A History of the Present Illness

by Louise Aronson

  “How are you?” I asked.

  “Never better,” he said so softly that I had to step closer to hear him. It was as if he didn’t have the energy to force out the air required for speech.

  “No nausea. Even the plumbing is A-OK. I’m gearing up for the next round.”

  “Maurice.”

  He managed an unconvincing smile. “You must mean the back pain.”

  For a week he’d had worsening pain that he hadn’t mentioned. I told him I’d give him a shot and send him downstairs for X-rays.

  “Ha!” he said. “This is all a ploy to drum up business for your husband.”

  Somehow, on a previous trip to radiology, Maurice had noticed that the radiologist and I shared the same last name, put two and two together, and then charmed my usually circumspect husband into disclosing much of our family history, including our rocky early courtship as Atul’s mother was dying of cancer in central Illinois.

  “We’re on salary,” I said.

  “I hope you don’t think that’s an excuse for losing your sense of humor.”

  “Cancer isn’t funny. And you need an X-ray.”

  “Don’t be silly,” he said. “I’ve been sitting around this place for weeks. Of course my back hurts.”

  Either he really didn’t understand what the back pain might mean—which seemed unlikely—or he was playing tough guy again.

  “Let me tell you a story,” I said.

  Maurice shrugged. I pulled up the vinyl chair and sat down.

  “A man goes to see his doctor because his knee hurts. The doctor asks the usual questions—when did the pain start, what makes it better and worse, and so on—then moves the knee up and down and back and forth. Finally he stands up and says, ‘The knee’s fine. It’s just everyday wear and tear. Try resting and icing it.’ The man looks at him. ‘Doc,’ he says, ‘my knees go everywhere together, and the other one doesn’t hurt a bit.’”

  “Easy for him to say. Lucky chump’s still living his life.”

  “Okay, but my point—”

  “I get your point.” He looked out the window. “Knees—and backs—don’t hurt for no reason. So probably the cancer’s spread more. If that’s the news, do I still get my next chemo?”

  “If you’re sure you want it. And maybe some radiation too.”

  “Well then. Tell the hubby I’ll be right over, and tell the boys downstairs I’m ready to be zapped when they’re ready to do the zapping.”

  *

  In accordance with Maurice’s wishes and because the oncologist said some response still wasn’t completely out of the realm of possibility, he began the next round of chemotherapy that afternoon, despite the disease up and down his spine and in his liver and almost certainly in his lungs as well. My days off started the next morning, so I didn’t see Maurice again until the end of the week.

  “There’s a woman,” he whispered. I was barely through the door. I hadn’t even said hello.

  “New. In a place like this.” He paused and took a deep breath. His hospital gown had come untied, and they’d forgotten to put in his teeth.

  I walked quickly to the bedside and turned on the overhead lights. His eyes looked glassy and unfocused, the kind you sometimes see in dolls, which, however lifelike, never actually look like real human beings. He needed intensive care. I reached over his head and depressed the nurse call button.

  “The woman waits,” he continued. “By the elevator. Person comes along. She lifts her skirt.” He stopped speaking and panted.

  I pulled the oxygen tubing out from behind his pillow and tried to slip it over his head. He batted me away.

  “Woman lifts her skirt,” he said. “Shows off her legs. Says, ‘Supersex!’”

  I turned on the oxygen, put one hand on his arm so he couldn’t stop me, hooked the prongs into his nostrils, and coiled the tubing around his ears.

  A nurse came into the room and looked from Maurice to me. “ICU?” she asked. I nodded.

  “One day,” Maurice said. With each inspiration, the skin at the sides of his face sank beneath his cheekbones.

  I put my hand on his arm again. “It’s okay. You can tell me the rest later.”

  “I’ll tell them we’re on our way,” said the nurse.

  “One day,” Maurice repeated, “a man comes by. In a wheelchair. And this woman. Offers . . . ‘Supersex!’” He grimaced.

  The nurse spoke into her cell phone, then gave me a thumbs-up.

  Maurice’s voice was barely audible. “Man says, ‘Soup, please.’”

  I had just unlocked my side of his bed. We had everything secured for the quick dash down the hall to intensive care. And now, finally, Maurice was ready to stop chasing sex and choose soup.

  I stopped the chemo and radiation, called the palliative care team, and started the morphine. Before I left work that day, I returned to his room. Maurice seemed comfortable, but also not at all himself. Already his legs and fingertips looked purple and mottled. I readjusted the oxygen tubing on his face. His breath smelled rancid, but when I leaned over to kiss his forehead, his skin was warm and soft against my lips.

  As I walked to my car, the feel of him lingered. I realized that I loved Maurice—if love is the right word for the irrational and wholly asexual passions I have since felt many times for the men and women in my care—and because of that love, I had done things for him that made no sense medically, and I had done those things to please him, and also and most important, if I could turn back the clock, I would do exactly the same things for Maurice for exactly the same reasons.

  Fires and Flat Lines

  I.

  The boy kept hold of the match until he could feel the flames on his fingertips.

  His mother’s name was Vivian; her identical twin was Sarah.

  After the fire, I dreamed of exuberant rose-colored cells with ectatic blue-streaked nuclei and stippled tufts of lavender cytoplasm—of cancer, in other words, but not any cancer, not the disfiguring or painful or lethal kind, but a tumor of my own devising, one I might conquer at both bench and bedside, liberating me from the facts and fables of strangers’ lives.

  Vivian never worried about the future, hers or anyone else’s.

  Early on, Sarah flew from Michigan to San Francisco.

  I came late into the story and knew Vivian only if you consider palpating the warm pink lining of a woman’s mouth and rectum, cutting yellow-gray strands off what was once her left breast, injecting poisons into her bloodstream, and harvesting her sister’s dusky marrow, but not actually introducing yourself as her new oncologist and having a conversation—if you consider that knowing.

  Every time they left to go home, the boy thought—no, he was sure—his mother would die.

  His mother was young, but he was just a child.

  Theirs was the sort of situation that neatly divided people into one of two types: those who bucked up and carried on, and those who sought comfort in culinary perversions and carnal oxymorons.

  “Read your book,” said the father to the boy.

  A is for apple . . .

  There was a calm to Vivian, as if, even unconscious, she recognized that her condition was only part of a larger hurt, a whole ocean of ache, cool and dark and menacing, stretching out in every direction.

  This is a story I’ve pieced together from gestures and glances, assumptions and fragmentary knowledge, a story that may not be true.

  II.

  Imagine that every day you made decisions of consequence, decisions that changed the shape of other people’s bodies and the content of their lives.

  One day, the boy overheard his father and aunt: “Don’t be crazy,” Sarah said. “Nobody’s ruining anyone else’s life.”

  “Give me a chance,” I said to the family. “Cancer is what I do.”

  A was for apple but also for adenocarcinoma and arrogance and atrocity.

  “Try this,” the boy’s father said to Sarah. “It’s delicious.”

  I pushed the probe into Sarah
and extracted what Vivian needed.

  Much later, when he heard the term palliative care, the boy thought it sounded just right; he had wanted the doctors to take good care of his mother, to be her pals.

  “Read your book,” said the father to the boy.

  B was for bald, C was for cure, D was for death . . .

  In those days, I remembered test results but not names, doses but not stories, achromatic jokes and medical mishaps, each family’s folklore buried beneath my own.

  E was for Excelsior, the neighborhood he loved and, as his father explained to Sarah, the only place they could afford to live.

  His father said it wasn’t sexual.

  His father said, “For you, because big boys ride two-wheelers.”

  L was for lies.

  The boy wondered where the ants went as they streamed along the sidewalk below his black, spinning tires.

  I explained that Vivian’s expression, though disturbing, was only a reaction to the tape holding down her eyelids and the tubes running into her mouth and nose and neck.

  The boy liked the ants, liked flipping them over and watching the flailing of their little legs.

  “I know it looks bad,” I said, “but there’s plenty more left to try.”

  At the bar on Geneva Avenue, his father said it was only sex.

  The boy dropped the match, and the ants burned from the outside in, like crumpled paper, starting with their little legs.

  P was for pneumonia and pressure sore, for pathos and prolongation.

  The death doctors, the famous ones, said you could bring closure to any death.

  “Your aunt and I . . . ,” his father began.

  Until my wife moved in, I had radios in my kitchen and bathroom, a clock radio by my bed, radios in my office and car, all tuned to news, not music, unless the music was something fast and funky, no more sentimental than a sportscast or a weather report.

  III.

  For years, all the boy remembered of the end was a nap when it wasn’t nap time and his father’s pale, pinched face through automatic swinging doors.

  What doctors don’t talk about is how grief swells and festers, how endings are never really the end.

  The nurse said, “The child never cried, not even once.”

  R was for rage and retribution.

  “I love you,” my wife said recently, “but you’d have me fight to the end, and I might not want to try something experimental. I might not want to be alive any way I could.”

  “She’s a strong one,” I told the family two days before Vivian died. “No reason to give up now.”

  The boy liked that the bike’s tires burned first, liked that they burned with very little flame and lots of dark gray smoke.

  S was for sadness, for secrets, for shame.

  I read about the fire in the paper and right away recognized the boy.

  “Eat,” his aunt Sarah had said. “I’m your mother now.”

  “Two people inside,” a witness told the newspaper reporter. “A man and a woman.”

  Above the house, over the flames and through the smoke, the boy watched as the sharp edges of Twin Peaks and San Bruno Mountain blurred.

  Until the green line beside Vivian’s bed went flat, I continued the perfectly timed bursts of electricity, the great thrusts of humidified air, and the steady drip of clear and potent liquids.

  The boy watched the fire, and then he spread his legs and put his wrists together behind his back.

  V was for vindication.

  As my wife and I drive out of McLaren Park and past the charred house, I launch into the story, and when I finish, my wife says, “For you, this city is a graveyard,” and at first I’m tempted to agree, but then I remember that a graveyard is a place without memory or imagination, without guilt or regret, a place of closure and rest.

  The Psychiatrist’s Wife

  She drinks lime switchers by the pool while her husband swims through a ship sunk by Blackbeard in the days of the Atlantic buccaneers. Alcohol abuse, her husband, the psychiatrist, would say if he could see her now. But he would be wrong. She knows, because she’s a doctor too. More of a doctor than he is, in fact, since she repairs damaged bodies and removes diseased organs while he sits in his chair talking, labeling, judging, then talking some more.

  When someone she knows approaches—another wife, occasionally a husband—she closes her eyes. Even in the shadow of an oversize sun umbrella, her pallor glows, startling and unfashionable. Brown hair hangs below her scrawny shoulders in careless wisps, but closer to her scalp it too lacks color. An inch above her ears, gray meets brown at a sharply demarcated line, like the place on a hillside marking the path of a recent, all-consuming fire.

  She looks at her watch and smiles. To constitute abuse, the dysfunctional relationship to the substance must be present for at least one month. She sips her drink. They’ll be here only another three days, twenty-two hours, and thirty-seven minutes. Then she’ll stop.

  The psychiatrist has come to the island for a medical conference on post-traumatic stress disorder, and his wife—as she has come to think of herself now—is accompanying him. He has been preparing for months, finding reprieve from his latest claim-to-fame role as director of the working group revising the Diagnostic and Statistical Manual of Mental Disorders in his research comparing the brain scans of Gulf War veterans with those of healthy civilians, rape victims, middle-aged Cambodians, ancient Jews, and young Somalis. Here in paradise—the brochure promised unrelenting sunshine and resplendent blue waters, but also escape and the ability to anticipate a guest’s every need—her husband disappears for three hours each morning and two hours each afternoon, emerging from the grand ballroom overstimulated and horny with triumph. She waits in their room as if stranded, responds against her will, lying like a corpse on skin-soft sheets, washing slowly when it’s over. He invited her on the scuba cruise, but she won’t go into the ocean any more than she will walk back into an operating room. Generalized anxiety, he argued. The unrealistic or excessive worry about two or more life circumstances for at least six months.

  They had flown from San Francisco to Miami, then traveled by cruise ship at her insistence. He lost an extra week of work. She didn’t, because when they made the booking four months earlier, she had already quit.

  For twenty-two years she had worked in a community hospital.

  Saint Specialist, they called it, half joking, because most patients had a different doctor for each of their organ systems.

  Her husband’s University of California Medical Center colleagues, she knew, sometimes called it the Death Star.

  On call for the surgical intensive care unit, she was paged every twenty minutes. She got called about high fevers and low blood pressures, about oozing wounds and racing minds, and too often—once a month, sometimes more often—about a death.

  One of those nights, around two A.M., her husband said, “Effective supervisors set limits.”

  They were in their new bed at the time, with its Italian hardwood frame and pricey French linens. She turned on the light, and he covered his face with a pillow.

  “This isn’t someone’s neurosis,” she said. “It’s multisystem organ failure.”

  “You’ve misunderstood.”

  “Of course. I’m not the famous expert.”

  He lifted one corner of the pillow. “I was simply suggesting—”

  “People get sick,” she told him. “They try to die.”

  He let the pillow fall back over his face. “And even then, most fail.”

  That anecdote, she knew, gave a misleading impression of her husband. Still, it happened.

  At least she came on the trip. “Plane or boat,” their only child, a teenage son, had said to his father, “no way am I going on your so-called vacation.”

  * * *

  An ebony man in white shorts and white gloves brings the psychiatrist’s wife another lime switcher on a tray that may be real silver. As he approaches, she smells his sweat and colo
gne and turns to look.

  A green-gray blur, a hummingbird, hangs above the bougainvillea. A child squeals in the pool. The child is not her child. Her child is older now and refuses family vacations. Her child cheats on tests he could ace without studying, simultaneously achieving social acceptance and academic mediocrity. Her child wears a ring on the fourth finger of his left hand to honor a vow of celibacy and burns books he considers untruthful or impure but thinks nothing of piercing his nipples, nose, scrotum, and umbilicus with cheap silver hoops and beaded baubles.

  The ebony man hands the psychiatrist’s wife her drink. The ice-filled glass contains a subtly jaundiced, not quite transparent liquid that burns going down. It gives her gooseflesh. It warms her, then makes her shiver.

  For years—five and a half decades, her whole life—s he thought like and love were parts of the same emotional spectrum. Now she knows they exist on separate tracks, ones that periodically intersect but don’t necessarily run parallel.

  The ebony man wipes condensation from the base of his tray. He has a scar on the side of his neck that emerges, thick and pink brown, larval and accusing, from beneath his shirt collar. The psychiatrist’s wife wants to ask where he got it and why he doesn’t have it removed, but this is the real world, not work, and the answers to those questions are none of her business.

  “Not to worry,” her husband had said. “A man quits, and the word that goes out is nervous breakdown. But a woman? She’s applauded for her devotion to family and openness to innovative and alternative career paths.”

  *

  Symptoms she’d developed in recent years:

  1. She waited until all the operating rooms were fully booked before giving her assistant the list of her upcoming cases.

  2. Knowing families wanted to talk to her, she took the stairway, not the elevator, so she wouldn’t run into them.

  3. She let her practice group’s physician assistant help with all but the most complicated procedures so he would scrub with her instead of the other surgeons and she’d rarely be alone in managing her patients.