There are some things I take for granted: that when my car is serviced, the air in my tires will be checked; that when I buy free-range chicken, the bird was running happily in the grass right up to the moment the ax fell; and that when I go to my doctor with excruciating abdominal pain, she will, without prompting, examine my abdomen.
When I first noticed my pain three weeks ago, I immediately thought of a friend — well, an estranged friend; his wife and I had had one of those arguments you can’t take back — who’d posted on Facebook that he had abdominal pain and would probably need gallbladder surgery. Two and a half months later he was dead from an aggressive cancer. He was young — much younger than I am. And I knew it couldn’t be my gallbladder, because I’d had it removed in 2004. So after I felt a pain in my abdomen, I went back and read my estranged friend’s Facebook post. Was it the same pain? Should I make an appointment with my doctor? Who would take care of my dogs if I died? Would I ever see the ocean again?
Dr. Demarco first came to see my grandmother Kitty in 1957, when I was just one year old, because she was having an anxiety attack. Earlier in the day a thief had come down the fire escape from the roof and taken some cash from the dresser in Kitty’s bedroom, where she’d been resting at the time. Kitty, who’d had a stroke months earlier, couldn’t call out or move, and the brazen crook had looked right at her before leaving the way he’d come in. By the time Kitty was able to communicate to anyone what had happened, she was exhausted and hyperventilating. Dr. Demarco came and sat on the edge of her bed, held her hand, and told her everything would be OK.
The other women in my family — my mother, my aunt Frances, and my great-aunt Anne — all swooned over the doctor’s good looks and his meticulous suit and his shiny black hair, slicked back and smelling of Brylcreem.
In the mid-nineties I was working in Bowery flophouses as a nurse, and I treated a man named Frank with a huge tumor in his throat. The right side of his neck bulged and pulsed. I used to crush his pain pills into powder so he could swallow them. He would help me put the doses into origami-like paper triangles to keep the powder from falling out. Before I left, I would get him some tap water so he could take a dose. His eyes would lock on to mine as he swallowed the powder with the water, as if to say, I may choke. Please help me if I choke. I would nod my head reassuringly and put my hand on his tumor. Then he would put his hand over mine, and we would both hold on to the tumor, which was sometimes hot from all the cellular activity and other times clammy. He would nod slowly back at me as he swallowed.
Frank. Sometimes I just like to say his name out loud. Frank.
Before I was born, my mother had identical twin girls. Dr. Demarco delivered them. One was three pounds three ounces, and the other was an even four pounds. Their lungs were underdeveloped, and they lived only a few days. My father took them to the cemetery in two little white coffins, accompanied by a parade of his fellow policemen, while my mother was still in the hospital. I knew about my sisters growing up, but I didn’t know where they were buried until I was thirteen, and we went to put Christmas wreaths on the family graves in Holy Name Cemetery. “You have a couple of sisters over there,” my father said.
My parents believed Dr. Demarco had saved the babies’ souls by acting quickly to have them baptized in the hospital nursery. “He rescued them from the Limbo of the Infants,” my mother said once, “and for that we can never thank him enough.” Limbo: the edge of hell where all babies went who still carried the stain of original sin. Limbo: a place where the souls of infants flew around without mothers and fathers.
I saw my doctor four times for the pain in my stomach. As a nurse, I often try to summarize my symptoms in a way that will lead the doctor to the conclusion I am hoping for. I used to employ a similar strategy in therapy: if I keep talking about my father, no one will ask about my mother.
On the first couple of doctor visits I minimized the abdominal pain and mentioned remedies I’d tried that seemed to be helping: taking Tums at night and Prilosec before meals; avoiding acidic foods like tomato sauce. During each visit the doctor stared at her laptop screen, nodded, and asked how my weight loss was going. “Terrible, but maybe that’s good, because if I had stomach cancer . . .” But she was too busy looking something up on a website to hear me. She worked in the same clinic that I did. She’d gone to Harvard. Everyone loved her. I had to trust her, right?
In 1976, my last year of nursing school, two men named Viktor and Branislav immigrated to New Jersey from Yugoslavia. They weren’t related and didn’t come together, but they both wound up in Bayonne, where they got jobs in the shipyards. After a couple of years Viktor realized that he and Branislav were the grandsons of bitter enemies in the old country. Viktor’s relatives in Yugoslavia encouraged him to take back the honor his family had lost over some wrong no one could remember: a broken taboo, an old injury, a misplaced bale of hay. The pressure pushed him over the edge, and one day he waited for Branislav at the corner of 39th Street and Avenue A. When Branislav walked by, Viktor threw lye all over him and then sprayed him with a fire extinguisher, which sealed the acid against his skin.
When I heard about the attack on the local news, I prayed I wouldn’t get Branislav as a patient. Three days later I looked at my ICU assignment sheet and saw his name.
It was clear that Branislav would not live. The doctors came into his room and shrugged. There was nothing for them to do except make sure the morphine didn’t run out. His face and chest were like blackened leather, and a tracheotomy in his neck bubbled with pale-yellow fluid. Though Branislav’s organs were shutting down, we performed dozens of dressing changes and sterile procedures to protect him from infection. It was a great opportunity for me to learn how to suction a patient, administer IV morphine, and manage a central line, where fluids entered the heart. A radio at his bedside played classical music, and once he tried to lift up his head during a violin concerto, and the thick, dead skin of his torso cracked and oozed.
Branislav died seven hours into my shift. He was twenty-six years old. I put my stethoscope against his chest, and although I couldn’t hear his heart, I could hear something: air shifting under the skin, gas in the intestines. Drops leaked from his eyes that looked like tears but weren’t. I touched his feet, which were still unburned and beautiful.
I had swollen glands for most of my childhood, and my mother would often take me to see Dr. Demarco. His waiting room was divided in two, with one side for people who wanted to watch TV and the other for people who preferred quiet. The chairs and couches were covered in forest-green vinyl with dark wooden arms, and the walls were paneled. When he called you back, you went right to his examining table. The first thing he always did was to put his big, warm hands on my shoulders, smile his Frank Sinatra smile, and say to my mother, “What the hell is wrong with this one, Margie?” And my mother would offer her take on my condition while he looked in my ears and eyes, palpated my neck, and listened to my heart and lungs. Once, after peering into my ears, he said, “Christ, Margie, stop with the Q-tips. She should have some wax in there.” Then he winked at me. Another time, when my mother was asking him to remove my tonsils, he said, “Jesus, Margie, why would I do that? I don’t know what they’re there for, but they must be there for something.” He told her to take me home, let me play in the sun, and go easy on the milk. “Give her a 7 Up every once in a while, will you?”
There is a website called murmurlab.org, where doctors can go to practice listening to heartbeats: regular or thumping or blowing or clicking. The site’s creators want to encourage physicians to use their stethoscopes and better learn the music of the valves and the chambers filling with blood. Too many doctors don’t listen to their patients’ hearts. Instead they send everyone to a cardiologist or order an echocardiogram.
I have a friend who kept falling down and whose blood pressure was rising. She went to multiple doctors for months before one touched her neck and asked, “How long has this lump been here?” It was the size of a golf ball. My friend might’ve seen it herself in the bathroom mirror but hadn’t. Why hadn’t any of those other doctors touched her as she’d gotten sicker and sicker, instead of ordering more tests that my friend avoided, because she felt too sick? Now that they’ve found the lump, my friend is receiving treatment and thriving. The golf ball is gone, and she has stopped falling.
My brother Johnny was fifteen when a doctor found his cancer and nineteen when he died from it. I was a freshman in nursing school. My brother went to Dr. Demarco with severe anemia, and the doctor admitted him to the hospital where I was interning. Dr. Demarco came to my unit, put his arm around me, and said, “Sweetie, I don’t know what this is, but I know it’s bad. You are going to have to be strong for your parents.” After he left, I stood for a long time in the utility room, looking at the clear plastic medicine cups, the mercury thermometers soaking in antiseptic, the blue wall tiles. Then I walked down the hall to my brother’s room, where he was lying on his side, facing the wall, shirtless. I could see the circular scar where he’d scraped a mole off the previous summer while swimming under the docks. The scar was even paler than his pale skin. I stared at it and felt as though the whole world were pale and fading.
Over the next week, during which my brother was transferred to Memorial Sloan Kettering Cancer Center, my parents said many times that Dr. Demarco had told them, “This is way beyond me.”
The tumor was finally identified as a rare sarcoma, a type that came with its own blood supply and a prognosis of four and a half months to live. When my brother lived four and a half years, my parents credited Dr. Demarco and his willingness to admit his limitations.
On my fourth visit, when my doctor said the next step would be an endoscopy, I confronted her about her failure to touch me. I told her that even I, a nurse, would have listened to the patient’s bowel sounds and felt the abdomen.
“You should have examined me,” I said.
My doctor smiled and said, “Well, you had no rebound tenderness.”
I was incredulous: “You can’t know that without applying pressure.” I wanted her to palpate, auscultate, inspect. I wanted the laying on of hands. But I had said my piece. I gave up, went home, wrote a history of my pain, and realized that I had started taking melatonin and chamomile at bedtime about a week before the discomfort had begun. I stopped taking them, and three days later the pain went away.
When my doctor moved to a different clinic, I hugged her goodbye. All was forgiven. What was the point of being angry, now that I would live?
I drink a fair amount of diet soda at work (though I cut back when I thought I had only three months to live), and one day I took my can to the break room for recycling and found a doctor in there stirring soup. He was new to our clinic but seemed affable and relaxed with the residents, so I asked him, “Do you examine your patients?” He looked puzzled, and I explained what had happened to me on my four visits for abdominal pain.
“You have to touch your patients,” he said. “It establishes trust. It tells them that you accept them completely.”
I thanked him for taking the time to talk to me. I wished he were my doctor.
My brother’s surgeon, Dr. Knapper, used to meet my father for a beer sometimes at an Irish bar on First Avenue in Manhattan. Dr. Knapper tried hard, over twelve and a half hours, to remove every bit of Johnny’s tumor, but when the cancer kept returning, and the surgeries kept failing, the doctor had to admit defeat. Still, he would stop by Johnny’s room. They shared a birthday — would share four before my brother died. Johnny told me Dr. Knapper would rub his forearm just above the intravenous needle. Johnny’s arm was always cool there because of the fluids running in, providing nutrition and hydration, and Dr. Knapper’s hand would warm it.
Dr. Demarco retired when he was eighty years old and moved to the Jersey Shore, where he drove a white Cadillac. One night my aunt said, “Guess who I saw at the store today buying bananas.”
It could have been anyone; everyone in New Jersey eventually goes to the Shore.
“Salvatore,” she said.
Had I ever known his first name?
Now that my abdominal pain is resolved, I wake every morning feeling grateful and rub my hand over the place where it was, wanting to become more familiar with my abdomen: its density, temperature, and curves. I think about my estranged friend and wonder if, before he died, he would sometimes wake and hope that everything had returned to normal, as it has for me. Except I need to find a new doctor. One who understands the importance of the physical exam. One who will touch me like Salvatore.