuition was eroding her savings, and her ex-husband Daniel refused to help. He believed private schools were politically incorrect.

  A middle-aged nurse, a good ten years older than Gwen, asked, “Can I help you?”

  “I’m Dr. Howard from Health Center 3.”

  The nurse gave her a disinterested, faintly disapproving look.

  Is it my appearance, Gwen wondered. Hair too long, dress too short for thirty-five? She was proud of her trim, tennis-toned body. A pretty face, too, she’d always been told.

  “A patient of mine is here. Larry Winton.”

  The nurse pointed to a red-haired man in a white jacket seated on a stool. He was watching a heart monitor.

  “Winton is his.”

  Gwen studied Kevin. What gorgeous green eyes, she thought. He could be cute if he lost twenty pounds. She halted further fantasy. He indeed was too young for her. But this reminded her of another plus in doing of a residency—so many opportunities to meet men.

  As Gwen approached Kevin, she saw he was exhausted.

  “Hi, I’m Gwen Howard. We talked about Larry Winton yesterday?”

  Kevin immediately brightened. He stood up and offered his hand.

  “It’s great you came by. He hasn’t had any visitors.”

  “That doesn’t surprise me. He’s kind of a loner.”

  Kevin looked at his wristwatch.

  “He’s going to be bronched soon. You want to see him now?”

  “Sure,” she said, her pluck fading again.

  Kevin led her to Larry’s room. She slipped past him, rolled a stool to the head of the bed, and sat down.

  Larry had a vacant expression. With each inhalation, the hollows of his neck retracted and he lifted his shoulders. To the uninitiated, he might be meditating or practicing yoga. The sad irony, Gwen knew, was that no one, not even the world’s greatest marathon runner, could sustain this level of breathing work for more than a day or two.

  “Hi, doc,” he said, his words echoing inside the oxygen mask. “What’re you doing here?”

  “He called me,” she said with a nod toward Kevin.

  “What do you think? Is it TB?”

  “Maybe,” she said, trying to sound hopeful.

  Larry looked skeptically at her, then at Kevin.

  “I don’t know what it is,” Gwen confessed. “I am so, so sorry this happened.”

  “Not your fault, doc. I fucked up. Blew off your advice. Shoulda got my ass here sooner. Don’t worry. They’re doing all they can.”

  “I know they are,” she fervently agreed.

  Larry’s smile was fractured by the curved, translucent shell covering his mouth. Gwen bit her lips and turned away. In the doorway, she saw two people in white gowns and masks. They hovered there like wraiths. Behind them stood a middle-aged Asian-American man wearing a sport jacket and tie. He was frowning.

  Herb apologized for being late. Kevin handed him the most recent arterial blood gas results. Herb glanced at the numbers, checked the oxygen flow valve by Larry’s bed, and gave a barely perceptible shake of his head.

  “Time to go,” said Kevin.

  Larry recoiled.

  “They do this every day here,” Gwen murmured. “You’ll be OK.”

  While Larry was being moved to a gurney, Kevin introduced Gwen to Herb.

  “What do you think?” she asked, struggling to tamp down her anxiety.

  “Not TB,” Herb answered. “Though I’ve been wrong about that before. Hypersen
sitivity pneumonitis, cocci, sarcoid? It could be anything. Let’s hope the bronch washings tell us something, at least a clue as to whether steroids might help.”

  Gwen liked the self-deprecation, but he sounded pessimistic. Laying crepe was what they called it when she was an intern.

  VIII

  THE PULMONARY FELLOW AND medical assistant transferred Larry to a recliner chair and proceeded to ignore him as they sorted through boxes of bottles and syringes. Herb, now gowned and masked too, entered the bronchoscopy suite. Larry grabbed the armrests and pushed himself back into the chair. His lips were trembling.

  Like a caged rabbit, Herb thought. A tide of empathy rose. He fought it off and diverted his gaze. Maintaining cool objectivity was essential, he believed, for performing this procedure with minimal risk to the patient’s safety as well as to his own mental health.

  “There’s nothing to be scared about, Mr. Winton.”

  Herb balked. He couldn’t pretend the consequences of his being late were potentially disastrous. He had to be completely present, whatever the cost to his equilibrium.

  He placed his hands on Larry’s shoulders and looked into his eyes.

  “You’ll get through this just fine,” he vowed. “I promise.”

  Saying those words stirred up memories he couldn’t suppress.

  In seventh grade, during a field trip to Manhattan, Herb’s class traipsed across Madison Square Park to see the statues of famous Americans. Herb lingered too long in front of the Civil War admiral who had famously yelled, “Damn the torpedoes, full speed ahead.” On realizing his classmates were gone, he jogged in widening circles around the park until finally giving up. He trudged in search of a subway station and soon faced a massive stretch of identical, fifteen-story red-brick apartment buildings. Just beyond was the East River. He turned around and saw six rough-looking teenagers blocking his path.

  “Whatchya doin’ here, chink?” shouted the gang’s apparent leader. “This ain’t Chinatown.”

  “I’m lost,” Herb confessed. “How do I get to the Long Island Rail Road?”