When Jana returns to the curtained cubicle, she finds eighty-three-year-old Mr. Cianetti has moved off the examining table and is sitting on a low metal stool. His frail crossed legs have hiked up the johnny so his genitals are visible, snuggled in the crack of his groin like resting mice, but he seems not to notice. His steady dark eyes follow her for a moment as she lays down his chart, then his face implodes in a grin which furrows the loose flesh of his cheeks and reduces his lips to mere lines but still comes out looking impish.
Jana loves her old patients. Ambitions all played out, they sit before her, ink still, mysterious with memory, removed from the dirty march of time. Some of these people are the ages her parents would be, though she rarely thinks of this, rarely allows herself to think of this.
"Your parents must be proud," he says.
She leaves his chart on the counter, takes a seat on the other stool, and rolls up beside him. "I'd like to admit you overnight, Mr. Cianetti. So we can do some more tests and get a better idea of what is going on. I want you to see a neurologist. His name is Ren Scofield and I've already talked to him about you."
"Of course." He squints at her. "You can tell me I'm dying."
"It's not a question of dying," she says, though of course it is and he knows it. He probably won't die today or tomorrow, or even next month, but at his age his prognosis is not good even if his brain tumor is operable.
She would prefer to have this discussion when she had time for it, instead of at a moment when she is pressed to leave to get her son, Evan, but one can't always choose these things, and she would also prefer to be the one to talk to Mr. Cianetti rather than leaving it until the next shift when Gaffney and Ettinger come on. They're both good docs, but they can be abrupt with the older patients, often imparting just enough information to inflame the patient's anxiety and exacerbate the physical complaints.
"I'm not afraid of death," Mr. Cianetti says. "When you're my age it has a certain appeal."
She listens to the aftermath of his words to see if he means it, to see if the words don't regroup in the silence to mean the exact opposite. Sometimes, out of the silence, more words and feelings will materialize. He recrosses his legs, reaches up to his earlobe, and strokes it with a single finger.
Their silence is a small bubble in a hurricane of ER sound-a wailing child, frantic footsteps, the squeak of rolling carts and gurneys. And there's another subtler set of sounds embedded here, which only she can hear: the sounds of full-blown illness, not measurable in decibels, or detectable by the human ear, but easily amplified by the mind. The surge of adrenaline, the synaptic havoc of a brain in distress, a heart beating furiously to maintain itself. He glances around the cubicle and she sees his nearly lashless lids have moistened. She touches his loosely fisted hand. Lightly. Briefly. The skin is mushroom soft, and through it she can feel his entire circulatory system.
The ding at the nurses' station indicates another patient has arrived. She hates that sound interrupting every conversation of import, goading her to the next patient, as if what they do here is merely a mechanical transaction. The six other doctors in her ER group, all men, respond with good humor to the sound (more patients, more profits) and at least once a month one of them takes her aside. "You don't have to solve all their problems, Jana, just their medical ones," Ron Gaffney is fond of saying. Or the group's director, gentle fifty-eight-year-old Bill McElroy says: "You were born in the wrong generation. In the old days it would have been fine to work at your pace." But they say these things gently and they keep her on because patients write letters of thanks to her, because the hospital administration wants them to have a woman on staff, and because she does her job quietly and well, taking on extra shifts whenever anyone asks.
"This isn't a death knell, Mr. Cianetti. I only want you to know it could be serious."
"Just tell me what to do, General." He grins. It amuses her to hear him call her "General," which is just what her husband, Cooper, often calls her. She didn't like the term at first, but she's come to accept it-just because she's a general does not make her a dictator, and it's true that she takes charge easily and gets things done.
"You're a good girl," Mr. Cianetti says, as if he's her teacher or her father, his tone implying that she has yet to see much of life. Hearing his words, she wishes he were her grandfather and she was the clear-eyed, naive girl he thinks she is.
"Do you have family?" she asks.
"No. No family. They're all dead."
She touches his hand again and ignores another dinging outside. "We know you have a brain tumor, Mr. Cianetti. The CT scan told us that. But we have to find out what kind you have and whether it's operable."
Slowly, she explains the plan for admitting him. She delivers the words simply, in the soothing way that makes patients old and not-so-old later recall her as a special doctor, trustworthy and fully present. He listens agreeably, squinting through his headache pain yet unwilling to belabor it, but when the nurse, Sue Dennison, comes to wheel him off, he looks at Jana with a panicked realization she will not be accompanying him. He keeps his dark, watery eyes on her with an expression of speechless betrayal as he is wheeled away.
THE ROADS ARE SLICK with a cold rain. Late to get Evan, she chides herself for taking too much time getting Mr. Cianetti settled. Evan is in an after-school program called Little Creations, which he began in this, his first-grade year. Though it is reputed to be one of the best programs in town, it was not Jana's first choice but a last minute arrangement necessitated by Evan's baby-sitter Mrs. Stubbs's sudden decision to "retire." Approaching sixty, Mrs. Stubbs claimed that Evan's energy was getting to be too much for her. She had been sitting for him since he was eight months old, so parting with her has not been easy for Evan or Jana.
A great urgency scrolls through her in these twilight moments when she transforms herself from doctor to mother. She feels a drive strong as a migratory compass. She cannot reach Evan fast enough, cannot believe they've been apart for so long.
Little Creations is located near the hospital-six minutes without traffic-but even so, today she'll be late. She drives too fast. She always drives too fast, maneuvering her Honda Accord deftly through city traffic, trying to outwit and out-drive the other cars as if they are all participants in some Olympic event. Behind the shatterproof tinted windows her demons can prance freely, and she easily outdistances even the surly young SUV drivers.
The water on Bellingham Bay is pimply with rain and the islands, usually visible, are shrouded in fog. The roads seem slimier than usual and she slows. The driver of a red Ford Explorer behind her, a youngish-looking man from what she can see in the dusk, leans on his horn, then he swerves into the right lane. When he's overtaken her, he cuts in front and slams on his brakes, forcing Jana to jam hers so hard that she comes to a full stop and misses ramming him by only a few inches. She sees him checking his rearview mirror, gloating, pleased he's "gotten" her, before he takes off at top speed, weaving from lane to lane.
A symphony of rage rumbles throughout her car. Rage in the pistons and rage in the carburetor, rage in the wipers slapping rain from her vision. Rage slithers through her irises and her flared nostrils. It bongos in her eardrums and travels down her jawbone to rattle her teeth. Rage is awake and alive, loose with possibility. The driver of the red car has ...