But the barred window of our little doctors’ office did not face the new structure. It looked backward onto the parking lot, with the ambulances coming and going, and even farther back toward the forest, where patients still went to smoke, drink, and have unprotected sex. And I continued to admit the remarkable patients we still welcomed. There were many such patients that year. But Radka is the one I want to tell you about.
Radka Semonovna was a beautiful woman.
I saw it at a glance the first time I met her, despite the dark circles under her eyes, her pale skin, and her bald head. And when I met her daughter, well, I knew for sure. Right off the plane from Bulgaria, she walked past the open door of our office, and I stopped talking. She was tallish and slimish, with dark hair cut short, thick eyelashes that cast a shadow on her cheek, a straight nose, and a finely drawn, full mouth. It was a beautiful face, an open face, and a puzzled face, I realized, as we talked an hour later at her mother’s bedside, and she tried to understand what was wrong.
She knew that her mother had had cancer for the last two years and was now dying. But as I talked, and she concentrated on understanding my English, I could see that it wasn’t easy for her; her thick-lashed brown eyes followed my lips, and a crease appeared in her brow. Radka also listened to me closely. Then she translated for her daughter what I’d said. She spoke Bulgarian, which I’d never heard before—sensual syllables that moved the inside of her mouth in all directions, front to back and side to side, and had a cadence like Russian.
“I know, doctor,” Radka told me between breaths. “The cancer has spread to my lungs, and it is in my bones and my spinal cord. That is what I told my daughter.”
Then Radka looked up at me from the bed, having stated the facts, and I sat down on it. I had her daughter sit down in one of our few remaining Naugahyde chairs. She took off her leather jacket and put it on the back of the chair.
“I’m going to give you antibiotics, as well as more chemotherapy,” I explained, “because there may be some infection behind or inside the cancers in the lungs; and although the antibiotics won’t kill the cancer, they will kill the infections, and you will breathe better.”
“Okay, doctor, thank you,” Radka said.
Radka’s daughter still looked puzzled, but didn’t ask any questions. She said, simply, “Thank you, doctor, thank you,” in a tone of voice that doctors don’t hear that often anymore, ever since we became health-care providers. Then I left them together, quietly speaking Bulgarian.
Originally Radka had not been my patient; she’d been Dr. Chang’s.
Dr. Chang was the other of the two new health-care providers on the admitting ward, along with Dr. Rajif, and she did them credit. She was pleasant, reliable, and well trained. She came in on time, stayed all day, and worked hard. She seemed to like her health-care consumers well enough; and her workups were almost as elegant as Dr. Rachman’s long ago. Although she did prefer a computer, she also wrote her workups longhand; and they were neatly scripted and intelligent. Reading them, I had no idea that, as Dr. Chang confessed to me one slow day, she did not know how to fully examine a patient.
“They don’t teach us any longer. There’s too much else for us to learn.”
Radka started out as Dr. Chang’s patient: The County Hospital sent her over to die and, in the meantime, to have chemotherapy. She’d been in excellent health until two years before, when cervical cancer was diagnosed. She had surgery and chemotherapy and felt well, but then, on a trip to meet her son and daughter in Yugoslavia (she was not allowed back in Bulgaria), she’d become short of breath. The doctors in Yugoslavia took X-rays and told her the cancer was now in her lungs, so she came back to the city and went to the County Hospital for a workup.
The news had not been good. The cancer was now in her lungs, bones, and spinal cord. The doctors at the County recommended additional chemotherapy and, since she lived with roommates, worked as a house cleaner, and her family was in Bulgaria, they sent her to us. Dr. Chang admitted her and scheduled the first round of her new chemotherapy, but the next day was Dr. Chang’s day off. I was taking care of her patients, and that was when I met Radka and her daughter. The new chemotherapy made Radka’s heart race, however, and so that very day she was readmitted to the County Hospital for monitoring. And when she returned, she became my patient.
Radka and her daughter were my first and so far only encounter with Bulgarians.
Bulgaria, Radka explained to me one day, was a very old country on the Black Sea. It was settled by slim, dark people but invaded regularly by Greeks, Turks, and Russians. The invaders were met quietly; they came, they saw, they conquered, and eventually they went home. Except for the Germans. The Bulgarians did not like the Germans, Radka said, and the Germans did not make out well in World War II Bulgaria. They did invade and conquer it; the king did shake hands with them; and the parliament did agree to enact certain new laws. But non-Jews as well as Jews showed up on the streets wearing yellow stars; broken windows in Jewish shops were somehow mended; and anti-Semitic graffiti was painted over by someone. Neither the Jews nor the Gypsies were transported from Bulgaria to concentration camps, and eventually the Germans, too, went home.
But the Russians must have been different, judging by the freezing of Radka’s beautiful face when I asked her why she didn’t go back for a visit. I knew that she’d been in America for several years; that, in spite of her PhD in economics, she cleaned houses for a living. She didn’t answer.
“Political problems?”
She moved her head—just a little jerk—yes. Nothing more.
I tried to fill in what she was not saying. The nineteen seventies—printing clandestine newspapers on mimeograph machines late at night, passing them hand to hand on the streets? Or the eighties—an essay written on the efficient economy of private business, followed by reprimand, transfer, job loss? Or the nineties—Radka’s husband, now in South America, an unpopular politician? Or a tax evader, a businessman who didn’t pay the right bribes?
She never told me.
The nurses ended up liking Radka as much as I did, and when she returned from the County Hospital after one of her relapses, they gave her a quieter bed in the corner of the ward. The corner bed was a prime bed if you were a person who needed silence and privacy, who loved Mozart and The Wall Street Journal, which you read with serious, black-framed glasses. In the corner, you only had one roommate, not counting the patient across the aisle. True, the telephone on the ward was also in the corner, which meant that people stopped on the other side of your curtain to answer it and to talk. Still, it was a prized place, and Radka knew it and was grateful for the move.
Soon there were flowers on the windowsill by her bed, and herbal remedies and vitamins in her bureau, and though her sleep was broken by the sounds of other patients, when we finally had a truly prized bed for her, a single bed in a private room, Radka was wary. That was when I began to see, behind her face, some long-ago shock, some long-ago decision.
“It sounds very nice, thank you,” she told me when I spoke of this new room she could move to. “But what happens if you need the room for someone else? Will I come back to my corner bed?”
She was right; she was exactly right; it was a politically astute and systemically wise question. But it was a question that no native-born American would have thought to ask or ever did ask. In America we know, for the most part, and especially in a public hospital, that the race is not to the swift nor the battle to the strong nor riches to men of understanding, but time and chance happens to them all. In order of arrival. And that once time and chance have awarded you your room, it’s yours and cannot be taken back.
But Radka was more careful, strategic, and stoic than a native-born American. She declined the private room and suffered in silence her nights of broken sleep. A few weeks and several occupants later, however, the private room was free again, and this time I pushed her in the direction of health and sleep, if not eternal security.
“
I think, Radka, you should move into the private room. You need the sleep. I can’t promise, but we’ll do our best to make sure you keep the room.”
Silence.
There was some worry she wasn’t telling.
Then I understood.
“You know,” I explained, “this is a public hospital; it’s run by the city for the poor. In my mind I call it God’s Hotel because that’s what we used to call hospitals for the poor, and what they’re still called in France.”
Radka nodded.
“It’s old-fashioned; it’s funky; it’s not fancy—but it’s free.”
“You mean, doctor, that the private room doesn’t cost more than this bed?”
“No,” I told her. “It’s all the same. Laguna Honda is a hospital for those who have nothing. We have some private rooms, some double rooms, lots of ward rooms, but all the beds cost the same—nothing.”
Radka got even quieter than usual.
“America,” she said. “America is a wonderful country.”
And by that she meant a generous country, a rich country of generosity, in the true sense of the word generosus—noble.
America, especially these days, in its role as everyone’s younger sibling, focuses on its faults. Like the Puritans, its stone-faced founders, America is sternly self-unforgiving. We see only what we do not do, have not accomplished, have done badly or even wrongly. And seen from the perfect eyes of the perfect God, this vision of ourselves may be just and accurate, but seen from Radka’s eyes, America is almost unbelievable. Hunted by her own country for some right or wrong that she did; stoically, with tight lips and quiet mind, cleaning houses, with little hope of ever going home …. Why should America take account of her? And yet it does. Freely and with goodwill. America keeps Radka warm in the winter and cool in the summer, gives her food, treats her cancer, and surrounds her with kindness, if not luxury. And asks for nothing back, not even gratitude.
America is a wonderful country. We should be proud.
Not long after that, we found Radka an even better room, in doomed Clarendon Hall, across the filled-in valley. There she would have only three roommates, and even better, she would have Dr. Lydia, who spoke Russian, as her doctor. Radka was sad to leave the admitting ward, and I was sad to see her go, but it was for the best. I would visit her now and then, and her daughter could call on me, if she needed. So she went.
Radka’s turned out to be a long Calvary, as so many deaths by cancer are. She wasn’t ready to die. She wanted to see her son pass his boards, finish his internship; she wanted to make sure her daughter stayed safe; and she took the chemotherapy, which, at first diagnosis, she thought about not taking at all. She took the carboplatin, which made her beautiful hair fall out and her fingers go numb; then she took the Taxol, which made her heart race nigh unto death. And when those failed, Dr. Lydia found her something else to take, and she took that, too. She didn’t complain, but she wasn’t ready to die, to leave, to shove off for that next unknown continent. Eventually, though, there wasn’t anything else for her to take, and she sent her daughter over to find me.
Her daughter was as beautiful as ever, except for the new line between her brows, her sadness, her helplessness, and her resignation. Would I come over to Clarendon to see her mother, who was not doing well?
Now, Dr. Lydia was an old doctor, old and old-fashioned, and stood up, I knew, for the old protocols of politeness. So I telephoned to ask if it was all right for me to visit.
It would be helpful, Dr. Lydia told me. Radka was withdrawn, and the psychiatrist thought she was depressed, but she wouldn’t take anything for her depression. Perhaps I could convince her. It was sad, so sad, Dr. Lydia said, such a sad case.
I walked over with Radka’s daughter to Clarendon. Down around the worksite of the new building, then through the doors of the old Edwardian. We went up the stairs, down the hall, and into Radka’s four-bed room. She had the corner bed nearest the door, and when I came in, she was lying down, so flat and thin that she disappeared into the covers. But there were herbs by the bed, a radio, books, and her black-framed glasses. Her hair had grown back and was thick, curly, and gray.
But she was very sick. It was a struggle for her to move, talk, or even breathe; and she wasn’t coughing because it took too much energy. She seemed dim, her flame of life low and flickering, dying down; her lamp running out of fuel, just as the medieval metaphor had it. She was suffering mentally and physically, with her usual silent but oh-so-expressive stoicism.
Then I left the room to go to the nursing station and look at Radka’s chart. Dr. Lydia was old, but she was good—thorough, careful, and kind—and there was the report of the lung scan showing even bigger cancers; there was the report of the oncologist, who did have one more medication to try, although she wasn’t optimistic. There was the report of the psychiatrist, who recommended an antidepressant; and there were her lab reports, documenting the ebbing of her life force as so many fewer milliliters of blood and bone.
Then I went back to Radka’s room, which, except for her, was empty of other patients. It faced north, and natural light must never have quite hit her corner.
Her daughter stood up. “I have to go to work now …. Thank you, doctor.” She looked at me. Her beautiful light had dimmed, too. Her face was tired and tense and sad. But she was cleaning Radka’s houses, and so she left.
There was just us.
I sat down in the chair by the bed. Radka sat up, leaning against the pillows at the wall. She queried me with a look.
“It’s not great,” I said. “But there is something else to try. It will help.”
She nodded.
“Also, the psychiatrist wants you to take some pills to help you feel better, more lively.”
“Yes, he told me. Should I?”
“I think so. They don’t have many side effects, and after a few weeks, you’ll feel better, stronger, more able to deal with—all this. How’s your son? Is he coming to see you?”
She brightened. “He can’t come. He’s studying for his boards. But we talk on the phone every week. Maybe in the summer if he can get … you know … permission … a visa.”
She stopped talking to breathe, and we sat together for a while. She leaned forward. “Would you like to see some pictures … of Bulgaria?” She looked at me, and I nodded. “There, in the top drawer …Would you get them, please?”
I opened the top drawer. There wasn’t much in it, but there was an envelope, and it had the pictures. I moved my chair so I was sitting right next to Radka, and she took out the yellowed black-and-white photos, with their creased, shiny surfaces. She looked at the first one, then handed it to me.
“This is my house in Bulgaria.”
I took it. We were out in the country; there was a big, one-story wooden house, and the photo was taken from across a garden looking toward the house. The garden was not like my garden—small with some roses, dahlias, and vegetables. This garden was cultivated; it was serious; and it had a purpose. It was probably an acre of leeks and staked beans, cabbages, squash, tomatoes, and potatoes, orderly, in many rows.
Radka watched me look at the photo.
“We had many things but no money,” she said.
She handed me the next photo. Vivid and smiling, with a shock of dark brown curls, standing next to the house was … Radka. Next to her was a large, laughing man. Sleeves rolled up; black hair; black, thick mustache.
“Me. My husband. I was strong.”
“When was this taken?”
“Five years ago.”
I could imagine the two of them, living a not-so-easy but well-populated life. Other intellectuals visiting; dinner outside in the summer darkness, with candles, fireflies, crickets.
“Our house wasn’t far from the city, just an hour or so. We went out for the weekends and the summers.”
Card games; working in the garden; frustration with the System; anger, a decision, repercussions, flight to another continent.
I look
ed at the other photos, different views of the house and the garden, then I handed them back.
“Thank you.” I stood up. Despite, or perhaps because of, her vulnerability, Radka was not a person to hug. “I’ll speak to Dr. Lydia,” I told her.
“And my daughter?”
“Yes.”
I didn’t see Radka again. A few months later, her daughter came over to the admitting ward to tell me that Radka had decided to go to Dr. Kay’s hospice unit; her son had graduated and passed his boards. After that she died very quickly. Her daughter came to find me once again, thanked me, and once more invited me to Bulgaria, which was a beautiful country.
I do plan to go sometime. I’d like to find the pilgrimage route across it, through the mountains, and then down to the Black Sea; and I’d like to meet the rest of the Bulgarians.
But in the meantime, a big change was coming to Laguna Honda. It was packing up its bags in Hawaii; it was flying back to our city; it was finding a place to live, and then I heard it walking, in its elegant, soft brown leather shoes, which were nicer than the administrators’ shoes, the architects’ shoes, even the lawyers’ shoes.
It was Dr. Dan, come back.
Eleven
RECALLED TO LIFE
DR. DAN AND I had never been properly introduced.
What had happened was this: He’d arrived at Laguna Honda for the first time during the year I was in Switzerland, which was a tough year for Dr. Romero as medical director. The Department of Justice visited thirteen times, each time grilling her about the workings of the hospital, and the admitting ward had been chaotic. She didn’t like being medical director anyway, with its demand for negotiation and compromise. It was easy for Dr. Romero to lead with one of her two sides—the sweet, compliant side or the sardonic, righteous side—but compromise, having to start from some place in the middle, was almost impossible. She didn’t believe in it.
God’s Hotel: A Doctor, a Hospital, and a Pilgrimage to the Heart of Medicine Page 29