"You just wouldn't believe this would happen," the nurse said, shaking her head. "I mean, that a man like this would take it like that."
"Tell your relief nurse," he said, "to call me if he starts to act up again. On the way out I'll leave an order for a tranquilizer."
At the nurses' station he signed the order for a routine dose of twenty-five milligrams of thorazine three times a day. He tried to call Mrs. Benjamin Davies on the telephone but there was no answer. Then he saw two other patients and drove home.
"He had me boxed in," he was telling his wife. "When they ask the direct question you can't lie."
"Doesn't he have a family?"
"Yes, he has a wife and a married daughter who lives out of town. I've never seen either of them, but I spoke with his wife on the phone after the operation. I told her it was successful, and she asked no questions. I was hoping to see her with him this afternoon, but he had his secretary in there and he was running an office."
They were sitting in the living room. He was having a vodka and tonic before dinner.
"I would have had to tell him eventually anyway," he said, "because he's got a financial responsibility not only to his family but to his stockholders. If you lead a man like this to believe he's been completely cured this could be detrimental to the interests of his estate and of his business. In fact, you can get yourself into a nice legal jam that way."
"But if you got it all when you took out his lung he may be cured."
"I didn't get it all. It's started in his other lung, and he'll have to receive radiation treatments. That's another reason why he had to be told."
"Then it seems to me," his wife said, "that you did the only thing you could do. You shouldn't be sitting here blaming yourself."
"I'm not blaming myself, but I don't feel like celebrating the way I managed it."
If I'd had the chance over an extended period of time, he thought then, I might have prepared him a little better, but it wouldn't have made much difference. He was pretty sure of what he had and he knew more about the cure rate than he let on that day he didn't press me in his car. He didn't want to hear it then and he didn't want to hear it today, but the tip-off was that day in the car.
"I suspected him," he said, "but I guess I still read him wrong. He has all the outward mannerisms and the business-success history of a completely self-assured man. I should know by now that the ability to face life doesn't necessarily encompass the ability to face death.
"He was like a child," he said. "I hadn't felt any emotional involvement with him, because he wasn't a man you could get close to and, God knows, I don't seek that. I have too much of it with too many patients every day of my life, but when he broke down I went right out to him as if he were a child. Standing over him, it came to me that he was like a child that I had just struck and just hurt. You know what I mean."
From now on, he thought, lying in hed that night and trying to get to sleep, we won't be treating just an organic disease. We'll be treating a mental and emotional sickness, and you can call it the anaemia of hope. What this Davies has got, the metastasis to the other lung, is exactly what took Evarts Graham, and Evarts Graham did the first successful removal of a lung in a human being on that obstetrician in 1933. That obstetrician is still living, the last I heard, and Evarts Graham died in 1957 and the irony is that he himself died of cancer of the lung.
There is no doubt, he was thinking, moving into sleep now, that Evarts deserved that "Father of Modern Chest Surgery" and he looked the part, too. He must have been about six feet two and about 195 pounds and he stood straight and he was a scholar and you could see it. He not only could operate but he could teach, too, and one of his tricks was to find three different ways to say anything that he wanted you to hang on to. It was funny the way he did that, and Marion noticed it the first time she ever heard him when I took her to that meeting in Atlantic City and she came out and said: "He's good, but he says everything three times." It was the truth because he would say something like: "The underlying lung was responsible for the pus in the pleural cavity." Then he would say: "When you have the lung infected it will transgress the visceral pleura and infect the pleural cavity." And a few minutes later he would say: "It's a basic law of nature that if you have an infection of an organ adjacent to a cavity the infection will extend into that cavity unless controlled." It's funny how he would do that and I had never noticed it until Marion spotted it the very first time.
When he entered Benjamin Davies's room at 7:40 the next morning, the night nurse was sitting in the arm chair where Benjamin Davies had been sitting the afternoon before. Benjamin Davies was in bed, two pillows under his head, awake and staring at the opposite wall.
"Good morning, Doctor," the nurse said.
"Good morning. How are you?"
"Fine, Doctor."
"Good morning," he said to Benjamin Davies.
"Hello, Doctor," Benjamin Davies said.
"Why don't you take a ten-minute break?" he said to the nurse.
"Thank you, Doctor."
"How are you feeling?" he said to Benjamin Davies.
"I want to apologize, Doctor," Benjamin Davies said.
"There's no need to apologize. Anyone might have reacted the same way. I've forgotten about it, and you should forget about it, too."
"I shouldn't have acted that way. I knew it was cancer, but I didn't want to hear it."
"No one wants to hear it, but you're better off knowing."
"I don't have much of a chance, do I?"
"You've got a good chance. We got to you early."
"I know, but the national statistics on permanent cure of lung cancer is only seventeen per cent."
"Where did you get that?"
"I had some research done before I came in here."
"Your research isn't up to date and it's not complete."
"What do you mean?"
"Any good chest surgeon will have a permanent cure rate today of at least twenty-five per cent. Mine happens to be thirty-three per cent."
"Is that true?"
"Look. You and I understand each other now. We're not playing any more games. That thirty-three per cent happens to be the truth, and I happen to be proud of it."
"I don't mean to doubt you."
"I know, and I'll tell you something else. When a patient has this disease and knows it, he has a tendency, no matter what his chances are, of putting himself on the losing side. If a patient leams he has a ninety per cent chance of cure it's human nature for him to envision himself in the other ten per cent. I have I don't know how many patients who had just what you had and who are going about their work, having their fun and leading completely normal lives."
"I won't miss my lung?"
"Never. You wouldn't even know it was gone, if I hadn't told you."
"You're making me feel a little better, Doctor," Benjamin Davies said.
"Good."
It's not only I, he thought then, but it's also that thorazine. That thorazine gives them a feeling of well-being, and I might as well make the best of it right now while he's still on it.
"When do you think I might get out of here?" Benjamin Davies was saying.
"Well, we want to get you up on your feet more first. Maybe by the end of the week."
"That will be fine with me."
"We'll want you in here for a while every day, though."
"What for?"
Well, he thought, here I go.
"We want to give you some treatments. Now don't go jumping to any conclusions, but we're going to give you some radiation."
"What?" Benjamin Davies said. "I've got it in the other lung, too?"
"Now you're doing just what I told you not to do. You're jumping to conclusions. Your X-rays show just a small shadow on the other lung. Because it's so extremely small we didn't even look at it, so we don't know what it is. It doesn't look anything like that other tumor, and whatever it is, we're going to knock it out with radiation therapy."
&nbs
p; Benjamin Davies didn't say anything.
"Look. There's no reason to be concerned about this. We're just taking normal precautionary measures. You wouldn't want us to do otherwise. Besides, I've got you cured right now, and I want to be sure you boost my batting average. I told you I'm proud of it."
"All right, Doctor," Benjamin Davies said.
"Incidentally," he said, "I tried to reach your wife on the phone last night. Because you knew your problem, I thought that she should, too."
"She's been away at our country place over the weekend," Benjamin Davies said, "but I'd rather you wouldn't tell her, anyway."
"Whatever you say. That's up to you."
"My wife is excitable. She hasn't been too well herself these past few years and she knows nothing about these things. When I came in here I told her it was for something that developed from an old chest injury that I got in football. She hasn't any idea of what it was."
"All right. I'll remember that."
All things considered, he thought when he left him, I got away with it all right. If it weren't for those statistics I'd have gotten away with it even better, but you run into these statisticians every now and then and there's nothing you can say to talk them out of it. Their statistics become their cross, and that first one, whatever his name was, was the worst. I don't remember his name, but I'll never forget the man.
He was still in his residency then, and that first one was a retired life insurance executive. At 8 o'clock in the morning they had opened his chest for cancer of the lung and twenty minutes later they had found him inoperable and they had closed him again. At 8:55 he had started to come out from under the anesthesia in the recovery room.
"Do you know what time it is?" the nurse had said to him.
"I don't know," he had said.
"There's a clock on the wall there," she had said. "Can you read it?"
It is a standard procedure they use to test the patient's awareness.
"It's 8:55," he had said, and right then he had known it all. He had known it was an 8 o'clock operation and now he knew that they had merely opened and closed him and he had been dealing with life-expectancy charts and disease statistics all his working life.
Four days later he began to drink in his room. Three days after that he bled from an old ulcer, and after five transfusions they operated on him. They did a Billroth II, to close the duodenum and attach the stomach directly to the intestine, but the duodenum was so scarred that they couldn't close it completely so they put in a tube to bring out the bile and juices until the duodenum could heal.
The problem with such a tube is that, although it will be ninety-five per cent efficient, a small sinus track forms around it and the remainder of the drainage follows the outside of the tube as it would a wick, and digests the skin where the tube emerges.
So we used Philadelphia cream cheese, Dr. Matthew Carter was remembering now. We pasted the skin with Philadelphia cream cheese and we had to replace it every three or four hours. I'd get up at 6 o'clock and replace it and after every operation I'd run back and replace it again. I'd start my rounds with him and I'd finish my rounds with him and when I'd miss breakfast or my lunch I'd grab a package of Saltines and stop off and, while I was talking with him, I'd eat some of his stockpile of Philadelphia cream cheese.
He was really a nice old guy and that was an angel of a wife he had. She must have been about twenty-five years younger than he was and when he started to hemorrhage from that ulcer and we called her that night she said: "Let him go. He's an old man." But we gave him another eighteen months and he took most of it on that cruiser of his and he got in that deep-sea fishing he used to talk about all the time.
Benjamin Davies's wife can't be like that, he thought now, but it's too bad he can't lean on her. It's too bad I can't count on her for any help, either, but at least I've got him going my way right now.
For almost a month Benjamin Davies continued to go Dr. Matthew Carter's way. For three weeks, after leaving the hospital, he reappeared there five days a week and submitted to radiation. Suddenly, and without explanation, he kept no more appointments and when Dr. Carter, on several occasions, attempted to reach him by phone Benjamin Davies was out of town. Finally, Dr. Carter spoke on the phone with the plant doctor who had referred Benjamin Davies.
"You know he's a tough man to reason with," the plant doctor said. "He's been feeling like his old self again, but you know he's the type that can't accept it when something is wrong with his body. The idea of radiation therapy bothers him and one Saturday a couple of weeks ago he told me that he was discontinuing the treatment."
"We can't let him do that."
"I know it. I told him that, but I can't reason with him. He won't even see me any more. He's actually been out of town a lot, but I told him to go see you."
"If I can get him on the phone," Dr. Carter said, "I think I may be able to get him to come in, I'll try."
Dr. Carter tried, but never reached Benjamin Davies by phone. A letter he wrote to him brought no response, although the Bill Carrie sent was promptly paid, and Dr. Carter heard nothing of Benjamin Davies again until two years and two months later when the plant doctor called and said he was sending Benjamin Davies into Mercy Hospital the next morning.
"He has a lot of pain constantly now," he said, "and he's coughing some blood. He's lost about twenty pounds and he doesn't want to see anybody. I don't suppose there's anything you, or anyone else can do for him now, but I'd like you to take him over again."
"Certainly," Dr. Carter said. "He's still my patient."
The next morning and afternoon Dr. Carter was operating at University Hospital. Dr. Robert Robinson saw Benjamin Davies.
"I was looking at a dead man, Matt," he said. "He's got no chance. I'll bet you it's all through him now. He was in such pain that all I could do was put him on morphine. If he's lucky he'll go in thirty-six hours."
"He may hang on longer. He's a pretty rugged guy. Was he clear mentally?"
"Only about the pain. His wife was all excited. She doesn't seem to know what's going on."
"She probably still doesn't know. At the time we did him she thought we were repairing an old football injury."
"You're kidding."
"I'll take him on the rest of the way," Dr. Carter said.
"You're welcome to that one," Dr. Robinson said.
The rest of the way stretched on through the next three days.
V
"Excuse me," he said now to the older woman. "Are you Mrs. Davies?"
He had seen the two of them walking up and down the hall. As he had approached Benjamin Davies's room they had paused by the door and were talking.
"Yes," she said.
"I'm Dr. Carter."
"Oh," she said, looking at him. "I'm glad you got here."
She was of medium height and carefully groomed and it was still apparent that she had once been quite beautiful. She had rather large brown eyes but the rest of her features were small and delicate. She was obviously extremely nervous and fatigued and may even have been crying.
"This is my daughter," she said.
"How do you do?" the daughter said.
She was a thirty-year-old model of her mother, perhaps an inch taller, but with the same precise, patrician features. She was wearing a mink coat over her shoulders and was carrying her mother's.
"Look, Doctor," the daughter said. "You've got to do something for Father."
"I am doing something for him. I—"
"It seems to me you're doing very little."
"You've got to help him," the mother said. "He's starting to feel pain now and he doesn't want to see us and I don't understand this."
"It seems to me," the daughter said, "that—"
"Excuse me," he said, "but I'm going to do something for your father right now. The first thing I'm going to do is to go in and see him and give him something for that discomfort. Then I'd like to talk with both of you."
"I'd certainly like to talk with
you" the daughter said.
"You go down to the lounge, just two doors down from here, and I'll see you there in a few minutes. Is that all right?"
"At least that's something," the daughter said.
When he walked into the room the nurse was at the head of the bed, with her back to him, filling a water glass from the carafe. She turned when she heard him and nodded to him and moved aside.
"Good morning," he said to her.
He walked to the side of the bed and took Benjamin Davies's left hand. Benjamin Davies, much thinner than when he had seen him last, his cheeks hollow and his skin faintly yellow and pulling tight over the cheekbones, was lying on his back, slightly elevated.
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