Knife Music

by David Carnoy

  When he examined women, he always had a female nurse or resident present at the examination. It was to protect him as well as the patient, because if anything went down—if the patient had a complaint—there was another woman there to act as a witness. In the three years Cogan had been at Parkview, two doctors had lost their jobs for allegedly doing inappropriate exams.

  “I know you took some pain meds yesterday,” he said to Greer without examining her. “Did you take anything today?”

  “I took one pill last night. But other than my breasts, I feel fine. I got all three balls dancing.”

  “Really? Lemme see that.”

  She picked up the device and inhaled deeply.

  “Wow,” he said. “There’s a woman down the hall who can barely get half of the first one.”

  “Well, when you first gave it to me, I thought you must be crazy.”

  “Very good. I’ll be back.”

  His last patient was in the worst shape of the three and the youngest at thirty-six. She was El Salvadorian and had three children, and Cogan felt bad for her because she was going to “box.” That was slang that meant she was going to die, and although he hadn’t liked the phrase when he’d first heard it, over the years he’d found that it had become an integral part of his vocabulary, so much so that he rarely used the d-word anymore.

  The woman had breast and lung cancer. They hadn’t caught either very early, and now they were carving her up in an attempt to save her. She’d had both breasts and an entire lung removed. She was now weighed only eighty-five pounds. If she were fifteen years older, Cogan wouldn’t have operated on her, but she was thirty-six and she had three kids and he wanted to try everything he could, even though he’d had to argue with administrators to get the OK. But now things had taken a turn for the worse. She had a lump on her shoulder that he was worried was a metastasis. He’d done the lung operation three weeks ago. Now the cancer was spreading. She was going to box.

  “Hi, Mrs. Dominguez. How are you doing this morning?”

  Mrs. Dominguez didn’t say anything. She just made a face and gave a little shrug of her shoulders. Cogan wasn’t sure whether she understood what he’d said or just didn’t want to talk to him. Her English wasn’t good, so he always brought along an interpreter. There were a couple of nurses on the floor who spoke Spanish, and he would ask one of them to accompany him when he went to see Mrs. Dominguez.

  “Ask her how her pain is,” he said to the nurse, Claudia, who was standing next to him. “Is she in pain?”

  Claudia translated what he said and Mrs. Dominguez immediately became more animated. She spoke quickly, rattling off an answer.

  “She says she has trouble breathing. She has pain in her chest. In her arms. In her back.”

  “Ask if she took anything this morning.”

  “She took a pill about half an hour ago.”

  “Did it help?”

  “A little, she says.”

  “OK. Well, tell her I don’t want her to be afraid to say anything if she’s in pain. She should ask one of the nurses to come find me and I’ll up the dosage. OK?”

  “OK,” Mrs. Dominguez said after she heard the translation.

  “Tell her I just want to examine the lump on her shoulder.”

  After Mrs. Dominguez nodded her consent, Cogan slid her pajama down her arm and pressed down lightly on the lump, which was just a little smaller than a golf ball. It felt spongy.

  “I want you to tell her that I have to do some tests on that. I’m not going to do them now because I want her to rest. But this afternoon I’ll come and do a test.”

  Claudia translated what he said.

  “She wants to know if you are going to do another operation on her.”

  “Hopefully, we won’t have to do a biopsy,” he said to the nurse. “I’m just going to stick a needle in there and see what comes back. Hopefully, the lab will be able to tell just from the fluid. Don’t translate it like that. But tell her something along those lines.”

  Whatever she said was good, because Mrs. Dominguez seemed relieved.

  “Thanks, Claudia,” he said to the nurse. Then to Mrs. Dominguez: “You hang in there, OK?”

  Claudia translated what he said.

  “OK,” Mrs. Dominguez said.

  “I’ll be back this afternoon.”

  Whenever he met with patients who were in the advanced stages of cancer, he thought of Dr. Liu, an oncologist at the hospital who was known for his brutal honesty. Liu was Chinese, and although he spoke English well, he spoke with a harsh Chinese accent, which only seemed to add to the brutality of his medical analysis.

  For instance, a patient who had lung cancer that had reappeared after a brief remission would ask with trepidation how things looked, and Liu, ever so bluntly, would respond: “You have lung cancer. You are going to die.” Just like that. No sugar-coating. No posturing.

  Many left his office in tears, wondering how their doctors could have sent them to Dr. Liu. But remarkably, a few weren’t angry. A few said thank you. They liked him because he was very up-front and knowledgeable about his field. He knew the literature. He knew his patients. He followed them very closely. And they appreciated it.

  You have cancer. You are going to die.

  Thank you for telling me. Thank you very much.

  Cogan couldn’t do it. Even if some people appreciated it. He couldn’t shut the door like that, slam it in their faces. He always left it open a crack.

  “If it was me,” his ex-wife had once argued, “I’d want to know I was going to die. And I wouldn’t want to waste my time or money on awful treatments that weren’t going to work.”

  “Easy for a healthy person to say,” he replied. But these people were desperate. Desperate to cling to any hope. And to extinguish that was cruel. “I tell them the truth,” he said. “With certain types of cancer, I tell them there’s little chance the treatment will work. But they don’t want to hear it. They say, there must be something you can do. And the truth is, there’s always something you can do. That is the cruelty of modern medicine.”

  “No,” she said. “It’s you who doesn’t want to hear it, Ted. It’s your denial. You know what’s right but you let people convince you otherwise.”

  “Maybe,” he said. “But it doesn’t matter. The result is the same.”

  “Someday it might not be.”

  “Yeah, someday I’ll be the one doing the dying.”

  “I didn’t mean that.”

  “I know,” he said. “I know what you meant.”

  10/ SHADES OF RED

  April 1, 2007—12:05 p.m.

  CARRIE PINKLOW LEADS THE WAY OUT TO THE BACKYARD, TO A glass-topped metal table that’s shaded by an umbrella. The house isn’t as big as the Kroiters’, but it’s still nice, and looks like it’s been renovated in recent years, with an extra room added behind the garage. Her parents are recently divorced, Carrie explains, and while she spends most of her time here, she does occasionally stay with her father, who’s “temporarily” living in a two-bedroom apartment in Los Altos.

  After they’re seated, Madden takes out a small notepad from the inside pocket of his sports jacket and opens it in front of him on the table next to his coffee mug. Then he takes out a microcassette recorder and sets it on the table between them.

  “Did you get shot?” she asks.

  “Excuse me?”

  “Your leg. Did you get shot?”

  “Oh, no. I had polio as a boy,” he explains. “Do you know what that is?”

  She makes a face like, Please, give me a break, I’m not an idiot. Then she says, “Roosevelt had it.”

  “Yes, that’s right.”

  “You don’t look that old. I thought they had a vaccine.”

  “I’m fifty-eight,” he says. “I was one of the last reported cases.”

  “I’m sorry,” she says, suddenly expressing heartfelt concern. “That’s too bad.”

  “If you don’t mind, I’d like to record you, Carri
e. I don’t like to miss anything. Is that OK with you?”

  “OK. But if I start to break down or anything, you have to promise to turn it off. I’ve been crying all morning. I still can’t believe it.”

  “Fair enough.”

  Madden looks at her. She’s pretty but in a much different way than her friend. It’s all up-front, there’s nothing beneath the surface. She has dark straight hair, a nice complexion, a small nose, and bright blue eyes. But she’s short and a little on the thick side—one of those girls whose bone structure will never allow them to be truly thin. Like her mother, who he met on the way in, she has a chest, and from the cut of her tight v-neck T-shirt, she’s not afraid to make sure everybody knows it.

  In her diary, in her less complimentary moments, Kristen had used such nouns as “flirt,” “drama-queen,” and “big-mouth,” to describe her best friend. And although his reading may have colored his initial impressions of Carrie, nothing indicates that Kristen was too far off in her assessments. Yes, Carrie’s eyes look a little puffy from crying, but she’s also taken the time to apply a healthy dose of make-up, along with a shade of lipstick that he considers unnecessarily red for this type of interview. Even if she does seem prepared for the likelihood that in the days ahead she’s going to be at the center of a public drama, she is nervous. Her jaw is working hard on a wad of chewing gum, and he’s noticed her picking at the cuticles on her fingers.

  “She called you a few times yesterday on her cell phone,” he says.

  “Yeah, I spoke to her. And we IM’d back and forth a little.”

  “And how did she sound?”

  “She was pretty upset, I guess.”

  “You guess?”

  “Well, yeah. She wasn’t a happy camper. She said the police were coming over to interview her and she’d been trying to reach Dr. Cogan to warn him.”

  “Did she reach him?”

  “She said she spoke to him for, like, thirty seconds and he brushed her off as soon as he heard her voice. He told her he couldn’t speak to her and to please stop calling him. He wasn’t trying to be mean, he said, but he couldn’t talk to her. Then he hung up.”

  “And that was what upset her?”

  “Well, more like the combination of everything. With the police coming, she knew he was going to get in trouble, that he might lose his job. But at the same time she was angry at him for not listening—and her father, too.”

  You should have listened, Madden thinks. You all should have listened.

  “She said she couldn’t deal with it,” Carrie goes on. “She didn’t know what she was going to do. I mean, this had been going on for a couple of days—ever since her parents found her diary.”

  “But she didn’t mention anything about wanting to kill herself.”

  The girl falls silent. She stops chewing her gum and looks down at the table, fidgeting in her seat.

  “Carrie, did she say something?” he urges.

  “She might have.”

  “What did she say?”

  “Well, it wasn’t like she said she was going to kill herself, but she just made some comments.”

  She looks away again, tears welling up in her eyes. Then she covers her mouth with her hand and her expression becomes that of someone who’s truly distraught.

  “I have . . . this friend,” she says.

  Madden waits patiently for her to collect herself.

  “I have this friend,” she starts again. “Her older sister was living back east. In New York. When the whole 9/11 thing happened.”

  Madden looks at her, raising an eyebrow.

  “Yeah.”

  “Well, the older sister knew this guy. He called her that morning and said, ‘You won’t believe this, but this plane just hit the tower next to me. It just plowed right into the building.’”

  He nods, hoping the detour would lead back to the main road.

  “The thing is,” she says, “they ended up chatting on the phone for like almost a half an hour. I mean, they were just kind of joking around like they normally would, and he told her to turn on the TV and stuff.”

  “And she didn’t encourage him to get out,” he says, guessing the end.

  “Yeah. And he ended up dying. And the thing was, all his friends and her family blamed her for it. I was just a kid then, but I always remembered that. And how it really messed her up. She was never the same.”

  At the Kroiter home yesterday, he didn’t have any tissues with him. But this time he’s stocked. He peels one off the travel Kleenex pack he has in his coat pocket and hands it to her.

  “Thanks,” she says, and dabs her eyes.

  “I’m not here to blame anyone, Carrie. I’m only trying to piece together what happened.”

  “I know.”

  She puts the Kleenex to her nose and blows. He waits for her to continue. After a moment, she says: “She was talking about how she’d been watching An Officer and a Gentleman. You know, that old movie with Richard Gere in it. Have you seen it?”

  “I think so,” Madden says, not sure he had.

  “Well, it was like one of her favorite movies. And there’s a scene toward the end where Mayo—the guy Richard Gere plays—there’s this scene where Mayo’s friend Sid kills himself because his fiancée rejects him. You know, it’s very tragic, and we always cried when we watched it. Every time. And she was just talking about how she understood how he felt and why he’d do it. She never had before, but now she did.”

  A little astonished, Madden looks at her.

  “How did Sid kill himself?” he asks.

  “He hung himself in the shower.”

  Again, his eyes blink involuntarily. They can’t hide the impact of her response.

  “Why?” Carrie asks. “Is that how she did it?”

  “Your mother didn’t tell you.”

  “No.” Her voice fills with panic. “Is that how? Is it?”

  He nods.

  “Turn it off,” she says. “The tape. Please, turn it off.”

  11/ THE COUNTDOWN

  November 10, 2006—7:30 a.m.

  AFTER HE WAS FINISHED WITH ROUNDS, COGAN WENT DOWNSTAIRS to the cafeteria for breakfast. He took oatmeal, two bananas, a yogurt, and orange juice, then carried his tray slowly out into the middle of the dining room, looking for someone to sit with. He saw Kim with a couple of other residents, then, further on, Bob Klein, a vascular surgeon, sitting alone reading the San Jose Mercury News. Klein saw him coming and waved him over.

  “Rough night?” he asked, setting the newspaper aside.

  “One MVA,” Cogan said. “Sixteen-year-old. Drove Daddy’s car into a telephone pole. Broke a couple of ribs, ruptured her spleen.”

  “White or black?”

  “White girl.”

  “Heard you had a run-in with Beckler.”

  News traveled fast. No doubt thanks to Rosenbaum.

  “Just gave her a little friendly advice.”

  “I’m sure.”

  A Jew with an all-American face, Klein looked ten years older than he should have. He was two years younger than Cogan but his hair was a shade grayer, and he had a permanent stressed look in his eyes. Cynical and self-deprecating, he’d once said, “I’m just one of those people who needs eight hours of sleep every night but who was stupid enough to pick a profession where that’s impossible.” For Klein, everything seemed to revolve around sleep and the conspiracy to deprive him of it. Everyone was a suspect, even—and especially—his family.

  Klein yawned. “My wife and kid are killing me,” he said bluntly. “I’ve got this presentation this afternoon. So last night, I say to Trish, since I put Sam down the night before, and I have some computer work to do, she should put him down. So she tries to put him down for a few minutes and then he starts screaming, ‘Daddy, I want Daddy,’ and she comes back and says, ‘Bob, he wants you.’ So I get up, and I go in, and she says, ‘Oh, just put him down, it’ll take a few seconds.’ So I’m sitting in the bed with him and I’m reading Ninja Turtle b
ooks. Half an hour later, he’s still knocking around the bed, so I walk into our bedroom and ask Trish, ‘Did the babysitter give him a nap or something?’ But she doesn’t answer. She’s lying there, snoring, out cold.”

  “That’s what babysitters do, because a nap is good for them,” Cogan said. “The kid sleeps and they just kick back for a while. But the kid’s wired later and you’re screwed.”

  “Exactly. But going back to the bed and laying down with him,” Klein went on, determined to give a full report of his suffering. “Now it’s eleven o’clock and he’s still wired. Every time he’d try to get out of the bed, I’d say, ‘Sam, if you get up out of this bed, Daddy’s gonna lock you in this room.’”

  “You gotta hammer them a little harder than that. Maybe he’s a little young, but Christmas is always a good thing. You guys celebrate Christmas or Hanukkah? I forget.”

  Klein’s wife, Trish, wasn’t Jewish.

  “Hanukkah.”

  “All right. So you say, ‘If you come into Mommy and Daddy’s room one more time, you lose a day. No present on the fifth day.’ Hammer him with that. That usually does the trick.”

  Klein nodded, impressed. “Since when did you become Mr. Child Psychologist?”

  “Remember Jane, the school teacher with the kid?”

  Klein mulled the name over. “Jane . . . Jane . . . dark hair? Big chest?”

  “Bingo.”

  “I think I need one of those. But without the kid.”

  “No, what you need, my friend, is the countdown.”

  “Countdown to what?”

  “To a better life. This is what you do: Next time you’re participating in the whole sexual-act thing with Trish—and I know it happens every once in a while—when you’re on the home stretch, you say, ‘I’m going to count to ten, and when I get to zero, I’m going to come.’ They love it. Drives ’em crazy.”