فصل 51

51

Chemotherapy began on Monday. Lucy, my mother, and I went to the infusion center together. I had an IV placed, settled into an easy chair, and waited. The drug cocktail would take four and a half hours to infuse. I passed the time napping, reading, and sometimes blankly staring, with Lucy and my mother next to me, interrupting the silence with occasional small talk. The other occupants of the room were in various states of health—some bald, some well-coiffed, some withered, some sprightly, some disheveled, some dapper. All lay still, silent, with IV tubing dripping poison into outstretched arms. I was to return every three weeks for treatment.

I began to feel the effects the next day, a deep fatigue, a profound bone-weariness setting in. Eating, normally a source of great pleasure, was like drinking seawater. Suddenly, all of my joys were salted. For breakfast, Lucy made me a bagel with cream cheese; it tasted like a salt lick. I set it aside. Reading was exhausting. I had agreed to write a few chapters on the therapeutic potential of my research with V for two major neurosurgical textbooks. That, too, I set aside. The days passed, television and forced feedings marking the time. A pattern developed over the weeks: the malaise would slowly ease, normalcy returning just in time for the next treatment.

The cycles continued; I shuffled in and out of the hospital with minor complications, which were just enough to preclude any return to work. The neurosurgery department determined that I had met all national and local criteria for graduation; the ceremony was scheduled for a Saturday, about two weeks before Lucy’s due date.

The day arrived. As I stood in our bedroom, dressing for graduation—the culmination of seven years of residency—a piercing nausea struck me. This was unlike the usual nausea of chemotherapy, which washed over you like a wave and, like a wave, could be ridden. I began uncontrollably vomiting green bile, its chalky taste distinct from stomach acid. This was from deep in my gut.

I would not be going to graduation, after all.

I needed IV fluids to avoid dehydration, so Lucy drove me to the emergency department and rehydration began. The vomiting gave way to diarrhea. The medical resident, Brad, and I chatted amicably, and I relayed my medical history, covering all my medications, and we ended up discussing advances in molecular therapies, especially Tarceva, which I was still taking. The medical plan was simple: keep me hydrated with intravenous fluids until I could drink enough by mouth. That evening, I was admitted to a hospital room. But when the nurse reviewed my medication list, I noticed Tarceva was not on it. I asked her to call the resident to correct the oversight. These things happen. I was taking a dozen medications, after all. Keeping track was not easy.

It was well past midnight when Brad appeared.

“I heard you had a question about your medications?” he asked.

“Yeah,” I said. “Tarceva wasn’t ordered. Do you mind ordering it?”

“I decided to take you off it.”

“Why is that?”

“Your liver enzymes are too high to take it.”

I was confused. My liver enzymes had been high for months; if this was an issue, why hadn’t we discussed it before? In any case, this was clearly a mistake. “Emma—my oncologist, your boss—has seen these numbers, and she wants to keep me on it.”

Residents routinely have to make medical decisions without the attending’s input. But now that he had Emma’s opinion, surely he would capitulate.

“But it might be causing your GI problems.”

My confusion deepened. Usually invoking the attending’s orders ends the discussion. “I’ve been taking it for a year without any problems,” I said. “You think Tarceva is causing this all of a sudden, and not the chemotherapy?”

“Maybe, yeah.”

Confusion yielded to anger. Some kid two years out of med school, no older than my junior residents, was really arguing with me? It’d be one thing if he were right, but he wasn’t making any sense. “Um, didn’t I mention this afternoon that without that pill, my bone metastases become active and produce excruciating pain? I don’t mean to sound dramatic, but I’ve broken bones boxing, and this is far more painful. As in, ten-out-of-ten pain. As in, I-Will-Actually-Soon-Be-Screaming pain.”

“Well, given the half-life of the drug, that probably won’t happen for a day or so.”

I could see that in Brad’s eyes I was not a patient, I was a problem: a box to be checked off.

“Look,” he continued, “if you weren’t you, we wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.”