Guarded Prognosis

by Richard L. Mabry MD

  Yes, as stubborn as his son . . . the one who still harbors a suspicion that Jean had a hand in his mother’s death.

  Caden wasn’t particularly anxious to get home on Wednesday evening and call his father, but he was ready for the day to be over. Unfortunately, as often happens in medicine (as in life), each time the end was in sight, something else came up. By the time he and Beth were finally ready to leave, the other two doctors, their nurses, and both receptionists had left.

  At last, he joined Beth at the front desk after she checked out the last patient of the day. He looked with satisfaction at the empty waiting room. “Well, we did it.”

  “You mean you did it.”

  “No, I mean we did it,” Caden responded. “I couldn’t do it without you. I’ll admit that I was disappointed when Rose said she had to leave and you insisted on stepping in, but you’ve done just fine as an office nurse.”

  “Thank you.”

  “And I think—”

  Caden stopped when a young man dressed in a T-shirt, shorts, and jogging shoes came through the door of the office. His clothing was different from what most people wore for a visit to the doctor, but that wasn’t the first thing Caden noticed. The man held a towel to his forehead, a towel that was gradually turning red. As Caden watched, drops of blood came through the cloth and fell on the waiting room carpet.

  “I . . . I’m sorry to come in here like this,” the man managed to say. “I was jogging, and I fell. When I tried to get up, I . . . I . . . ” He staggered and appeared about to lose his balance when Beth steered him toward one of the waiting room chairs.

  “Don’t worry about it,” Caden said. “We’ll get you taken care of.”

  “Can you walk back to the treatment room, or do you need a wheelchair?” Beth said.

  The patient started to shake his head but stopped when blood ran down his face from the movement. “Just help me. I can walk.”

  Caden and Beth steered the man to a treatment room, where he managed first to sit and then to lie on the examining table.

  “I’ll have a look at the laceration on your temple,” Caden said. “But first, let’s make certain it’s nothing more than that.” He pulled on gloves and ran his fingers over the head wound. “What happened?”

  “I stumbled while I was jogging in the next block. I started to fall, and I guess I hit the sidewalk, or maybe a rock.”

  “Were you knocked out?”

  “I was stunned, but I don’t think I lost consciousness.”

  “Where did you get the towel?” Beth asked.

  “I had it tucked into the waistband of my shorts to wipe away sweat.”

  “Are you hurt anywhere else?” Caden asked.

  “No. Just the cut on my head.” The man tried to sit up but evidently decided that wasn’t a good idea.

  After checking the head wound and covering it with a bandage, Caden examined the patient for other injuries. He concentrated on the neuro exam and was relieved by his findings. Finally, he straightened up from the exam table. “I think you’re okay. You were stunned when you hit your head and sustained a large cut on your temple.” He turned to Beth. “I’ll need an X-ray of his skull to rule out any fractures. Then I’ll put in some sutures on that wound.”

  “I’ll make sure the radiology facility down the hall is still open,” Beth said, and hurried from the room.

  It took a while, but eventually, Caden put the last of six sutures into the man’s head wound. Then Beth covered the laceration with a gauze bandage.

  “Do you understand the concussion warnings we went over?” Caden said.

  The patient nodded gently. “Wow, I didn’t think moving my head would cause the trip-hammer behind my eyes to start up.”

  “And you’ll need to see me or another doctor in about ten days for removal of those stitches. Do you have your own doctor?”

  “Yeah. We’re leaving town tomorrow, but I’ll follow up with him.” The man sat up slowly and made it this time. “I’ll call my wife to pick me up.” He reached for his hip pocket, then drew back an empty hand when he realized he was wearing running shorts. “May I use your phone? We’re at the motel just a few blocks away.”

  Beth directed him to the phone. When his call was over, the man said, “I’m sorry, but I don’t have any money or my insurance card or anything. I should have asked my wife to bring my wallet. Can I handle this later?”

  Caden opened his mouth, but Beth beat him to it. She was getting to be an expert in this sort of thing. “Certainly. Let me get your name and address, as well as that of your doctor.” She handed him a card with the office number on it. “The answering service will pick up any call to us tonight. Be certain to contact us if there’s any problem.”

  It was late before Caden and Beth locked the door of the suite and walked out. As he opened the car door for her, he said, “I hope it’s not too late to call Dad.”

  “Do you think you can put it off until tomorrow?”

  Caden waited until he had seated himself and fastened his seat belt before he answered. “I’d love to put it off indefinitely, but I don’t think I’d better. I just hope Dad will agree to see Dr. Markham about the surgery.” He started the car. “I don’t know how I’d get through doing his operation if he insists I do it.”

  That evening, Henry Taggart heard the “ding” of the microwave, but didn’t rush to get up from his seat at the kitchen table. His evening meal was heated, but he’d long since ceased to look forward to TV dinners. He ate because he had to, not because he wanted to.

  He had forgotten how unappetizing some of these “nuked” meals could be. They, and much of his loneliness, had gone away when Jean took on a larger role in his life than just an office nurse. But that changed when Nancy died. That was when Henry decided it was best to decline Jean’s offers to cook for him, either at her home or his. She suggested once they meet at a restaurant, but he declined. He had likewise refused to let her come over just to talk. It didn’t seem right any more.

  Of course, they still interacted at the office, but in their last conversation Jean had said something that he didn’t like to hear—from her or anyone. “Henry, you have some good years left, but only if you do something about it. You need to fight your cancer. Otherwise, it will kill you. You can’t let that happen.”

  Under normal circumstances, Henry might let his relationship with Jean move forward after an appropriate time passed. After all, they’d known each other for a few years, and they were both single now. There was nothing wrong with his eventually marrying again. And Nancy would approve of Jean. Of course, Caden might not, but that was a bridge to cross sometime in the future. Right now, Henry realized he couldn’t ask Jean to link her life to a man whose days were numbered.

  So, here he was—back to eating microwaved frozen dinners alone. Maybe after his surgery, perhaps after he’d started chemo, he might resume his relationship with Jean if his prognosis somehow improved—but not now.

  The microwave sounded again. Henry knew it would continue to do so until he finally opened the door and removed the TV dinner he was heating up. He’d always thought the second “ding” of the microwave was like someone saying, “Look, you were in a hurry, or you wouldn’t have put whatever it is in here. Now it’s ready. Come and get it, or I’ll keep reminding you until you do.”

  As he rose slowly from his chair and made his way to the microwave, he wondered if the same didn’t hold true of Jean’s repeated offers to walk beside him through the next phase of his treatment. At this point, she wasn’t offering to be his wife. She was offering to be what he needed most—a friend. He figured that eventually the microwave ding would stop . . . and so would Jean’s offers.

  Henry used a potholder to remove the food from the microwave and transfer it to the table. He took a fork from the drawer, grabbed a soft drink from the refrigerator, and sat down to eat. It was only then that he realized he didn’t know what he’d heated up. Oh, well. It didn’t matter.

  After Nanc
y’s death, after biopsy confirmation of his malignancy, he had given more thought to his relationship with God. He admitted in his heart that it had been tenuous for many years. He was trying to change that. Matter of fact, he’d made an appointment to talk with the pastor of the First Congregational Church. Maybe he’d even plan his own memorial service while he was at it.

  Whatever the reason, he’d started saying a brief grace before tackling the unappetizing food before him. His typical prayer was, “Thank you for this food. I’m grateful that I’m alive to eat it. Amen.” It wasn’t much, but he figured that God knew what was in his heart.

  He ate without thinking, almost mechanically. Then he cleaned the kitchen, although eating a microwaved meal directly from the package didn’t leave much for him to do. He rinsed his fork and glass, put them in the dishwasher, and he was done.

  Henry moved to his study, the room where he seemed to spend most of his time nowadays. As he settled into his recliner, the phone nearby, he tried to recall the quotation he’d read years ago, one attributed to a French military surgeon. It was something like, “I dressed the wounds. God healed the patient.” Perhaps he needed to adopt that attitude about his own treatment. He had a good team of doctors. But he had to admit there was something missing—and it was up to him to remedy that.

  Caden pushed back from the supper table. “I probably shouldn’t put it off any longer. I think I’d better call my dad.”

  “I know all I had time to put together was just sandwiches and chips, but I thought you’d eat more than that.” Beth started clearing the dishes from the table. “Is the call to your father bothering you that much?”

  “Yes. It shouldn’t, I suppose. I have no idea how my dad will react to my suggestion that the most experienced surgeon possible do his operation. I hope he’ll look at the positive aspect of this, and not argue with me when I say I shouldn’t be the one wielding the knife.”

  Beth eased into the chair next to Caden at the kitchen table and patted his hand. “You’re doing the right thing. I know you—you’re feeling guilty because you won’t be the one operating on your father, but you know how wrong that would be.”

  Caden’s expression reflected his mixed emotions. “I know.”

  “Tell him you’ll be with him in the pre-op area, you’ll be in the operating room, and yours will be one of the first faces he sees when he wakes up in the recovery room.”

  “And what am I supposed to do during the operation?”

  “You know what to do,” Beth said. “It’s the same thing I’ll be doing.”

  Caden took a deep breath, pulled out his cell phone, and speed-dialed his father. He could feel the perspiration begin to accumulate in his armpits, running down his side as the phone rang. “Dad, how are you?”

  “Hanging in there,” Henry said.

  “Today I talked again with Dr. Ross. He’s contacted Dr. Markham at the medical center, who has agreed to see you. If he thinks you have a surgically amenable lesion in your pancreas, he’ll do the operation.”

  “But—”

  He didn’t want to give his father the chance to argue, so Caden plowed ahead. “Dad, he’s the authority on this procedure. We could go anywhere in the country and not find anyone better qualified to do it. You know I shouldn’t be the one doing this operation. But I’ll be with you every step of the way—pre-op, surgery, recovery room. I won’t leave your side.”

  In the silence that followed, Caden could hear his father breathing into the phone, so the connection was still open. Please let him say yes.

  “I’ve been thinking about that,” his dad said. That was followed by several seconds of silence. Finally, the answer Caden had been hoping for came. “You’re probably right. I’ll call and set up the appointment with him. I suppose he’ll want to see the studies we’ve done so far, so I’ll talk with his secretary about getting those.”

  The relief Caden felt lasted for only a few seconds. He wasn’t going to be the surgeon performing his father’s operation, but his role as a son was far from over. There was still a lot more to come.

  20

  On Saturday morning, Henry Taggart sipped coffee from a thick mug and let his mind run free. He was sitting in his favorite chair in the room Nancy used to call his “study.” He guessed that’s what it was, although lately it had been given over more to contemplation than to reading. He hadn’t opened the journals and medical textbooks on the shelves behind him since he’d first been told he most likely had carcinoma of the pancreas.

  He hadn’t consulted a textbook or journal because there was no need for him to reconfirm what he’d known since his days in training. Oh, modern techniques had led to earlier diagnosis and better treatment, but the outlook was still dismal for patients. Such a diagnosis usually meant the patient had anywhere from a few months to, at best, a few years to live. Of course, there were exceptions, but they were rare. Doctors know that five-year survival statistics are a good indicator for longevity after treatment. But some patients believe they’ll be on the far end of the bell curve—the end that beats the odds. Henry was more pessimistic. Or perhaps he was simply realistic.

  When he’d called Dr. Markham’s office at the medical center yesterday, the woman who answered the phone had been both helpful and considerate. She’d walked him through everything necessary to set up his appointment for Monday.

  So now all he had to do was wait. That should have been easy, but he was finding it the hardest part of the process. Should he call Caden? No, he wanted to wait until his visit with Dr. Markham. There’d be plenty of time after that to talk with his son.

  As he sat there, ignoring the coffee cooling in the mug he held, Henry realized that, although he was used to overseeing whatever situation occurred, in this case he wasn’t. He wasn’t Dr. Taggart, the surgeon, the doctor in charge. He was just plain Henry Taggart. He had cancer—a really bad form of cancer. And he was frightened.

  Why had he pushed Jean aside when this was when he needed her most? He wasn’t sure why. The reasons that seemed so valid recently didn’t seem to hold water, not right now.

  He wondered why she’d been so ready to walk beside him each step of the way to his diagnosis. Was it for his companionship? Henry realized he could be short-tempered, although he’d tried to change that. Did she want to marry him . . . perhaps for the status it would provide, for the money that would be hers? No, there was no way he could believe she had that ulterior motive.

  He shook his head as though there was someone in the room with him. Jean would never do that. He thought the woman had feelings for him, and just wanted to help—if in no other way, then by the simple gift of her presence in his life. And he was sorry he’d stopped accepting the gift.

  The bottom line was that Henry Taggart was alone and frightened. He pulled out his phone, dialed a familiar number, and when the call was answered, said, “Jean? This is Henry. Can we talk?”

  “Certainly.”

  She wasn’t going to make this easy. Then again, he’d rebuffed her and probably hurt her the last time they’d talked. Their conversations at work had been professional but cool. He knew he needed to fix that. And he should do it face to face.

  “Could you come over . . . please?”

  Beth watched as Caden put down his phone, a disgusted look on his face. “No answer.”

  She shoved aside the knitting she was trying without much success to learn and turned in her chair toward her husband. “And that’s the only number you have for Agent Neilson?”

  Caden took a seat beside her on the living room sofa. “As I understand it, that’s his cell phone number. But he’s not answering.”

  “What else can you do?”

  “I could do what my attorney did when I first consulted him. I could call the Seattle DEA office, but I doubt I’d get an answer on Saturday. I guess I could go looking for him, but I don’t even know where Neilson and Harwell are staying. I’m stumped.”

  Beth took Caden’s hand and patted it. “Are g
oing through with what you threatened when Neilson called earlier in the week? Do you plan to tell the staff what the two men were actually doing in the office?”

  “That threat sounded good when I made it to Neilson, but I’ve thought about it since then. If I let the staff know the DEA agents are investigating, whoever’s responsible could just stop.” He slowly shook his head. “I want this thing to be over because the people behind it have been arrested, not that they’ve just decided to quit for a while.”

  “I’m glad you got the local police involved. Maybe Detective Caruso can roll up this ring,” Beth said. “Either with the DEA agents, or working on his own.”

  “I’m kicking myself for being so scared when the two men showed up at my office. I should never have cooperated with them without thinking about it. If I’d simply called their home office . . . If I’d consulted Mel Sewell . . . If, if, if.”

  “Stop worrying about it,” she said. “This is all going to work out. Just be careful and trust in God. He has your back in all this.”

  “I’m glad someone does.” He didn’t say more, because at that moment his phone rang. “Maybe that’s Neilson or Caruso.”

  From what she could hear of the conversation, Beth didn’t think that was the case.

  “I’ll be right there,” Caden said. He stood. “Ann has an emergency case at the hospital and needs my help in surgery. If I’m through by lunchtime, maybe we can finish that picnic lunch that was interrupted the other day.”

  As the patient was wheeled out of the operating room at a quarter to twelve, Caden snapped off his surgeon’s gloves and flipped them into the waste container. His disposable mask and head covering went next. Then he stretched, trying without much success to relieve the tension built up in muscles that were tight after three hours spent at the operating table.

  The incident that made the operation necessary started with heated words between the patient, Elvis Johnson, and another man inside a questionable club that should have been closed by that hour. The dispute eventually moved to the parking lot outside, where it ended with three gunshots to the abdomen of the unfortunate Elvis.