A History of the Present Illness

by Louise Aronson

  Hallway light bled through gaps above and beneath the door, then diffused across the room. It was just bright enough that Rodney could see K.C.’s open eyes trained on that place where—for a few months—there’d been a before photo: K.C. standing on the two legs God gave him outside the projects up on Cashmere and La Salle, his arms around the woman who’d visited daily until the afternoon she hadn’t pulled up the tan vinyl chair, but stood to one side of K.C.’s bed and announced that she loved him, but she was too young for all this, that she needed a life, a real life like the one she’d always dreamed of, that she wished him well and he’d always be in her prayers, and, finally, that she really, really hoped they could be friends forever, no matter what.

  Footsteps sounded in the corridor. Rodney listened, then smiled. It was Grace for sure, and he was about to advise K.C. to turn his head and catch some of the eye candy as big Gracey bowed and reached for the Bible on the floor, when pain exploded in his right foot like the sudden, excruciating burn of a lighter held to his toes.

  “Oh fuck!” he yelled, though the pain faded as quickly as it had appeared, replaced by a smolder with a throbbing behind it.

  K.C. asked if he was okay, but Rodney didn’t answer. He was concentrating, relaxing into a hurt so familiar it was almost as if he could smell the strange German pizza a nurse named Eva used to sneak him at the hospital in Landstuhl in those last, best days before they transported him back stateside. “You are lucky,” she had whispered, placing tiny rounds of sausage and melted cheese on his tongue and jerking her chin at the other beds. Her breath, warm and sharp from cigarettes and coffee, had traveled into his ear and down his torso, landing between his hips, where it blossomed into a problem he could no longer solve.

  Rodney shook that memory away by conjuring the image of his mother when she finally arrived at his foreign bedside. She had changed planes four times to get from San Francisco to him—her first air travel in nearly a half century of life, a trip for which she’d been given the cheapest ticket instead of the most direct route, a trip she’d made without hesitation even though he’d signed up against her wishes, even though he’d fucked up again, ending just as she’d feared he would.

  He had watched her scan the ward, skipping the white boys but slowing down at the brown ones, as if the desert sun might have lightened his color. If he could have shouted out while her eyes lingered on the black bodies covered in bandages, he would have. Finally, she saw him. Her lips parted and her eyes closed. Then she crossed the room, and it seemed for a second that she might climb over the plastic side rail and into the bed beside him. Instead, she leaned way over and kissed his forehead, then moved to stroke his arm. But before her fingers made contact, she’d done a visual sweep of his body, then stopped short, her hand trembling above his chest like those crazy birds after the bombing of Fallujah, unsure where—or whether—to touch down.

  Rodney blinked and dragged his left wrist across his eyes; the pain was better now, no more than an ember. He looked down the bed at the bump that was his feet, a short, sloped ridge that might have been anyone’s feet or even part of the bed itself, and there was no movement down there, but that didn’t matter, because this time he knew he felt something.

  “Grace!” he shouted, wondering where she’d gone.

  He slapped the call light again, slapped it and slapped it. “Yo,” he said to K.C. “Help me, man,” but K.C. only grunted and pulled his pillow over his head.

  Twenty minutes later—long enough for Rodney to be certain it was all coming back: the toe, the foot, the leg, everything—he heard the solid, steady steps again.

  “Hey,” he called. “Gracey, please,” and the door opened.

  The person in the doorway wasn’t Grace or any of the other girls, but a guy Rodney had never seen before, a guy who would have been a total waste of his time earlier, since he would never, ever watch some Joe bend no matter how hard up he was. In fact, he decided, he wouldn’t even mention the fallen Bible to the guy, he’d just call again later, hoping for Esther with her small, soft fingers, or Rita with her high-riding ass. But the guy could help him with something more important than a quickie thrill, more important—at least for this one moment—than even the good book itself, and so he said, “My right foot, man! I feel it!”

  The aide nodded and pulled back the covers, and together they stared at the long white space on the sheet next to Rodney’s mangled and scarred left leg. Rodney closed his eyes and waved the aide away.

  Every morning, he somehow forgot. Every morning he woke up and recognized the hospital bed and the colorless walls he shared with K.C., and he remembered he was damaged, but he forgot precisely how or why, and for a while—seconds at least, but sometimes much, much longer—he imagined that it wasn’t really so bad, and that he might have a normal life with a job and a family and the ability to wipe his own ass. He imagined that what was left of him was worth saving.

  Twenty-Five Things I Know About My Husband’s Mother

  1. She was born in the Ahmedabad district of Bombay province, India, in 1947, two weeks after partition, thirteen days after independence, the second of six children of a petty bureaucrat and a housewife with repressed artistic ambitions that seeped out in silent tears and storms of uncontrolled hilarity.

  2. By age ten, her hair reached below her buttocks. She never cut it.

  3. She did well in school and hoped to go to college. Her father said no.

  4. At seventeen, she had her first bout of depression. Or so we assume. All we really know is that she stayed in bed for a year, and neither the local healers nor the specialists her father took her to see in Bombay offered a plausible diagnosis or effective treatment.

  5. During that year, she read all of Jane Austen, the Brontë sisters, George Eliot, Thomas Hardy, and D. H. Lawrence. Twice.

  6. To everyone’s surprise, she married well, the youngest son from a good family, a doctor with a growing practice in Springfield, Illinois, an aloofness reminiscent of Mr. Darcy, and a skin condition that sometimes stained his shirt and trousers. The year was 1967. They were the only Gujarati in central Illinois.

  7. Her husband worked long hours and expected her to manage everything else. He didn’t love her, and she knew it.

  8. She had one son, then five miscarriages. After the first four, she took root on their living room couch. Her husband prescribed antidepressants, which she flushed down the toilet. “Life’s disappointments,” she explained to her boy, “one cannot be treating with pills.” Of that time, her son recalls a heavyset woman hired by his father to keep house; pale, bland foods; and relatively happy afternoons spent combing the tangles from his mother’s hair as she began to recover.

  9. After the fifth miscarriage, she moved into the guest room and enrolled in classes at the university. Three years later, she graduated with honors and a double major in English literature and business administration.

  10. That summer, her husband announced that he was relocating to Kentucky with his nurse, who, though neither especially young nor particularly pretty, was five months pregnant with his child and belonged to a pink-skinned but surprisingly open-minded extended family outside Louisville.

  11. After her husband’s departure, she spent a week in the hammock on the screened back porch, in what turned out to be her last such sojourn. Her son shopped and cooked and cleaned until one afternoon he returned from the store to find his mother trying on business suits. Before that day, he’d never seen her in anything but a sari.

  12. For the next twelve years, she worked at the university from which she’d graduated, first as the administrative assistant to the chairman of the English Department, then as the dean’s special assistant, and, finally, as the registrar of the College of Arts and Sciences.

  13. When her son was a sophomore in college, her ex-husband collapsed in the smoking lounge at the Dallas–Fort Worth International Airport. Attempts at resuscitation were unsuccessful. At the time of his death, he had four children. His estate went
to the three youngest.

  14. Her husband was the only man she ever slept with. “Love,” she told her son, “especially romantic love, is an invention meant to distract the lower classes by compelling them to strive for the unimportant and unsustainable.”

  15. When her son inquired how she could feel as she did about love, on the one hand, and study romantic literature on the other, she said, her accent thickening as it always did when she was annoyed, “You are too much focusing on logic and science.”

  16. When, several years later, her son told her he’d been accepted to the University of California, San Francisco School of Medicine, she said, “I suppose you must learn for yourself that form is not always content’s container.” He had no idea what she was talking about.

  17. She was one semester short of her Ph.D. in nineteenth-century British literature when she was diagnosed with widely metastatic cancer. Her son flew home from San Francisco, where he was midway through his fourth and final year of medical school. Scans and biopsies revealed an aggressive, primitive tumor of unclear origin, for which there were no good treatment options. “Go back to school,” she commanded her son. “There is nothing to be done here.”

  18. Upon hearing her fate, she took up walking. Before and after work and all day on weekends, she crisscrossed the small city and the university campus, sometimes venturing so far as the surrounding farms and fields, always in pain. When she became too weak to walk, her son took a leave of absence and moved home to care for her.

  19. People he’d never heard of sent flowers, books, and a remarkable array of foods. The breads and curries of his childhood arrived from small towns in Illinois, Wisconsin, and Indiana, while neighbors and coworkers dropped off such exotic dishes as fried chicken with bacon stuffing, mashed sweet potatoes with marshmallows, and jello molds with canned pineapple. The less his mother ate, the hungrier he became, until one morning he could barely button his jeans.

  20. She died sixteen days later.

  21. Her son sat with the body, reviewing his every memory of his mother, and in the end he concluded that he had never seen her happy, only less sad.

  22. In her top dresser drawer he found plane tickets to India in her name and his for the ten-day break between his medical school graduation and internship and also a stack of aerograms to which were stapled photographs of young women, the ones on top gazing right at the camera, the bottom ones with downcast eyes and demure expressions.

  23. If she hadn’t died that April, her son might not have married me, a fellow Indian who has never been to India, a modern girl who is both a doctor like his father and a romantic like his mother and so sometimes kisses her patients and admits that she loves them.

  24. Her only child became a radiologist. He spends his time scrutinizing and analyzing those parts of people that remain invisible to the rest of us. To this day, he claims strictly intellectual origins for his professional interests.

  25. She never met her grandchildren, though the youngest, a girl, looks just like her. Whenever that child sleeps in, her son holds his breath, and when she laughs, he closes his eyes as a once-blind man might upon waking to the excruciating beauty of an ordinary sunlit morning.

  Soup or Sex?

  Maurice Kasmarek was my second admission on the first day of my first real job as a doctor. I’d been hired as a hospitalist by the same large San Francisco health maintenance organization where I’d finished my training just two weeks earlier, and I marveled that the world suddenly and somewhat arbitrarily considered me fit for unsupervised practice. My inaugural patient that day, a twenty-two-year-old with cystic fibrosis, came in every three months carrying preprinted orders from her pulmonologist detailing every aspect of her care. I was fairly sure I’d admitted her at least once before during residency, but though she knew all the nurses by their names and significant others and children and even pets, she didn’t remember me at all. When I walked into her room, she said, “Do you really even need to examine me?” I said I really did, and she said, “All right then, let’s get this over with. But you’re gonna have to read my chart to get the history.”

  Maurice showed up an hour later and, after being wheeled across the street from oncology, refused to let the transport guys push him down the hallway to his room. “If I’ve got to go into this place,” he argued, “at least let me get there under my own steam.” It took him twenty minutes to cover twenty yards.

  I tracked his progress from the nursing station. “Look out, honey,” said the nurse beside me, who, despite his omnipresent five o’clock shadow, was rumored to be one of the locally famous transvestites, the Sisters of Perpetual Indulgence. “This one’s a heartbreaker.”

  Once Maurice caught his breath and settled in, I went into his room to do the history and physical.

  “Mr. Kasmarek—” I began.

  “Oh, hell,” he interrupted. “The name’s Maurice. We’re both grown-ups. Why don’t you call me that?”

  “Okay,” I said, though usually I’m a bit of a traditionalist when it comes to patient-doctor etiquette.

  He raised the part of his forehead that should have had eyebrows. “So what’s your name?”

  “Chitra,” I replied. “But you can call me Dr. Agarwal.”

  I waited a split second, and then I smiled.

  “Ha!” he said. “You had me going. Yes you did. Bravo, Dr. Chitra, bravo!”

  And so, in the first two minutes of our acquaintance, we became Maurice and Dr. Chitra, a compromise arrived at without any negotiation and a solution that pleased us both.

  Nearly an hour later, in addition to the medical essentials, I learned that Maurice was twice divorced, had no children, and prior to the cancer had been a supervisor for Pacific Gas and Electric. When we finally finished the history and physical, I explained Maurice’s medical condition to him in case they hadn’t in oncology or in case the physician telling him, uncomfortable him-or herself, had mumbled or obfuscated, and also because it was entirely possible that Maurice himself, not wanting to hear the bad news, had chosen denial or belief in divine intervention over the dismal facts. It seemed that he knew and understood his situation, but when I showed him the Preferred Intensity of Treatment form, hoping he’d choose comfort only, so I could page the palliative care team and get going on my next admission, he said he wanted everything done: chemo and radiation as needed, intensive care, even cardiopulmonary resuscitation.

  “But it won’t work,” I told him, referring to his odds of surviving CPR. “I know they’re always saving people on television, but in real life, in your circumstances, I wish I could say it would help, but it won’t.”

  He grinned. “Sure it will.”

  When he smiled, he looked eighty, not sixty: sagging gray skin, narrow ropes of withered muscle securing head to torso and elbow to shoulder, and indentations at his temples from all the weight he’d lost. Since he’d managed databases and distribution schedules, I tried to seduce him with numbers. “There’s good data on this,” I explained. “If you have cancer and it has spread—”

  “Metastatic,” he said.

  “Right. Anyway, if your heart stops—if you’re dead—even if we could restart your heart—which we almost certainly couldn’t—there’s a less than one percent chance you’d make it out of intensive care and no chance you’d leave the hospital alive.”

  “Dr. Chitra,” he said. “Give it all you’ve got.”

  I tried explaining again, but Maurice wouldn’t change his mind. “Let me tell you a story,” he said, and pointed at the chair beside his bed for me to sit down. I looked at my watch; I had at least two other patients waiting by then, but I took a deep breath and sat.

  “There’s a woman,” Maurice began. “No spring chicken, but not far into middle age either, forties maybe, something like that. Anyway, one day she lets herself into the front hall of the house she grew up in and calls upstairs to her father, ‘Dad, it’s time. You almost ready?’ She’s a good daughter, you see. Since her mother passed, s
he does her best to take care of her father even though her cooking isn’t what it could be and she’s able to tolerate a whole lot more dust than her mother ever did, which the father’s having a hell of a time getting used to.”

  He checked to make sure I was listening.

  “She gets no answer and calls again, this time raising her voice. Nothing. So she goes upstairs, taps her father on the shoulder, and, when he turns around, says, ‘Dad, for the fourth time, we need to leave,’ and the father says, ‘Daughter, for the fourth time, I’ll be there in a minute.’”

  I didn’t laugh.

  “Don’t you get it?” he asked. “It’s the daughter who’s deaf, not the father. But everyone just assumes it’s the old guy that’s got the problem. Dr. C., you disappoint me.”

  “You’re not that old,” I protested.

  “You still don’t get it.”

  But I had understood the story; I just didn’t see how it pertained to Maurice. Unlike the father in his story, he was sick, very sick.

  Maurice’s eyes seemed overlarge in his shrunken face. Radiating sadness and hope, he looked like one of those children on television where a voice-over says that for just five cents a day, you—comfortable, healthy, and wealthy American sitting on your couch—can save a life.

  “I’ll call your oncologist,” I offered. “There must be something else we can try.”

  Maurice slapped his bed with one hand and smiled. “They told me you were smart!”

  That time, I laughed. “And the clinic nurse told me you’d asked.”

  Defying all my predictions, Maurice survived a first and then a second cycle of chemotherapy, though every time I tried to discharge him, he developed some complication that required him to stay in the hospital. One morning more than three weeks into his stay, he asked to see me. I found him not in the vinyl armchair from which he usually held court, but in his bed. Framed by the pillow, the whites of his eyes appeared yellow.