Chapter 9
Chapter Nine
NYLA
After that strange conversation with Jaden in the hospital park, the rest of the shift, thankfully, went by without any difficult calls.
But what he said in the park has been on my mind all day.
Last night I even dreamed about that cloud goat and saw it in front of me, dissolving relentlessly no matter how hard it tried to fight against it.
Today I’m back in the emergency department, and that’s a good thing, because outside rain is whipping against the glass front. If I were riding along in the ambulance, I’d end up getting wet sooner or later. My immune system is still sensitive; the cold I could catch would be a bad one.
What if I’m already sick? If my cancer is back and I just don’t know it yet?
Three days until the follow-up examination.
Trying to focus on my work, I step up to the emergency coordinator’s desk. ‘Hey, are the test results back yet for the woman with the swallowing difficulties in treatment room five?’ I ask the tall man in scrubs.
‘That was patient P030424-031, right?’ I nod, and he glances at his monitor. ‘They should be done any minute; I’ll let you know. By the way, I’m supposed to tell you that Dr. Franks wants to see you before Jaden shows up and you don’t have any time left.’
Jaden. He’s going to spend part of my shift with me today, and I don’t know what to make of that.
‘Okay, then I’ll take care of that right away,’ I say, and head for my boss’s office.
When I reach Dr. Franks’s office, I knock. He calls me in.
‘You wanted to see me?’ I ask, whereupon he reaches for the medical file on his desk.
He gestures to the conference table next to the sprawling plant in the corner of the office. ‘Have a seat.’
Although he looks at me with his usual friendly expression, I feel a little queasy. I slide onto the chair and watch as he opens the file.
‘Is there a problem?’ I ask.
He clears his throat, puts on his reading glasses, and begins to read from the file. ‘Female patient, 42 years old, presents with recurrent and now for four days persistent mild swallowing difficulties without fever or weight loss.’
At once it’s clear to me that he has my patient’s file in front of him, the one who is currently waiting for her test results. I frown, he gives me a searching look for a moment, then lowers his gaze to the file again.
‘The throat is slightly reddened, otherwise no further symptoms, no known allergies or chronic illnesses, no family history of disease. Non-smoker, no medication.’ He turns to the next page.
‘Vital signs within the normal range, throat essentially unremarkable. Works as a teacher in Spryfield. Single mother, three children.’
‘Yes, and at the initial examination there were no neurological abnormalities and no problems in the abdominal area either,’ I add, to show him that I am sufficiently familiar with the case. ‘However, she seemed very tired to me, had pale skin and deep circles under her eyes.’
He regards me with a serious look. ‘What does all that suggest to you?’
I slide forward on my chair. ‘Well, given that she’s a single mother and works at a school in one of the worst social hotspots in Halifax, she’s probably under a lot of stress.
’ She even came to the emergency room with her complaints because she couldn’t get away during her family doctor’s office hours.
‘Since no other alarming abnormalities have been found so far, a functional dysphagia is the most likely explanation, but …’
‘Exactly.’ My boss takes off his reading glasses and thoughtfully folds the arms together. ‘This woman is suffering from a swallowing disorder without organic causes. She needs relaxation techniques, methods of stress avoidance, and possibly help with her children.’
That’s true, but only if that really is the cause of her symptoms. I’m about to explain exactly that, but Dr. Franks signals to me that I’d better not interrupt him now.
‘Then let’s see what you prescribed for the woman instead.
’ His fingers close more tightly around the medical record, his knuckles standing out.
‘Extensive lab diagnostics including tumor markers and thyroid function tests, MRI of neck and head, thoracic CT, an ultrasound of the thyroid, and and and.’ Discouragement dominates his expression as he fixes his gaze on me. ‘What were you thinking?’
I have an inkling where he’s going with this, so I raise my hands in a calming gesture. ‘Functional dysphagia is only one possible explanation for the symptoms, and I wanted to make sure I wasn’t missing anything.’
I notice that he’s trying to stay calm, but also how little success he’s having. ‘These tests cost several thousand dollars.’
‘The patient could be suffering from a serious illness. A brain tumor, a severe infection, tracheal cancer,’ I reply earnestly.
What kind of doctor would I be if I didn’t examine her thoroughly?
The woman’s life could depend on it. ‘The tests were necessary, there’s something wrong with her, as I said, she was extraordinarily pale and exhausted. ’
‘The woman leads a strenuous life; of course she’s tired,’ my boss counters. ‘Any other doctor—including myself—would have sent her home. The tests you ordered are excessive.’
They are not. ‘And what if she is sick after all? The illness might be just beginning.’ Are we supposed to wait for the condition to progress? The sooner we treat, the better.
He shakes his head; again, he looks worried. ‘You’re seeing ghosts.’
‘But we don’t even know if…’
‘This woman is healthy, and the test results will show that.’ With a quick movement, he rises from his chair and indicates that we’re done here. ‘From now on, you will submit your planned tests and examinations to me in advance for approval. Something like this must not happen again.’
Incredulously, I stare at him. ‘She is sick, I’m sure there’s something.’
He shoves the file into my hand, his disappointment unmistakable. ‘Discharge the woman.’
I know I have to follow his instructions. He’s the boss, and you don’t contradict the boss, least of all in a hospital. But until I have the test results, she’s not going anywhere.
Clutching the woman’s file to my chest, I say goodbye and leave the room. I’ve barely closed the door behind me when a furious kind of helplessness surges up inside me. Why doesn’t he believe me?
I really need to calm down.
Inhale.
The test results will show that I’m right.
Hold.
Then Dr. Franks will realize his mistake, but that is by far not the most important thing.
Exhale.
The patient will live because we recognized her illness early enough.
She will laugh, love, dream, and follow her path.
She will watch her children grow up, find great love, and decades from now look back with a smile on this life that was given to her.
She will do all the things Lilly can no longer do.
The door in front of me is white, and in one spot right next to the handle the paint has chipped off.
Darkness lurks in this patch and looks as if it might seize the entire door at any moment.
The fact that I’m standing here as if I were set in concrete and can’t go in is ridiculous.
My future is waiting behind this door, and it’s the only one I have.
Besides, I know how inpatient chemotherapy works, I know every routine, every move, all the facts.
Even so, my fingers are trembling and sweating at the same time, my breathing is shallow, my thoughts are racing.
I grope for the extra-long earrings I’ve been wearing ever since I shaved my head and no longer have anything else to hold on to.
I take one last breath, then I step inside. My gaze first falls on the light colors on the wall, then on the cozy recliners lined up along the window front. If you only saw them, with the blankets and pillows laid out, you might think this was a wellness area.
But there are also IV stands, pumps, and emergency equipment. Nurses in blue uniforms, doctors checking that everything is in order.
Patients with partly bald, partly hairy heads, some of them emaciated and pale. On the recliner next to the floor-to-ceiling window sits a woman who looks to be about my age. She’s wearing a colorful scarf on her head, her deep blue eyes find me, she gives me a friendly nod.
At that moment a nurse spots me. We take care of the paperwork, and when she then asks me to choose a free seat, I pick the one next to the woman with the colorful scarf.
‘Hi, I’m Lilly,’ she says as I sink onto the recliner. ‘Your first time?’
I nod. ‘Nyla, nice to meet you.’
She raises the back of her chair and turns toward me. A pendant flashes beneath the zipper of her hoodie. Delicate, silver, very simple—it’s her name. Lilly. Three small blossoms grow from the ends of the Y. A daisy, a snowdrop, a poppy.
‘That’s gorgeous.’ I point at the pendant.
She reaches for the chain, her bony fingers touching the metal lovingly. ‘It’s one of a kind, my own design.’
Very creative, to decorate the Y and not the dot on the i, which I’ve seen as a heart, a flower, or a sun so many times already. ‘Really pretty.’
The nurse inserts the IV line; I can feel it, but I don’t look.
‘Why are you here?’ Lilly’s fingertips play with the pendant.
‘Hodgkin lymphoma. And you?’
‘Same.’ She lifts her hand for a high five. ‘Then I guess we’re going to rock this together, huh?’
My hand meets hers, my gaze sticks to her face. Lilly’s cheeks are hollow, her skin pale. ‘Which cycle are you on?’
‘The sixth.’ For a moment her eyes turn watery, but she quickly blinks the tears away. ‘So I’m a pro—you can snag all the tips from me,’ she adds, giving me a wide smile.
‘How many do you have left?’
She lifts her shoulders, probably wanting to seem casual, but I can tell she isn’t. ‘The doctors are estimating nine, but that keeps changing.’
Nine cycles? Wow, that’s rough. I’m expected to have four.