Guarded Prognosis

by Richard L. Mabry MD

  Henry took a calming breath. “Do you have something sort of soothing?” he asked before the technician could repeat the question. He just wanted to get the test over with.

  After they settled on easy listening instrumentals, Henry adjusted the padded headset over his ears and took his place on the slab-like bed. He half-listened to the technician’s explanation of what was about to happen. So far as he was concerned, what he planned to do was lie there and let the tech take over.

  He had turned down the suggestion of his oncologist that he take Valium to pre-medicate himself before the test. Lying still for thirty minutes could seem like an eternity, but Henry decided he would go through this experience without pharmaceutical help. In his surgical practice, he couldn’t begin to count the number of times he’d ordered this same test or a variant of it, aware to some extent of the mental and emotional trauma associated with it but writing it off as necessary. Now Henry was getting the opportunity to experience it firsthand. He’d generally offered a pill to help calm his patients, but perversely he declined one for himself.

  After the test had gone on for an interminable length of time, the technician’s voice came through his earphones. “About five more minutes. Hang in there.” It seemed more like thirty, but finally the electronic voice in his ear said, “All done.” Henry breathed a sigh of relief. He’d never again subject a patient to this ordeal without some words of encouragement—and a strong suggestion that they avail themselves of sedation during the experience.

  “What do the images look like?” Henry asked after he was dressed again.

  “The radiologist will review them and contact your physician,” the technician said in a tone that indicated he’d said this before.

  “Look, I’m a doctor,” Henry said. “Why can’t I look at the images?”

  “I just check them to make sure they’re technically adequate. The radiologist will review them—”

  “I know. ‘And contact my physician.’ Thanks anyway.”

  On Wednesday afternoon, Henry was fully clothed as he sat in Dr. Gershwin’s private office. That was an improvement over his first meeting with the oncologist, when he sat on the table in an exam room, trying unsuccessfully to cover himself with a paper exam gown. Nevertheless, Henry was still nervous. He was usually on the other side of the desk in these situations. This time—despite his three decades of experience as a surgeon—someone else was in control of what would happen next.

  He knew as well as any doctor the steps to work up a patient with a presumptive diagnosis of pancreatic carcinoma. Henry could recite the protocol in his sleep. And if that work-up confirmed the diagnosis, he was familiar with the therapeutic options available. Unfortunately, he also knew—and what he still had trouble getting his mind around—was the prognosis that accompanied this diagnosis. Surely it couldn’t be happening to him. Patients had this condition. Patients, but not Dr. Henry Taggart.

  In treating cancer, doctors talked about what they called “five-year survival.” Henry had looked up the figures recently to confirm them for pancreatic cancer. Only about 20 percent of patients survived for one year after diagnosis. The number that lived for five years was even more dismal.

  In a long surgical career, Henry had made this diagnosis himself less than a dozen times, and in each instance, he’d referred the patient to a nearby medical center where all types of treatment were available. Truth be told, he hadn’t followed those patients to see what their life was like toward the end. As best he could tell from the reading he’d done, it wasn’t pleasant. Henry had almost fully made up his mind that he wouldn’t reach that stage. He just hoped Caden would help him, if and when it came to that.

  “Sorry to keep you waiting,” Dr. Gershwin said as he hurried in and took a seat behind his desk. He shrugged, and Henry heard the crackle of starched fabric as the crisp white coat settled on Gershwin’s shoulders.

  Henry noted that the doctor didn’t offer to shake hands. Already building the wall that changes me from colleague to patient. I guess I’d better get used to that.

  The consultant leaned forward and said, “I’ve reviewed your CT scan—”

  “I tried to look at it myself,” Henry said. “The technician said he couldn’t let me.”

  Gershwin shrugged it off. “Rules of the medical center. Anyway, the main thing it tells me is that you have a widened duodenal C-loop, probably due to pancreatic carcinoma, but there’s no evidence that it has spread. In other words, your case is amenable to treatment. So . . . ”

  Henry nodded.

  “I think we proceed with a laparoscopic ultrasound. If we can get a decent needle biopsy that way, we’ll have a good idea of where we stand. Then we decide what to do next.”

  Although Henry was prepared for this—actually, was anxious for the biopsy—he found himself enveloped in a cold sweat. Soon he could have tissue confirmation of the presence of a malignancy growing in his body. At that point, it would go from a clinical scenario to a reality. He was playing host to a tumor that would eventually kill him.

  “I’m sorry,” Henry said. “I missed that last part. What did you say?”

  “I was asking about scheduling the procedure. As you know, this will be purely endoscopic—no real surgery,” Gershwin said. “The anesthesiologist will give you something IV, and you probably won’t remember a thing. You’ll need someone to drive you home though.”

  Gershwin found the calendar on his desk and pulled it toward him. “I presume you’ll want us to do this as quickly as possible.”

  No, I want this to just go away. Henry swallowed hard. The biopsy would make a likelihood a certainty. He’d no longer carry a diagnosis of suspected pancreatic cancer. It would be proven. Then what would it be? Surgery, chemotherapy, radiation, a gradual dwindling away until he eventually died? Or would he end his life on his own terms?

  He tried to put eagerness in his voice and failed. “Sure. The sooner the better.”

  “Do you think anyone suspects what’s going on?”

  “Not that I can tell. What have you accomplished so far?”

  “I’ve begun to close some of the open loopholes.”

  “Is that all you’re going to be doing?”

  “No. The false prescriptions have all been concentrated in one area of the city. That means just a few pharmacies. I’ll follow up on those as I can.”

  “You mean buy off the pharmacists?”

  “That or terminate them. You know. Make it look like a drug addict robbed them.”

  There was silence for a moment on the other end of the line. “What about patient charts?”

  “I think I know how to deal with that.”

  “Let me know if I can help.”

  “I will. Maybe we can get this taken care of without making too much of a mess.”

  “Or drawing too much attention.”

  7

  Caden sat at his desk on Wednesday afternoon. Across from him were the two agents, Neilson and Harwell. Neilson wore a suit, while Harwell wore a white lab coat over his dress shirt and tie. Caden could read the name embroidered on the breast pocket: Caden Taggart, MD. He wondered if Harwell had chosen that particular white coat because it fit him, or because it was his idea of rubbing it in. Maybe both.

  “You men have been working for a couple of days,” Caden said. “I know better than to ask what you’ve found, but can you at least tell me how much longer you plan to be in and out of my office?”

  “We should be through here in another day or two.” Neilson nodded at the other agent. “We need to discuss with each other what we’ve learned, fill in some blanks, and then we’ll be ready to bring this to an end.”

  “And when do I know what you’ve found?”

  “Sorry. We can’t talk about an ongoing investigation,” Neilson said.

  Caden took a deep breath, but it didn’t help. These men were holding his participation, at least the use of his name and number, over his head. Between what was going on with his father and not kn
owing what the agents were going to recommend, especially in view of the two anonymous messages he’d received about the DEA investigators, he was finding it difficult to keep his cool.

  “I think I’d better get a lawyer. Not because I’ve done anything wrong, but because I’ve heard enough stories of innocent people caught up in the wide net you folks spread.”

  “Look, Dr. Taggart—”

  “No, you look.” Caden’s vocal level was rising, but he didn’t care. “I’ve been nothing but cooperative, and all I get in return is silence. I think I’m going to protect my rights by engaging an attorney. I should have done it earlier, but that’s old history. I’m doing it now.” He stood up. “Until that time, I’m not going to talk further with you.”

  The agents looked at each other, nodded at Caden, and left his office.

  He pulled from his wallet the card with the cell number of Melvin Sewell. The attorney had said to give him a call if he could ever do anything for the doctor. Well, Caden had decided that he needed an attorney protecting his rights. He laid the card on his desk, pulled his phone toward him, and started dialing.

  It was late on Wednesday. Other than the security lights that remained on all night, only one other room in the suite of offices belonging to Doctors Henry Taggart and Claude Horner was lit. The illumination, such as it was, came from the desk lamp in Dr. Taggart’s office.

  Henry sat behind his desk, the door to his office closed, poring over the printed pages before him. Periodically, he paused to make a notation on the legal pad by his right elbow. He turned page after page of the thick documents, trying to decipher the language and translate it into understandable English. Mainly he wanted to see how it applied to his own situation.

  Suddenly, a tap on the door made Henry look up. Before there was time for him to react, it opened slowly to reveal his partner standing there. Claude had a questioning expression on his moon face. He was about the same age as Henry, but unlike his partner, who was tall and a bit lean, Claude Horner was short and chunky. His collar was loosened, and his tie hung at half-mast. His partially gray hair was swept back except for a few unruly strands that defied control.

  “Oh!” Claude said. “I wondered why the light was on.”

  Henry shoved all the papers into his top desk drawer. “I came back after my appointment . . . after I finished this afternoon. I wanted to go over some documents.” He stared at Claude. His words were benign, but the tone was a bit accusatory. “What are you doing here?”

  “I left my briefcase somewhere. It’s not in my office so I decided to look here.”

  Henry hadn’t heard anyone moving around, and no light shone in the hallway behind Claude. His partner’s story didn’t ring true, but he chose to ignore it. “I haven’t seen it, but I’ll keep an eye out for it.”

  The two men were silent for what seemed like an eternity. Finally, Claude gave a short nod. “Thanks. I’ll let myself out.” He started toward the door, then paused and turned back. “I don’t suppose you’re ready to tell me where you were this afternoon.”

  Henry shook his head. “Personal business. Right now, that’s all I want to say.”

  Claude nodded and left, closing the door behind him.

  Henry waited at his desk until he heard a car door slam, followed by the sound of a car starting and driving away. When he was satisfied that his partner had left, he opened the desk drawer, removed the papers, and resumed his study of them.

  He was looking for the answer to a question—one that would help determine the course of his life, and for that matter, the duration of it.

  Caden sat in his recliner in the living room of his home. The TV set was tuned to some sitcom, but he wasn’t paying a lot of attention to it. His mind was on his conversation with Mel Sewell earlier today. The lawyer hadn’t seemed to mind getting a call when he was about to leave his office, not even when he heard what Caden wanted.

  “Have the DEA agents told you what you can and can’t reveal about their investigation?” Sewell had asked.

  “Not really. I suppose it was just something I assumed.”

  “What have you done up to this point?”

  “I gave my staff and colleagues a cover story to explain the agents’ presence. Other than that, nothing.”

  “Did you think about engaging an attorney?”

  “When I asked initially if I needed a lawyer, the senior man didn’t really encourage me. He talked about ‘keeping it simple.’ But today I decided that maybe I’d better engage one.” Caden gave a half-chuckle, more apologetic than expressing mirth. “Can you give me a name?”

  “Sure. Mel Sewell. Experienced attorney with a great reputation. I’d trust him with my life.”

  “I didn’t call to trade on our history,” Caden said. “I just—”

  “Look. If you’re certain you’ve done nothing wrong, this will probably consist of no more than a conference, maybe a couple of phone calls. I’ll be glad to help you, if you’ll let me.”

  Caden thought about his bank balance—adequate but not unlimited. “What kind of retainer will you need?”

  “Mail me a check for a dollar. That establishes a lawyer-client relationship and makes everything we talk about privileged.”

  “That’s . . . that’s very kind of you.”

  “You essentially saved my father’s life and never sent a bill,” Sewell said. “I’m happy to help out. Now get that check to me, and then feel free to let the agents know that future conferences with you will have to include me.”

  Caden’s reverie was interrupted by Beth’s appearance in the doorway.

  “Penny for your thoughts.”

  He looked up, startled by her sudden appearance. “I . . . I was just watching this TV program.”

  Beth switched the TV off. “I doubt it. You probably couldn’t even tell me what the program was. What’s on your mind?”

  “I’m sort of ashamed that I let it go this long.” He related to her his last conversation with the DEA agents, and then his call to an attorney. “I don’t think I’m in any trouble, but I’ll feel better with someone protecting my interest through all this.”

  Before Beth could respond, the landline rang. Since she was still standing, she walked over and answered it. She spoke a few words, then handed the phone to Caden without comment.

  “Hello?”

  Henry’s voice was as calm as though he was relaying a weather report. “Son, I wanted to let you know that I’ll have the biopsy on Friday. I’ll call you when the pathology report comes back.”

  “Beth and I can be there—”

  “Jean is going to drive me. No need for you to come.”

  After a bit more conversation, Henry ended the call. Beth looked at him with eyebrows raised, and Caden told her what his dad had called about.

  “Do you want to be there?” she asked.

  “Yes, I’d like to be with my dad, but he said Jean would drive him to and from the procedure.”

  Beth nodded. “And you hate it that Jean is going to be with him and you won’t. Tell you what. Do you have the home number of your receptionist?”

  “Yes, both for Donna and Mona.”

  “Call one of them. If you can’t get in touch with either one, call Rose. Tell her something has come up and you need to be out tomorrow and maybe Friday.”

  “I can’t do that.”

  “You do it all the time when you have an emergency case. Do you have any surgery the next couple of days? Any consults to see?”

  Caden shook his head. “No.”

  “What about emergency calls?”

  “Jim Sparling would cover for me,” Caden said. “He’s always happy to get a few extra patients.”

  “So, you can be gone. I’ll phone Jean and let her know we’ll be there but ask her not to tell Henry. We can stay at a motel in Dallas. When it’s over, we’ll show up at his house. Trust me, he’ll be glad you’re there.”

  “But the DEA . . . ”

  “You said the agents weren
’t thrilled that you’re engaging an attorney. Let them stew while you’re gone.”

  “I—”

  “We’re going. Your father will fuss, but eventually he’ll be happy at your presence.”

  When Caden awoke on Thursday morning, it took him a minute to orient himself to unfamiliar surroundings. Then, little by little, he remembered—the drive yesterday evening; the burger, fries and malt consumed in the car; the problems finding the motel despite directions from his GPS. By the time they’d unpacked their necessities, he and Beth were ready to fall into bed. After that, his sleep was so deep it rivaled general anesthesia. Maybe that was why he was still sort of groggy.

  He squinted at the bedside clock and realized that he and Beth needed to get downstairs or they’d miss the buffet breakfast offered by the motel. He felt ravenous, and he wanted about a gallon of coffee to get started. He reached over to shake his wife awake but found her side of the bed empty.

  He got up and padded into the next room, grateful that Beth had made their reservation at this all-suites motel, so they’d have a bit more space. She was up and dressed, seated at the desk with their laptop computer open in front of her.

  “I guess I slept later than I intended,” he said. Then, noticing the cup in front of Beth, he said, “Have you already been downstairs?”

  She shook her head and pointed to the coffee maker in the tiny kitchenette area. “There’s another cupful in the pot on the counter. That should hold you while you get dressed.” Beth glanced at her watch. “If you don’t get bogged down, we’ll still make it to the breakfast area in time to eat here.”

  “And if we don’t, I vaguely recall passing a couple of fast food restaurants last night.” Caden poured the remaining coffee from the pot into a mug and took a long sip.

  “I’ll make another potful if you need it,” Beth said. “Now get going.”

  As Caden was about to start shaving, he heard his cell phone ringing. He started toward the bedroom to answer but stopped when he heard Beth pick it up. He could hear her voice, although he couldn’t discern the words. Well, whatever it was, she’d let him know.