"You're a coward," he said. "You're afraid to discuss it, because you can't prove it. You can't prove any of it."
He was helping to drive the cattle to the water holes that summer, riding out with the others early each morning to sweep the valleys, each man taking an area alone. By the end of the day they would have assembled quite a herd, but after a day or two the cattle would have moved out again, trying to get to good grass, and they would have to bring them back.
It was noon and the temperature must have been no. There was not a cloud in the sky and not a tree on the horizon and it was so clear that he could see a hundred miles. The jack rabbits slept in the shade of the soapweeds, and in this great, scorched, heat-welded, immobile universe nothing else moved. Only his horse moved, moving him, the only sound the clop-thock of its hooves against the stones. It moved more slowly now, for it had been working since sunup, and finally it stopped, starting to drop its head and he heard the last hoof sound die.
It was so still that he could feel the silence, and then it came. It came to his consciousness like a clap of sudden thunder, but not ceasing nor subsiding. It assaulted his ears, filling his head, filling this universe, the dry, grating, million-rattle, steady thunder sound of a million insects everywhere, always there.
So there must be a God, he thought, sitting there unmoving and assailed by the sound. Call it God or Force, but there is a Something and it is here and everywhere.
In Gross Anatomy, in his first year of medical school, examining every vessel that fed every muscle, isolating every nerve that activated it, dissecting every organ, he knew that the answer wasn't here and there must have been a Something that motivated and moved this man. Witnessing a complete autopsy, watching the emptying and then the careful, skilled, hidden, and disguised closure, it came to him that what they had removed would tell them why this now manikin-man died, but it would not tell them why he had hoped and feared and lived.
"You can't be a surgeon," he was to come to say many years later, "and not believe in some kind of supreme law. You can't witness the whole series of dynamic, immutable changes that is life from beginning to end without believing. I have seen death hundreds of times. I have seen brave men die and men you would call cowards die, and at the end there is no difference between them. There comes over all of them that same blessed euphoria, and only their survivors suffer. You may not want to call it God's numbing, as I have heard it called, but you can't deny it."
He did not come to medicine and then to surgery, however, to serve but to be served. It is merely, he recognized and admitted to himself, that what serves me is regarded, and not wrongly, as service and I am one of the fortunate.
"Tell me something, Doctor," he heard someone ask Peter Wakefield at a dinner party one night. "I'm curious to know why you became a surgeon."
Peter had come over from England to deliver two lectures, and he had been charming them all evening with his graciousness, his erudition, and his humor.
"My dear lady," he said, dropping his head, his pink chin overflowing his collar and Peter looking at her out of the tops of his blue eyes. "I became a surgeon for the same reason that my plumber became a plumber. There's really no difference, you know, except that I have more need for him than he, fortunate fellow, has for me."
On another evening it was not Peter but Carl Broeck from the Netherlands. They were talking about Carl's home town, which was Heerlen, and he was telling Carl how, when they went through there during the war, the Germans were running for the Siegfried Line and so the town was untouched and not left in ruins like the small towns in France and it reminded him of the suburb of any northern American city.
"It is a funny thing about that town," Carl said. "You know, I sometimes think that the reason I became a doctor was because of that town. In that town then, when I was a small boy, the most important man was the doctor. He was a big, impressive man, and we had then the telephones that you would crank and when the operator would answer you would say: 'Give me, please, number ten.' Or you would ask for number sixteen or twenty-nine, or whatever the number was. One day I watched the doctor when he cranked the phone. When the operator answered he said: 'My home.' That was all he said, but the operator knew who he was and she knew his number and when I heard this I said to myself that I wanted to be a doctor, too, and be important like this.
"I suppose," Carl said, "that, if I had grown up in a big city, the doctor might not have seemed so important. I suppose that, if I were growing up now, the doctor might not seem so important, either, because that is changing back home."
"It is changing here, too," he said to Carl then. "When I was in college I was important. I played football, and everyone knew me, and I hated to have it end. I used to see the football players graduate and disappear, selling bonds or insurance or going into some manufacturing plant. I couldn't imagine myself doing this.
"Of course, it happened that I was better in the sciences than I was in the arts, and one evening we were sitting around the fraternity house and the others were talking about what they were going to do when they graduated. One of them was going into a bank. Another was going into his father's business, whatever it was, and someone turned to me and said: 'Hey, Matt, what are you going to do?' I said: I'm going to be a doctor.'
"The moment I said it, I felt a change come over the room. They all looked at me, and I could see it in their faces. I hadn't done anything yet, except to make a statement, but already I was important.
"I suppose," he said, "that if I want to be absolutely honest about it, this and the need to prolong the academic association rather than face the necessity of making a living, is why I went to medical school."
"Of course," Carl said. "It is a perfectly natural thing."
VIII
"How about Mrs. Brower?" he said to the talker. "Mrs. Louise Brower. Has she checked in yet?"
The talker was on the phone again, but when she had seen him she had put her hand over the mouthpiece and looked up at him.
"No, Doctor. I finally got Admissions a minute ago, and they said they hadn't seen her yet."
"That's all right," he said, and he motioned to her to go back on the phone. Then he walked to the rack and took out the chart of Grace Cowan.
Grace Cowan was forty-one years of age, and she had first come into his office eight days before. She was unmarried, lived at what is considered a good address, had the outward manifestations of both wealth and sophistication, and was still a physically attractive woman. Aside from the fact that she drank too much and smoked too much she had treated herself well all her life, and there was an irregular shadow in the upper lobe of her left lung.
"Do you suppose it's cancer, Doctor?" she had said, openly.
"I can't say right now," he said. "That's what we've got to find out."
"But it wouldn't surprise you, would it?" she said.
"Nothing surprises me any more," he said.
"I'm sure that's true," she said. "Few things surprise even me any more."
He remembered the lines six days later, after he had stopped in to see her just before he operated. Her only relatives were her sister, about five years older and also looking as if she had once emerged from a Miss Somebody's finishing school and come out at the Cotillion. Her sister's husband was about fifty, impeccably groomed, slim, with classically even features and slightly wavy gray hair. He resembled the man you see flattering the bored, bare-shouldered woman in the full-page magazine color ads for whisky, perfume, cosmetics, or a deodorant, and his name was Warren Leeds.
"I'm feeling quite well right now, Doctor," Grace Cowan said.
"You'll be all right," he said. "There's no need for worry."
"I'm not the least bit worried," she said.
"Doctor," her sister said, "you will take good care of her?"
"Of course," he said, "and you mustn't worry."
"I mean, you'll really do your best?"
"Of course I will," he said, no longer struck by the absurdity that they think you might apply o
nly partial effort.
"She's my only sister, and she means a great deal to me."
"Excuse me, Helen," Grace Cowan said, "but I'd like to talk with the doctor a moment alone."
She said it very nicely, and her sister and Warren Leeds walked out into the hall.
"You'll have to excuse my sister," Grace Cowan said. "She's like our mother was—the emotional type."
"I understand that."
"I have a couple of questions, Doctor," she said. "I'd like to know how much of a scar this is going to leave."
"Well, it will be a fairly extensive one."
The truth is, he thought, it will be the biggest one you ever saw, but what difference does it make at a time like this?
"I mean," she said, "how obvious will it be?"
"It will start below your left breast and extend in a C part way around the back. It's my brand—C for Carter—and at your bridge club, when they start bragging about their scars, you might even win first prize."
"The reason I'm asking," she said, "is that I do wear bathing suits and sometimes low back dresses."
"In cases like yours," he said, "I then make the incision a little lower."
"You can actually do that?"
"Yes, I've done it quite often."
It was the truth. You put the anterior, or front, end of the incision in the breast fold and keep it a couple of inches lower when you bring it around the side and up between the shoulder blades. That means you have to tunnel up under the skin in the back, and so you can call it a nuisance or, if it is important to the patient, a nicety.
"Then it won't show?"
"Not while you're wearing any reasonable costume. I don't think a bikini would hide it completely, and neither would a dress that's cut down in the back to your coccyx."
"Well, I had neither of those in mind," she said. "I'm a little beyond that age."
"Good," he said. "Then we'll hide it, and after six months it will hardly be visible anyway."
"I have just one more question."
"Go ahead."
"I have never had an operation before," she said, "but I've heard or read somewhere that, when a patient comes out of the anesthesia, they talk. I mean, I understand that they absolutely divulge their souls."
"That's not quite true," he said. "Some patients will talk briefly and rather rationally, but I have never known of anyone to reveal any secrets. You don't need to be concerned about that."
"I'm not concerned," she said. "I was just curious."
"Good. I'm going to leave you now, but I'll see you downstairs before they wheel you in."
"Thank you, Doctor."
In the hall he saw the sister and her husband.
"You may go in now," he said. "She seems in good spirits."
"She's taking this better than I am," her sister said.
"Why don't you go in, Helen?" her husband said. I'll be there in a minute."
"Of course," she said, and then: "And please do your best, Doctor."
"You know I will."
"Doctor," Warren Leeds said, watching his wife walk into the room, "I want you to know how important my sister-in-law is."
"I know how important she is," he said, "to both your wife and you."
"It isn't just that, Doctor," Warren Leeds said. "You can't have any idea how important she is. What I'm going to tell you may shock you, but I want you to know."
Why, he's breaking up, he thought. The man in the ad is coming apart.
"I wish you'd tell me anything you think I should know," he said.
"You should know this, Doctor," Warren Leeds said. "Grace isn't just my sister-in-law. Grace and I are in love. We've been lovers for almost twenty years. That's how important she is to me."
"I see."
"Doesn't that shock you?" Warren Leeds said, but just glancing at him and looking away.
"No, it doesn't shock me," he said, but thinking that it did surprise him because this was the first one who had ever told him. "After all you're telling me because I'm a doctor."
"You're the only one in the world who knows now, Doctor, other than ourselves. Of course my wife doesn't know. She doesn't have the slightest suspicion. I think Grace and I have handled it very well."
Oh, you've handled it very well, all right, he was thinking. I'm glad you didn't say you've handled it beautifully.
"You see, I wanted you to know this, Doctor," Warren Leeds was saying, "because you simply must save her. You simply must."
"Now take hold of yourself," he said, looking right at him. "For any thoracic surgeon this is a reasonably routine operation. I don't expect any complications, and I'm going to cure her."
"But she has cancer, doesn't she?"
"I don't know that. We're going to find out this morning."
"But she's convinced she has cancer."
"Just a moment, Mr. Leeds," he said. "Just reason this out. I've devoted most of the past twenty years of my life to this disease and its cure by surgery, and I don't know for sure what your sister-in-law has. She can't possibly have any knowledge remotely comparable to mine."
"But it doesn't seem to bother her," Warren Leeds was saying. "I'm upset, but she isn't. I must say I don't understand how she can be like that."
"She's a courageous woman. It seems to me that out of respect for her courage you should face up to all the possibilities, too."
"Believe me, I'm trying. I haven't behaved like this with her, or in my wife's presence, either. I had to let down with someone, though, and that's why I've told you."
"And I respect your confidence. What I want you to understand, however, is that even if your worst fears are realized, and this is a cancer, I'm going to remove it. I do this every day of the week. Do you understand that?"
"I understand," Warren Leeds said, looking at him now. "I apologize for behaving badly."
"There's no apology necessary."
He'll be all right, he thought. The pieces of the man in the ad are coming back together again.
"I did behave badly, but I'm quite all right now."
"Then forget it," he said, shaking Warren Leeds' hand, "and don't worry. She'll be all right."
"Thank you, Doctor," Warren Leeds said, and then he turned and walked toward the room.
When he opened Grace Cowan, making the incision as low as possible and tunneling, as he had promised, he found the left lung cancerous and he removed it. There was no visible spread to any of the adjacent areas, however, and when he examined the lymph nodes, the depots at which a cancer stops if it spreads through the lymphatic channels, he saw that the nodes were small and the pigmentation was a normal black and not marked with small patches of white. He isolated and removed three of the nodes for immediate microscopic examination, and when the report from the pathologist was negative he knew that Grace Cowan was running in luck.
Most of the first post-operative day Grace Cowan spent under sedation. At 6:30 that evening, however, the private-duty nurse was on the phone.
"Dr. Carter," she said, "I'm sorry to bother you, but I'm having a bit of a problem with Miss Cowan. I spoke to Dr. Bronson, and he said to call you."
"What's the problem?" he said.
"The patient is complaining of pain, but she won't let me give her the hypo. She says she doesn't want any morphine."
"She didn't mention this to Dr. Robinson when he saw her this afternoon."
"I know. That's why I can't understand it."
"How is she otherwise?"
"Otherwise she's doing quite well. Her blood pressure is good. Her temperature is 102 and her pulse is fast, but I think you expect that."
"Is she taking her liquids?"
"Yes. Except for the morphine she's extremely co-operative."
"Then I'll tell you what you do. We'll give her something by mouth. Give her fifty milligrams of demerol. Give it every four hours if necessary, and if she asks what it's for, tell her it's to prevent the possibility of infection."
"You said fifty milligrams of demerol, ev
ery four hours if necessary?"
"That's right, and I'll be in to see her the first chance I get tomorrow."
"Thank you, Doctor."
It was now 9:34 in the morning when he looked at the chart. The temperature was 101 as expected and the blood pressure was good at 128 over 82, but the pulse was fast at 105, and the respirations shallow and rapid at 32 per minute.
She's having pain while she's awake, he thought, but if she won't take the morphine she's got to take the pain. Then he checked the fluid balance and saw that the intake at 2500 c.cs and the output at 900 c.cs were satisfactory, and he scanned the nurse's notes.
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