Health Care: A Roentgenogram

cxrDaniel Haller, Julius Mackie, William Powlis—these three men saved my life.  I was 25 and in my final year of medical school.  I’d had a nagging cough for several months and my friends urged me off and on to get a chest X-ray, check it out, though they half laughed when they told me.  No one, I least of all, imagined anything would turn up.  I was interested in radiology at the time.  It seemed like a good specialty.  New technology and a growing field—MRI was really taking off—great hours, a residency that wouldn’t kill me with years and years of on-call, plus I really liked it and was pretty good at reading films.  So when I put my own chest film up on the light box the last thing I expected was a large mass—as we call things that shouldn’t be in a person’s body.  The word has such connotations of size and weight, Newtonian physics, a cold, precise world where everything ends predictably.

Fortunately, Dan Haller, my oncologist, told me I had Hodgkin’s Disease, a “good” cancer to have, because it was always treatable and usually curable.  He put me through the drill of tests and scans, including a special form of torture no longer practiced called a lymphangiogram, where dye is inserted with needles in the webs of your toes.   Julius Mackie cut me open, took out my spleen, and assorted lymph nodes— a “staging laparotomy” to determine the spread of the disease and guide treatment.   Then he sewed me back up.  I was not an easy patient.  When the surgery residents gathered around me in my room on the med-surg floor, I told them I thought I might have an obstruction.  I was still woozy from the morphine, but I knew everything, which means I knew too much, and was sure I’d suffer all the complications.  Most medical students were part-time hypochondriacs.  You couldn’t read about so many terrible diseases and take care of people afflicted with them and not become infected with a little fear, a little irrational fatalism.  In my case, an overactive imagination had actually produced results.  But somehow, despite my elaborate concerns, I recovered from the surgery unremarkably and began my radiation treatments.

When I inscribed my first book, Plums & Ashes, for Bill Powlis, my radiation oncologist, years after he cured my cancer, I wrote that aside from my parents, he was the person most responsible for my being in the world.  About this, there is no exaggeration.  Although rare, Hodgkin’s disease had been inexorable, a death sentence for children and young adults until its modern treatment with radiotherapy (and/or combination chemotherapy).  Bill Powlis was and is a master of that field.  He is a remarkable physician, fully informed and proficient, gentle, good natured, unflappable, an excellent listener, and a great teacher, which is so important because all patients, not just medical students, have much to learn if they are to collaborate effectively in their own recovery.  There’s a lot to know when it comes to cancer treatment, and the stakes are high.  Fortunately for me, I was treated by one of the best and at one of the best institutions in the country, the Hospital of the University of Pennsylvania.

Even then, I found it a difficult road.  I wore a hat religiously in an effort to hide the back of my scalp where my hair fell out.  More than once I had to explain to someone (in a whisper) why my head remained impolitely covered indoors.  The actual treatment took only a few seconds.  But the whir of the machine casting its high-energy beam promised that a few hours later, with clockwork punctuality, I would become sick to my stomach.  And the treatments followed a workaday schedule, Monday through Friday, for months.  Nonetheless, I tried to go on with my life.  I changed my residency plans—decided to go into pathology instead, less on-call, and I could do research, pursue poetry as a dual ambition.  I sat in on Daniel Hoffman’s graduate writing seminar on the other side of campus, telling him in confidence that I would have to leave early each session, so I could get back to my apartment before the nausea kicked in.  Only once did I mistime my exit, though I don’t think I’ve ever felt so wretched in my life, before or since, even during my initial diagnosis, when cancer transformed me from indestructible hot-shot proto-doctor into one of my on-call “admissions” lying on a gurney.  I’d loitered, to toss in my two cents about an interesting poem, and didn’t quite make it home.  It was February, and I bent over between the ATM and the convenience store in my gray parka while passersby tried to ignore me, just another drunk or homeless person in the snow…to be continued


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