The view of Boston – from the peak of MGH – was beautiful. The snow of Boston’s worst winter in decades had nearly melted away. 40 degrees still felt balmy, and rain was forecast for later in the afternoon. Mom and dad were staying with friends on Beacon Hill and walked to MGH. I had a meeting in Cambridge earlier in the afternoon, so it was a short drive across the river. There is an ethos to MGH that I’ve never liked. The joke, of course, is that this is “Man’s Greatest Hospital” and perhaps this is my aversion. Self-important people who consider themselves to be better than everyone else. What’s “better?” If “got better grades and MCAT scores” is better – then sure – they are better. But if “provides more coordinated, collaborative, patient-centered care” is better, these folks get a dismal score. I’ve never felt that dad’s care here was very good. His primary care doc for many years was here – and he always impressed me as a pompous dork. I didn’t understand why dad kept seeing him. Then dad spent nearly three weeks as an inpatient last December and his care was terrible: the physicians handed him off from one to another almost daily. Nobody really took ownership of his “case.” (Isn’t it tragic that we depersonalize people by calling them “cases?”) Finally – I had to engage so we could get him discharged. The family member who is a physician is always tough to manage, so I generally try not to tell dad’s providers that I’m a physician. But in December – I had to piss on their fire hydrant so that they would know that I understood how crappy a job they were doing. One doc apologized – explaining that they were shorthanded due to holiday vacations and a pregnant colleague. “No more hospitalizations,” said dad. He meant it.
Dad’s PET scan was two days ago. The last course of chemotherapy was in October. This would be when we get the news. No cancer? More cancer? Some cancer?
The waiting room of an oncology office is an odd combination of hope and
despair resignation. One can feel the hope, and can see it on the faces: “we’ll be ok.” Yet one can also see the resignation. The lady in the chair next to dad is helped to her feet by the effervescent medical assistant. They know each other very well. This isn’t the sort of place you want to be known very well. She looks so tired. Is that a smile or a wince?
Dad reads the newspaper. The NCAA track and field championships are happening this week. He knows all the names and their best times.
His appointment was for 1:30 and it’s 2:15 now. Mom asks .. “does this mean something is wrong? Is this bad news? It seems so long.” Dad rolls his eyes. “We always wait.” “Everything is fine.” I almost agree. But Have a sense that everything is not fine. Here she comes: the medical assistant directs us to follow her back behind the door. She seats dad in the hallway and takes his blood pressure, weight and temperature. Mom and I clog the hallway for a moment. Dad makes a silly joke about something. Nobody laughs. He’s nervous. We’re so nervous.
We wait another 20 minutes in the room. There are only two chairs, so I sit on the exam table. The doc arrives. We’d never met in person but I had talked with him on the phone. He’s younger than I am but not by much. He shakes my hand. “Good to see you again” he says. “We’ve never met. I think you’ve met my brother. I’m the good looking one.” Nobody laughs. I’m so nervous.
He steps back into the hallway and retrieves a chair. We’re all sitting. He looks at dad. He looks at the floor. He looks at mom. “It’s not good.” The cancer is back. The next 45 minutes are a blur. We see the PET scan. It’s everywhere. Percentages, options, alternatives, clinical trials. Dad is taking notes feverishly. Mom is holding back the tears. I’m listening. I’m in “doctor” mode. Following along. Dad is a “case.”
The doc leaves. We are quiet. We hug. We are not a family that hugs. Then we stop hugging.
When we get outside, it’s raining. Mom didn’t remember much of what the doc had said. I start repeating things. Percentages, options, clinical trials.
I knew this might happen. When dad was diagnosed, I knew that he had a 1/5 chance of cure. We didn’t talk about that. I never discussed the number with them. Nor did the doc. Until now.