When Breath Becomes Air(36)

Good. One good thing.

As we uncovered the patient, the scrub nurse, one with whom I hadn’t worked before, said, “You on call this weekend, Doc?”

“Nope.” And possibly never again.

“Got any more cases today?”

“Nope.” And possibly never again.

“Shit, well, I guess that means this is a happy ending! Work’s done. I like happy endings, don’t you, Doc?”

“Yeah. Yeah, I like happy endings.”

I sat down by the computer to enter orders as the nurses cleaned and the anesthesiologists began to wake the patient. I had always jokingly threatened that when I was in charge, instead of the high-energy pop music everyone liked to play in the OR, we’d listen exclusively to bossa nova. I put Getz/Gilberto on the radio, and the soft, sonorous sounds of a saxophone filled the room.

I left the OR shortly after, then gathered my things, which had accumulated over seven years of work—extra sets of clothes for the nights you don’t leave, toothbrushes, bars of soap, phone chargers, snacks, my skull model and collection of neurosurgery books, and so on. On second thought, I left my books behind. They’d be of more use here.



On my way out to the parking lot, a fellow approached to ask me something, but his pager went off. He looked at it, waved, turned, and ran back in to the hospital—“I’ll catch you later!” he called over his shoulder. Tears welled up as I sat in the car, turned the key, and slowly pulled out into the street. I drove home, walked through the front door, hung up my white coat, and took off my ID badge. I pulled the battery out of my pager. I peeled off my scrubs and took a long shower.

Later that night, I called Victoria and told her I wouldn’t be in on Monday, or possibly ever again, and wouldn’t be setting the OR schedule.

“You know, I’ve been having this recurring nightmare that this day was coming,” she said. “I don’t know how you did this for so long.”

—

Lucy and I met with Emma on Monday. She confirmed the plan we’d envisioned: bronchoscopic biopsy, look for targetable mutations, otherwise chemo. The real reason I was there, though, was for her guidance. I told her I was taking leave from neurosurgery.



“Okay,” she said. “That’s fine. You can stop neurosurgery if, say, you want to focus on something that matters more to you. But not because you are sick. You aren’t any sicker than you were a week ago. This is a bump in the road, but you can keep your current trajectory. Neurosurgery was important to you.”

Once again, I had traversed the line from doctor to patient, from actor to acted upon, from subject to direct object. My life up until my illness could be understood as the linear sum of my choices. As in most modern narratives, a character’s fate depended on human actions, his and others. King Lear’s Gloucester may complain about human fate as “flies to wanton boys,” but it’s Lear’s vanity that sets in motion the dramatic arc of the play. From the Enlightenment onward, the individual occupied center stage. But now I lived in a different world, a more ancient one, where human action paled against superhuman forces, a world that was more Greek tragedy than Shakespeare. No amount of effort can help Oedipus and his parents escape their fates; their only access to the forces controlling their lives is through the oracles and seers, those given divine vision. What I had come for was not a treatment plan—I had read enough to know the medical ways forward—but the comfort of oracular wisdom.



“This is not the end,” she said, a line she must have used a thousand times—after all, did I not use similar speeches to my own patients?—to those seeking impossible answers. “Or even the beginning of the end. This is just the end of the beginning.”

And I felt better.

A week after the biopsy, Alexis, the nurse practitioner, called. There were no new targetable mutations, so chemotherapy was the only option, and it was being set up for Monday. I asked about the specific agents and was told I’d have to talk to Emma. She was en route to Lake Tahoe with her kids, but she’d give me a call over the weekend.

The next day, a Saturday, Emma called. I asked her what she thought about chemotherapy agents.

“Well,” she said. “Do you have specific thoughts?”

“I guess the main question is whether to include Avastin,” I said. “I know the data is mixed and that it adds potential side effects, and some cancer centers are turning away from it. In my mind, though, since there are a lot of studies supporting its use, I’d lean toward including it. We can discontinue it if I have a bad reaction to it. If that seems sensible to you.”



“Yeah, that sounds about right. Insurance companies also make it hard to add it later, so that’s another reason to use it up front.”

“Thanks for calling. I’ll let you get back to enjoying the lake.”

“Okay. But there’s one thing.” She paused. “I’m totally happy for us to make your medical plan together; obviously, you’re a doctor, you know what you’re talking about, and it’s your life. But if you ever want me to just be the doctor, I’m happy to do that, too.”

I hadn’t ever considered that I could release myself from the responsibility of my own medical care. I’d just assumed all patients became experts at their own diseases. I remembered how, as a green medical student, knowing nothing, I would often end up asking patients to explain their diseases and treatments to me, their blue toes and pink pills. But as a doctor, I never expected patients to make decisions alone; I bore responsibility for the patient. And I realized I was trying to do the same thing now, my doctor-self remaining responsible for my patient-self. Maybe I’d been cursed by a Greek god, but abdicating control seemed irresponsible, if not impossible.