'Food for Thought' - by Carla Lever
Today I told a woman she was going to die. It didn’t feel like I expected.
She took it in, pupils dilating almost imperceptibly. But I saw. Seeing as it’s my job to have nowhere else to look. “How long?” she asked.
That’s it. Not ‘how,’ ‘why,’ ‘are you sure?’ Not anger, resentment, resignation. Relief? Quite possibly.
How long. As if I could tell her – climb in, past the skin, cleave the flesh, sink into the bone, get down and close with cellular precision. Talk to her cancer. Hang out, have a chat. “Hey, so how long are you thinking of keeping my good client around for?”
Here’s a secret. The patient wants to know. You tell them. You tend to underestimate; live anything longer and they feel like a winner, a fighter. Anything less and the doctor’s the loser. But sometimes? Sometimes you simply make that shit up. To the best of your ability, of course, using estimates and scientific graphs and statistical methodology: rate of cancer spread vs. capability of vital organs, minus any underlying symptoms, minus the will to live. That’s the real wild card. Wild. Nature, red in tooth and claw. Even here in the middle of Joburg. Especially here in the middle of Joburg.
In a certain socio-economic bracket, death seems an impossible abomination. Unfeasible. Improbable. Impolite. The decays and disgraces that cause those less equipped with private healthcare, medical aid and Mercs to lose control of their bowels, to spit, to spew, to seep seem all the more outrageous inside those four Velvaglo lavender walls.
She had beautifully manicured hands. I noticed, because the first thing she did when she sat down was to pull a gold ring from her handbag. “I don’t like to drive with it on,” she said as she slipped it on the fourth finger of her left hand with practised ease. “It’s like having a hijack beacon flashing from your steering wheel.” Patients have foibles like that. It makes it trickier to simply see my job as cellular gambling. It makes it trickier to tell them that, on this hand, they’re drawing dead.
Some of them go in for faith healing. Whether they do it with aromatherapy or jesusology, it’s all the same. They still die. Eventually. I had a patient once, he insisted that he didn’t need the chemo, that god had cured him in his sleep. His family buried him with full mass – said it was a metaphorical healing. Said God had cleansed him of his sins not his cancer, he just didn’t understand the message properly. I think, if there is a god, metaphor shouldn’t really be his style. Straight up, I think it should be. “No, I’m not going to cure you, in fact you’re going to die this time next week.”
That’s my job, though.
Don’t think I’m callous. Death is pretty bizarre. I see it a lot and it never fails to make an impressive entrance. It’s a character actor, sliding into any new role like a hand in a glove. It knows its lines. None of them are good for exits.
If death comes as the end, we doctors are here to wind the curtain. Which doesn’t mean we get any sense of closure. Leave work at night, death leaves with you, sticking like an over-the-counter cough syrup and with the same cloying smell. Sometimes, when I get home, I don’t touch the kids for the first bit.
Adults, like kids, want a complete narrative. Like kids, their first impulse is to ask ‘why?’ Unlike kids, they don’t understand when they’re not given answers. I guess it never goes away, the need for a narrative you can hold. One that’s containable within the cardboard covers of a book, within two outstretched hands, within the limits of our attention span between supper and sleep.
I find my patient narratives harder to hold since I’ve become a mother. The stories I spin, the little analogies, the poignant but telling pauses have all become harder to get out. Because it’s not living that people do ever after. And ever after can’t be held between two covers, two hands, the time between breakfast and bed. So I cook. I make things. I…consume them. We can’t outrun death, but we can make damn sure we’re too tired to worry when it comes.
Right now I’m making vegetable biryani. After twelve years of Proudly South African braaing, Tim’s turned veggie on me. It wasn’t the ethics of the thing; he just said he couldn’t take the taste anymore. Gone, just like that. Annoying, really, the pointlessness of it. I can’t even claim he’s morally evolved. He’s just…difficult. I sometimes have the unworthy thought that he did it solely to piss our friends off at parties, but then I remind myself that these things happen; our bodies have pulls and responses that we just can’t control. It’s as medically irrational and utterly real as pregnancy cravings, although the only thing he’s delivering these days is a neat end-of-year financial report. Numbers tend to behave; subtracting, dividing people is much trickier.
It’s not too bad, I suppose – I find vegetables rather beautiful. Have you ever looked at one under a microscope? A whole world of pattern, a structure so perfect you’d think there was a purpose bigger than just your dinner. Maybe there is. What we take in becomes part of us. Fair trade – we’ll become part of it again soon enough.
Some of the vegetables, once cleaved, hold a light veiny blush towards the centre. Chopping through them thoughtfully, the resistance satisfying but not straining at my wrist, I think of my day job. Of secret, cellular worlds. Of cleaving and cutting. I think of god, of stories, of dinner.
I wonder, sometimes, what the right thing is to do in the face of other adults, other kids. When your diagnosis contaminates something in them, is it always the right course of action to administer it clinically, fully, from cover to cover, beginning to end? Should one follow the journey from heart line to flat line in a linear fashion, or is there a better, a softer route? My mother always told me that if I couldn’t think of something nice to say I should keep quiet. Somehow I don’t think those rules apply anymore, but I can’t be sure. Perhaps when there’s a harsh home truth to be told, the art is in the right telling. You can’t completely inoculate people against a bad truth, but you can prescribe a dose of alternative perception. Let’s call it my experimental therapy. Maybe that’s even crueller, in the long run. But then maybe successful policy has to be cruel to be effective.
You know there’s the one kilogram rule, right? Babies under a kilogram in public hospitals aren’t given drugs. Limited stock, see? Government issue rules. A fine tradition of doing things like that, us humans. Exposure therapy. Stick a kid on a hillside and come back in the morning. Problem solved, bru.
…Poor people’s babies, I mean. Not you and me: we’re stuck with our little terrors. We get the privilege of knowing we’re going to die. In a country where so many need so much, doing the right thing becomes a measurable matter of grams. I guess that works when you’re number crunching. It’s not so great when the number in front of you is just one and it’s up.
You can’t show it. Fear, I mean. Forget dogs, patients – now they can sniff fear. It’s about acting, right? Acting you know what’s wrong, acting you know the best way to fix it, acting you’re not scared shitless by the impossible advance of the thing inside them. Acting’s a decent profession, isn’t it? People get awards for it and stuff.
I guess it comes down to choosing your role more carefully. I’d like to choose mine – pick who I’m going to be. Maybe control is picking who you’re going to be in the face of this…advance. Picking how you face things, even if just while you’re alone. Maybe doing the right thing is just an issue of correct casting.
The first time I saw a terminal patient in Baraguana was also the first time I saw a patient. My hands shook. Which was a problem, you know, because he didn’t speak very good English so that’s what he was looking at. As I felt his glands and filled out the report, his eyes never left my hands. Was he wondering what I was doing? Or maybe he was looking at my wedding ring. Maybe he was weighing up how much time he had to buy a better state of health care.
Her hands were smooth. Today, I mean. Smooth, like she’d just been for a really good manicure – like she went for manicures regularly. I couldn’t stop looking at them. I was mesmerised by her hands that spoke of nothing but a blank white page, on which was inscribed a spouse, in which was inscribed the DNA of a very comfortable death.
I’m so tired of death. So, so tired. Maybe I should have another baby. Maybe I should make another biryani. Maybe I should tell you to fuck off out of my kitchen.
…That wasn’t very nice. I’m sorry. It’s just that we’re nearing the end and I always get twitchy at endings. So here’s biryani. Something you can hold between your two hands, something to fill the space between the pages of a book, to fill the time before the flat line. Eat it. Eat it now.
I’m sorry, I need a drink. I know I shouldn’t now I’m on the tablets. Give my body a fighting chance, Tim says. Tim doesn’t say much. I say a lot of things. I’ve been saying a lot of things. I don’t know about the rest of them, but it’s the right thing to do, for me.
The biriyani’s done now. It’s all coming to an end. How funny to know that something you spend time making into one perfect form has to be broken down to be enjoyed. But that’s right. I guess there’s always a right time for the breaking. You’ve gotta know when to hold ‘em, know when to fold ‘em. Know when to walk away, know when to run. Johnny Cash, that. Everyone remembers Kenny Rogers, but Johnny did it first. Who’s the author, the protagonist? Maybe what we choose to remember comes out of what we choose to like best.
I choose to like the power of the telling best. Just for now, for while I’m alone. I choose a white coat, not a blue split gown. I choose to tell the story I see play out in my audience, not the one I feel playing out in my bones.
Tim partly chose our narrative at home, too. “Hey – it’s going to be ok. I’ve told the kids you’re just feeling a bit under the weather. No mention of the C word round here! Doctor says we’ve still got some time. Here’s to time!”
Sometimes he feels my forehead with what I can only diagnose as mechanical tenderness. I think he doesn’t want to expend emotion yet. But then frugality in an accountant is invariably considered a virtue. I’m a stay-at-home mom, I appreciate a bit of extravagant emotional spend. When we have to go in to the doctor tomorrow, it will be the only time I will catch Tim looking at me anxiously. He will look to me to cover the gap, look like a man who’s lost the plot. For my doctor, I would imagine, there will be nowhere else to look. It is her job to look at endings; ours to avoid them. Me? I will look at them both blankly, like a smooth, otherwise empty page on which is written a spouse, a family, a very comfortable death.
What is the right thing to do, to say? I already know what I will say to myself. I will say stop. Turn the page. Turn to that back one, the blank one that you know is coming. To the last one, glued to the cardboard, glued to the cover. Look. Use your hands. Your hands, use your beautiful hands.