Sunday, December 15, 2013

Patients, #17, The Man with Cancer

     One day Mr. X. was on his way to work like the rest of us, and the next day he wasn't.
     He had a job as a landscaper with a big local employer working seven-to-three with lots of guys, his buddies, with whom he also got together on weekends to fish Lake Lochloosa and shoot the bull.  They did this for fifteen years, and Mr. X. said it was a hoot.
     At home he had a wife and two daughters, and sometimes there were his wife's sisters and his daughters' friends--so many women!  Yes, he loved his family but his buddies made him feel good, like a man, and so did the heavy machinery he drove on the job, and the beer-drinking looseness of those Saturday afternoons on the lake with a cumulus sky like the dome of heaven holding them all in their proper relation.  He carried around a photo of the time he'd nabbed a 9-pound bass.
     His wife made an appointment for him to get a physical, so that's how we met.  At forty-seven Mr. X. was too young, based on national guidelines, for the rectal exam.  But I suppose I'm a rule-breaker because I did one anyway.  I had an uneasy feeling about him--he was feeling too good--and it was a gut decision, another 20 seconds.
     "Nothing wrong there," he said.  "Just doing all this for my wife.  You know how women are."
     "Right," I said.
     "Do you really have to do that?" he complained.
     "I won't do anything you don't want."
     "Ahh, what the hell, go ahead.  At least I can tell my wife you did everything."
     Two inches up, there was a growth like a knot on a gourd.
     Oh, no, I thought, my chest twisting like a wrung-out towel inside me.  Please, no.
     "It's probably nothing," he said.  "I bet I have hemorrhoids."
     "We ought to find out," I said, guiding him into the surgery room.
     "Sometimes there's a little blood," he added.  He hadn't mentioned this earlier.
     A nurse turned on the anoscope and unsealed the biopsy instruments while Mr. X. signed a consent form.
     "The biopsy won't hurt," I said.  "It's in an area with no sensory innervation."
     "Do I really need all this?" he asked.  "I feel fine."
     "You need it," I said.
     "Can't it wait?" he persisted."  I want to go fishing tomorrow."
     "If I let you go, you might never come back," I answered.
     "You're probably right," he said, and laughed.  But I could see he was afraid.
     Five days later I received the pathology report:  invasive colorectal carcinoma.
     From then on Mr. X. was a cancer patient, and had no friends.
     Only one of his buddies visited him at the hospital, staying half an hour without mentioning the illness.  Instead they talked about work as though nothing had changed.  Their joviality was forced and Mr. X. said that afterward he felt hollow.
     None of the others visited or returned his phone calls.
     "Where are they when I need them?" he asked.
     "It's terrible," his wife said.  "Those guys used to be his best friends."
     She told him she'd never leave him.  "You're everything to us," she said.
     Mr. X had all the benefits of American medicine:  surgery, a colostomy bag, and chemo.  Five years later when metastases showed up like a handful of coins in his lungs he got laser knife therapy.  He had it five times, along with a trial of experimental chemo.  Two years later he qualified for hospice.
     He had made new friends by going to church.  He also participated in the hospice support group.  And then he died.  He never got to see his daughters graduate from high school.
     I couldn't save Mr. X., so this failure jostles around in a pocket of my conscience with so many others, like jagged chunks of granite.  But I remind myself that I saw him through those ten years and grew to love him.  I understood that he was able to live with his cancer, but suffered over the dereliction of his buddies.  That was the worst part, he told me.
     "I'll never understand it," he said.
     "And yet," he confided, "I might have done the same thing myself if it had happened to one of them.  It's odd and it shouldn't be that way," he went on.  "But I wouldn't even have thought about it."  

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