Procedures for Treatment

Sandra Florence

Zoe drove through the morning thunderstorm that had quickly filled gutters and many intersections making them impassable. She took a back route through the ever-expanding medical complex to the parking garage. As she turned the corner a flock of oblivious pedestrians, some with umbrellas, others with newspapers held over their heads, lurched into the street right in front of her.

“Look out!” Miranda yelled grabbing Zoe’s arm.

She braked, spraying water in three directions before the engine died. Fuck, that’s all she needed…to run over some idiot today.

“Sorry.” She said looking over at Miranda, trying to calm down. Rain had a strange effect on desert dwellers.  Zoe waited while packs of medical, nursing, and pharmacy students took the opportunity to wade across the flooded street. She switched on the ignition and the Rav sputtered to life.

In spite of the downpour, they arrived early for Miranda’s treatment planning session. They watched the RA’s and the docs arriving, and played a game, matching the actual life-size doctor with the small photo on the wall.  

“There’s Dr. O’Herlihey,” Miranda whispered pointing to a black and white photo. A cheerful-looking woman with a stylish bob smiled at them from the wall. “She was Mimi’s oncologist.” Miranda was referring to a friend of hers who was in the last stages of liver cancer. Zoe noticed how vulnerable Miranda looked. Her beautiful blue eyes were wide, almost teary.  She reached over and put her arm around Miranda hoping she wouldn’t mind since she did not like public displays of affection.

    After sitting in the waiting room for at least forty-five minutes, they were escorted to an exam room.  Zoe stared at the wall. Hospitals were always cold and she was beginning to feel numb. Miranda read a flyer about a support group for the brain injured.  She  looked up. “I wonder if I’ll have to take time off from work during treatment?”

“Well, that’s something you can ask the doctor. I don’t think it’s a given, but…you should if you need to. I certainly would.”  

    Zoe listened carefully to the steps in the hallway. She thought she could distinguish between the footsteps of a nurse, an assistant, or doctor by the pace, sound on the floor, and the pause at the door. She hadn’t heard any footsteps, however, when Dr. Corelli’s RA, Kiko Tinaba slipped into the room in her white coat, trousers and what appeared to be satin Chinese slippers. They turned out to be Sketchers but still, they were a nice touch. Dr. Tinaba couldn’t have been more than twenty-four.  Her head was shaved, a tiny silver Buddha dangled from her neck, and her eyes sparkled behind trendy wire-rims.  She shook hands with Miranda and Zoe, sensitive to the fact that they were a couple. 

      “Ms. James, I just have a few questions to ask you before you see Dr. Corelli.”

      “I will get to see him today won’t I?” Miranda expressed the same concern Zoe had. Would they indeed see the real Corelli, the doctor who had completed his residency under the doctor who had created the procedure.

      “Of course, he’s just finishing with another patient.”  As Dr.Tinaba spoke, Miranda hung on each word, but Zoe became mesmerized by the voice. There was a clean clear …no…fresh cool…. tone. She couldn’t quite figure it out.  Maybe it was the precision of the voice that entranced. As Dr. Tinaba asked Miranda questions, Zoe got up to get a drink. She felt fidgety as she paced. She had just turned around in the room when Dr. Corelli hurried in and said, “Ms. James, I’m sorry to keep you waiting. He reached for her hand and she side-stepped him and said “no, it’s not me. There she is. Miranda turned and smiled, he laughed, the RA chuckled. 

     “You looked so nervous I thought you must be the patient.” They all chuckled again.

     “Well Ms. James. This is a good decision you are making.”

     “Do you think so?” Miranda seemed hesitant.

     “Oh yes! The Cyber Knife,” Corelli explained, “is state of the art non-invasive surgery. There are only 50 of these machines in the country. You are in very elite hands.” 

      “Isn’t it dangerous?” Zoe asked not because she didn’t understand the risks one took with any medical procedure. It was more that she was dumbfounded by the virtual aspect of it, the thought of Dr. Corelli manipulating the cyber knife in cyber space, and shooting pencil beams through Miranda’s head.

Dr. Corelli smiled at Zoe. “Oh, no. We don’t do anything dangerous around here.”

There was a sweet, playfulness to Dr. Corelli. Zoe liked him. He made cyber surgery on the brain seem like an afternoon at the opera.  

                                                             ***

After dinner, Zoe watched Miranda head straight to her room and log onto the WebMD site. “I just want a little bit more information than the doctors gave me,” she said closing the door. Part of the problem as Zoe saw it was that Miranda had worked in health services over twenty-five years. She knew nurses and doctors; she knew the ins and outs of hospital procedure; she was aware that mistakes are often made by even the most diligent health professional. And as the old saying went, people in the medical field make the worst patients.  Zoe usually believed what the doctor told her if she liked the doctor. She knew that mistakes could be made, but she chose to leave things alone. And if she couldn’t actually trust in the doctor, she could trust in the good nature of the universe.  Miranda couldn’t.  She simply knew too much.  She always had questions after she had finished her consults even though she made lists of questions. What are the chances of seizure, will I need to take steroids, will my vision be affected. How much hair will I lose?

     The resident had suggested she would have to have six weeks of treatment. That seemed extreme for what was supposedly only a small piece of tumor left after brain surgery two years before, made inaccessible by its location on the sagittal sinus vein.          

     “Well, you see,” Dr. Tinaba said, “we don’t want to zap you with too high a dose. It is better to treat a little at a time so the brain cells that die, don’t die all at once and cause other problems. This way the brain has time to re-absorb the dead cells.”  Even a child could understand this explanation.

     Dr. Corelli had corrected the resident’s calculation, however. We can do this treatment in five days. Only five days. That’s much better thought Zoe squeezing Miranda’s hand for support.  Miranda squeezed back slightly then said, 

    “ But will that be safe? I mean you can do that?” And Zoe thought about all those dead cells lying around in Miranda’s skull if the treatment went too fast.  Dr. Corelli was amused and reassuring. He spoke with his hands, his eyes and a soft Italian accent.  

     “Of course! You see the tumor is about the size of a walnut.” He pulled out 

the x-ray and put it in front of Miranda and Zoe. 

     “We will be able to fractionate the treatments because of the size. It is small, yes, but still you don’t want it in there.” They stared at the dark walnut inside Miranda’s head that was pressing ever-so-lightly on her right lobe.

                                                             ***

Miranda logged off the computer and came into the living room. She had managed to find what she was looking for: 1 in 1,000 patients may have blindness after treatment.

     “I don’t want to be blind,” Miranda said dropping into the chair next to Zoe who was watching Law and Order, the original. It was an episode she had seen at least three times but she was transfixed by the quirky criminal being interrogated by Lenny. 

     “You are not going to be blind,” she said, continuing to watch Lenny do his thing. She reluctantly turned toward Miranda, trying to be more empathetic and patted her leg.  Would that suffice? Would that be enough to hold Miranda until a commercial break?  She had been comfortable in her stony silence, not wanting to talk anymore about “the procedure.” They had talked all day about it. Miranda asked questions Zoe couldn’t answer. And Zoe made assurances. She felt a surge of resentment at spending yet another day, another evening trying to find answers to unanswerable questions.  Then she felt the guilt and took a breath letting herself relax. A commercial came on and she hit mute. She turned to Miranda. 

     “I know you’re scared, but it will be okay.”

     “How do you know that?” Miranda asked in a tone that was almost angry. Zoe felt the despair setting in. Telling Miranda she would be alright wasn’t going to fix her fear. No amount of assurance would.

     “I just know, that’s all.” Zoe persisted. “I just feel it. You have to trust. And besides, it’s benign.”  Zoe did feel optimistic. That wasn’t a lie. She also felt fear herself because her reserves were low.  It had been about two years since the original tumor had been discovered. They were packing for a weekend trip when Miranda began to complain of an excruciating head ache that would not go away. A trip to the ER, a six- hour wait, and a CT scan would reveal the problem. Zoe was reading a book to Miranda called, The Town That Forgot How To Breath, trying to take her mind off the pain in her head when the doctor appeared and said…

      “I am sorry to have to tell you this, but you have a tumor on your brain.”  Zoe dropped the book and burst into tears. Miranda looked up at the doctor. 

     “We will need to do an MRI to get a closer look at what we’re dealing with. We’ll get you prepped for the procedure shortly, but I’ll give you a minute,” he said, visibly disturbed by Zoe’s wailing. He patted Miranda’s shoulder and left.

      “My god! Is this it? Is this the end of my life?” As they held each other and sobbed, doctors, nurses, more sick people passed or were wheeled by them. One young woman who had apparently escaped from the hospital’s psychiatric unit was subdued by police officers and brought back in, strapped down and screaming. They were finally moved into a room and it wasn’t long before the lab tech showed up to take blood and prep Miranda for an IV.

     “Do I really need an IV for this?”

     “It’s just a precaution,” he said. “This way you’re ready to go.” He worked gently, but Miranda’s veins were not cooperating. He tapped and inserted the needle and deftly moved it around under the skin searching, then moved to another spot. 

     “I’m sorry,” he said as one vein after another slipped away from him. Finally he found a vein that could hold the needle and he said, quietly, “Eureka.”  Miranda breathed a sigh of relief and leaned back against the pillow. 

      This procedure, a much more exact and close look at the brain, did reveal that the tumor was benign, on the outside of the meningial tissue and non-life threatening. She would, however, need a craniotomy, and then she would need time to recover.  Their relief was as quick as their distress had been.

      During the recovery time, Zoe, did everything for Miranda, cooked healthy meals, bathed her, helped her dress, called friends and family and reminded them to come by and visit. She trudged to her full time job overwhelmed by the confluence of emotions, and at times her fear of being trapped manifested as anger. There was so much uncertainty. Miranda reported so many symptoms: tiny seizures, a cut in peripheral vision, tremors and internal shakiness, sensitivity to light and noise, ringing in her ears, pain at the back of her head where the flap, a horseshoe- sized incision was located, held together with giant staples. Zoe came home from work early one afternoon and found Miranda standing in front of the bathroom mirror examining the incision.

     “My head hurts,” she said furiously rubbing the back of her head.

     “Of course your head hurts. You just had brain surgery. It wouldn’t make sense if your head didn’t hurt.” In truth Zoe could only imagine what Miranda must be feeling everyday as she sat in the living room beset by the after effects of someone poking around in her brain. These symptoms could possibly indicate a breach in the temporal parietal juncture causing scattered arrhythmic electrical patterns her neurosurgeon had explained.  And so they waited, together and apart, and Zoe had been amazed by her own capacity to deal with the daily demands on her, both physical and emotional. She had managed to keep her own fear at bay and rise to the occasion.  They walked around the block each evening, down the alley past an old adobe being renovated and barking dogs. Miranda leaned on Zoe for support and balance, and when the noise and light became too much, they headed back to the house.  Finally, after months of being vigilant, Miranda 

began to emerge out of the dark cloud that had been engulfing her, the symptoms began to disappear. Zoe was grateful to have her back.

                                                                  ***

     “I shouldn’t go on line and look for answers,” Miranda said, looking down at the floor and shaking her head. Zoe agreed. Every time she did, Miranda found more conflicting pieces of information, more duplicate symptoms, more confusing exceptions to every other piece of research. But she couldn’t help herself. Like a bystander who cannot turn away from a terrible accident, Miranda looked and looked. Except in this circumstance she was no bystander.

                                                                 ***

The first day of treatment Zoe took time off from work and drove Miranda to the medical center.  

     “People in hospital parking lots drive a little crazy,” Miranda warned, as Zoe circled looking for an empty spot. She wondered if Miranda was referring to other drivers or her. She did often become aggressive behind the wheel. 

     “Why is that?”

      “They’re often slightly debilitated from medications, pain, maybe bad news.” Zoe whipped their tiny Rav into an open spot just ahead of a Lincoln Navigator. 

     “There is no fucking way that giant-ass vehicle is going to fit in this space,” she grumbled. The Navigator sped away screeching its tires and narrowly missing an equally large-ass truck barreling up the incline into the lot. They climbed out onto the top level of the parking garage and made their way across the grounds passing people in various stages of decline and recovery, depending on how one looked at it, waiting for Van Trans, Handi-Cars, and  unreliable relatives scheduled to pick them up. Near the entrance to the Cancer Center, two blue signs in front of them read, THIS IS A NON SMOKING CAMPUS, and SMOKING AREA UNDER THE BLUE AWNING - . Zoe looked around for the blue awning and expecting to see a cluster of smokers furtively puffing under it, but she didn’t see either.  They boarded the elevator which took them to the basement, and Radiation Oncology.

Miranda slid her identification card through the machine and was checked in. They found comfortable seats against one wall next to a table piled high with bananas, apples, and fruit juices. Zoe picked up a Cran-Grape for herself, and an Apple for Miranda. Zoe was so thirsty she downed the juice in two gulps. Then she headed for the vending machines and bought a large Snickers bar. She offered a few bites to Miranda, but Miranda was restless and distracted. 

     “I wonder if I should alert the receptionist to the fact that I’m here,” she said looking around for a receptionist to speak to. 

     “I think that’s what the card and machine are for…that is your check-in,” Zoe tried to reassure her as she shoved down the rest of the candy bar crumbling nuts and tiny chocolate pieces on the front of her shirt.

      “I just want to make sure.” Miranda got up and went over to the large circular reception area just as a receptionist came out of the back. 

     “Hi, yes….if you put your card through, you are checked in…..oh! let me look just to make sure.” The clerk typed in some numbers and Miranda’s name appeared on the 

screen. Miranda returned to her seat and Zoe got up to get another fruit juice, suddenly aware of how thirsty she was again.  

       A man in moccasins milled around the waiting room looking for a magazine, coffee,

snacks.  There seemed to be a miscommunication between the radiation tech, the receptionist and a patient. They couldn’t locate her. They kept calling her name,

     “Barbara Jackson, Ms. Barabara Jackson” Zoe knew the woman was in the bathroom and that her husband was in the hallway talking to someone. 

 How come I know where the patient and her husband are but the staff doesn’t, Zoe thought, feeling slightly contemptuous of them.  And another thing, why can’t these people sit still so somebody can find them?  Should I tell the staff where they are?

Is it any of my business?  Within a few minutes, the woman emerged from the bathroom and rejoined her husband just in time as the radiation tech made another sweep of the waiting room and located the wandering couple. Zoe was relieved, and glad she had not interfered.

     She glanced over at Miranda who was still thumbing a copy of the Smithsonian,     

     “Denizen’s of the Deep: New Views of the Weirdest Creatures You’ve Ever Seen.”  

Not today she thought.  She noticed a young woman who was bent over a clipboard filling out forms for her sister who was in the hospital. Zoe had heard enough of a conversation between the rad tech, the doctor and father to understand this.  Miranda looked up from the magazine.

     “That family seems very needy,” she said leaning toward Zoe. 

     “The girl’s sister is in the hospital already.” 

     “Oh!” Miranda said wincing.   

The father of the girls, long-haired, with Indian Pride tattooed on both shoulders, kept pacing, chattering to the nurses and even the man who was cleaning out the giant aquarium.  A short-stocky elderly man was escorted back to the waiting room by a smiling pregnant rad tech. He hung on her arm and kept talking to her. Then he stopped by the reception desk after spotting two doctors. 

     “Hello, hello,” he said, raising both arms at the two men sitting on stools by computers. 

     “Hello, Mr. Archer, how are you today?” One asked and both turned and smiled giving him the full force of their attention. 

     “Fine, great. I guess I don’t have to come back until……tomorrow…oh no….uh! Monday…Monday cuz we’ve got the weekend coming up. And I’m feeling good, good,

but I’ll be back.” The doctors nodded.  He inched closer.……”Now which one are you,” he asked pointing to the younger doctor, “are you Jensen or…….Franklin?” The doctors were both standing now and they towered over Mr. Archer.  

     “Neither, I’m Hanson…..”

     “Edgar, we’ve got to get going now before traffic gets too bad and the kids are hungry,”  his wife intervened, gently pulling him away and reminding him of a pending engagement and the two grandchildren she’d been corralling during his treatment.  

     “Oh yeah! Oh yeah! Just let poppy go potty and we’ll get going.” He disappeared into the long hallway. The oldest child dangled from one of the chairs next to Zoe, and started singing, “poppy’s going potty, poppy’s going potty.”  Zoe smiled at the boy, then turned to Miranda. 

     “Some people need a lot of attention, don’t they.”

     “Did you see the scar? Miranda whispered. “There was a huge scar above the temporal area. It’s probably a loss of inhibition. Maybe a partial temporal lobotomy.” 

     “Do they still do that?”  Zoe asked.

     “Well, sure! Lobotomy just means lobe or removal of a lobe.”

 Zoe was startled by a radiation tech in pink teddy bear scrubs calling Miranda’s name. She came over to shake her hand. 

     “Hi, my name is Mary and I’ll be giving you your treatment today. She beamed at both Zoe and Miranda. Zoe could tell the meds had finally kicked in but they only seemed to have made Miranda more anxious.

     “Can she come with me,” Miranda asked pointing to Zoe. 

     “Oh sure, for the first part of it, while we get you set up.” The three of them made their way back to a large room. Another tech helped Miranda up on the table and brought the mask over. It was white with ½ inch square holes all over it, a combination fencing mask and medieval face plate. 

     “My lips are so dry.”  

     “Here’s some water,” Zoe brought over the bottle of Dasani and Miranda sat up to drink.  

     “Do you want some music?” one of the techs asked.  “Let’s see….we’ve got Oldies, some kind of piano singer, and classical.”  

     “Oldies, that’ll be good.” Soon a tune from the late 50’s came on, Goodnight My Love.

Zoe leaned against the wall and imagined drive-ins, cruising main in long-low, chrome encrusted cars. A night sky filled with stars. Yes, it was comforting. The techs began fitting Miranda into the mask.

     “It’s tight back here where the screws are,” she pointed to the back of her head. One tech tied a rubber band around her feet to make sure she was even, then began manipulating the mask again. Miranda put her hand up, “wait, I’m sorry,” she said. The technician removed the mask and Miranda sat up to cough. She looked over at Zoe. Zoe smiled and gave her a thumbs up.  Miranda swallowed hard, took a deep breath then lay back down. The mask went on again. 

     “Lift your chin, okay, how’s that?”

     “Uh, okay. It’s very tight back here.”

     “There’s not much we can do about that. Can you handle it for about 15 minutes?”

     “Yeah, okay. Will you keep talking to me and telling me what you’re doing?”

     “Sure, we can do that.”

There were green beams of light knifing across the room above the exam table where Miranda lay. 

     “Okay we’re going to do the first x-ray now,” Mary said, and the other tech turned rapidly toward Zoe and shooed her from the room. She walked back to the waiting room thinking of gamma rays, something about marigolds and gamma rays, and moonlight.

                                                           ***

She could see the Indian father standing by the reception desk as she approached the waiting area.  His desperation and uncertainty about his daughter’s fate were palpable. His other daughter had put down the clipboard and wrapped herself up in a red blanket. Zoe felt the cold but didn’t want to talk to the father even though that might have been the compassionate thing to do.  She walked by him avoiding eye contact. She found 

another seat against the wall and picked up a copy of House Beautiful flipping absentmindedly through its pages. Poppy and grandchildren were no where in sight but a father and his athletic-looking teen-age son had taken their place. The boy looked completely healthy and normal except for his shiny bald head. The elevator bell made a loud ding, and a mother wheeled her young daughter into the waiting room. The girl wore a leg brace with an American flag sock over it.  Zoe’s heart shuddered for a split second. She closed her eyes and took a deep breath letting in the pain. Outside, above them, the season began to shift from summer to an almost imperceptible autumn.

                                                              ***

MRI image from Wikimedia Commons, by Dr O. O’Neil