W. Roy Smythe, MD
Texas A&M Health Science Center, Temple, United States
Souvenir de mauve, 1888
In the hot Texas summer of my 77th year, my skin turned a little yella’, and I lost some weight. Doc Butler, who I’d been seein’ for ‘bout 30 years now, told me to go to the “cancer center” in the city.
I didn’t want to go, but hell, he told me they know more about cancer than he does, so I went. On the way to my first appointment, I got thinkin’ ‘bout life. I grew up in a small town that my granny used to say “wasn’t no bigger than a cooked pea.” With just a grocery, a post office, a beauty shop, a fillin’ station, and no stop lights, my home town was still sleepin’ just down the road from my farm. These days, farmin’ wasn’t more than gettin’ some dirt under my fingernails, but we still managed some corn, some hay, and one big ol’ peach tree in the backyard.
As a kid, I remember the cows walkin’ up as soon as they heard the back door screen slam shut in the mornin’—when it was still way too dark for them to see me come out the house. I did a lot of thinkin’ while the inside of the barn turned from black, to grey and, finally, light blue as the sun come on up behind me through the big door to the milkin’ stall. Those mornings the “pssst, pssst, pssst” sound of the milk hit the aluminum pail as I dreamed ‘bout growin’ up.
All of a sudden, I opened up my eyes and come on back to “the real world,” as Momma would say. I was sittin’ in the doctor’s office by myself. Momma was at home with the grandkids; I’d asked her not to come ‘cuz this whole deal was givin’ me a bad feelin’.
Sitting back again in the waiting room chair, I took out my wallet and slipped out the picture of my boy and girl—both now in their late forties—when they was kids. It was my favorite picture of the two of them. Actually, I had come to love not just lookin’ at this particular picture, but the feel of it, too—sort of crinkled on the front and soft and fuzzy on the back side where the paper was slowly rubbin’ off.
I ran my fingers over the surface, over the tiny lines, and their little faces—they was, I thought in a sorta’ sad way, faded to a light yella’ by time. Sorta’ like I was lookin’ now, I guess—yella’. Margaret was five then, and little Ronnie wasn’t quite two yet . . .
The doorknob jiggled, and a woman in a white coat busted into the room. “Hello, uh . . .” she looked down at the papers in her hand, “. . . Mr. . . . uh . . . Mr. Jones . . . right?”
“Yes, ma’am,” I replied, “that’s me.” She looked at me long enough to confirm that I wasn’t some imposter and then plopped right down in front of a computer.
“Your date of birth is seven-fourteen-forty-four?” “Yes, ma’am,” I answered, “don’t seem as if I am that old, you know . . .” She interrupted me right there, “your address is 1200 Route 16?” “Yes, ma’am,” I answered.
I figured pretty quick that this was gonna’ be a one-way street, and that she was gonna’ do all the drivin’. She clicked the computer keys real fast and kept talkin’.
“I have an email here from Dr. Butler. He says that his preliminary evaluation, which included laboratory assessment, a CT scan, and a biopsy suggest that you have a pancreatic malignancy that has spread to your liver, is that correct?”
She was starin’ at the computer screen. I waited a minute to see if she was gonna’ look over at me.
“If that means I got cancer in my pancreas, that’s what Doc Butler said he was afraid of, yes.”
“Did the nurse get your vitals?” she asked, again peckin’ on the keys like a rooster ‘bout to spur. She was leanin’ in so far towards the computer screen that her face was glowin’ white—like them horror movies on a black-and-white TV.
“Come again?” I asked.
She seemed a little put off, “You know, your blood pressure and heart rate, et cetera.”
“Yeah, she checked those right before I came in here.”
“I TOLD her to log these in!” she griped as she got up to leave the room. As she grabbed the doorknob, I asked, “Say, ma’am, are you the doctor?”
“No, I’m the physician’s assist . . .” as the door shut behind her.
I sat there for a minute. I thought I might just bust out laughin’, you know, the kind of laugh the teacher made when you was a kid and walked up to her desk and told her that the cow had eat your homework.
Suddenly, I realized I was tired. I got up early every day, around five or so, but had to get up at three this mornin’ to make the three-hour drive into the city for this appointment. I hadn’t been sleepin’ real well besides. I looked at my watch—it was ten already, and I hadn’t seen hide nor hair of the cancer doctor. I started wonderin’ whether or not I was gonna’ see him at all. Still thinkin’, I leaned my head back on the wall and fell right to sleep.
The door bust open again, startlin’ me awake. I saw the doctor stride in, ahead of two others. He was tall and looked real young. He had on a coat so white that it almost hurt my eyes, and it looked starched stiff enough to ward off buckshot from six paces. His shoes was real shiny. I was still starin’ down at his shoes when I noticed he was standin’ over me lookin’ down. The smell of someone’s cologne was on the suffocatin’ side.
I stood up and reached out for his hand, but he was rubbin’ ‘em together with somethin’ that smelled like rubbin’ alcohol and liniment. I put my hand back in my pocket and sat back down.
“Hi, Mr. . . .” I be damned if he didn’t have to look at them papers, too, “Mr. . . . Jones?”
“That’s right,” I replied. The other two folks, also in white coats, but shorter ones, moved to the back wall. They was starin’ at me like I was a new calf comin’ out breach.
The doctor sat down on the same stool as the lady before him and started clickin’ away at the keys.
“So,” the doctor said cheerfully, like he was the clerk at Macy’s or somethin’, “how are you feeling?” I figured he knew how the other two folks was and that he was askin’ me, but I wasn’t sure ‘cuz he was lookin’ at the computer.
“Alright,” I said.
“Good, good,” he replied, squintin’ at the computer. He shifted on his stool and I could hear that starched coat foldin’ on itself. “So . . .” and he tailed off, clickin’ away like a madman at them keys.
I cleared my throat to get his attention—I wanted to know what came after “so.” “I’m sorry,” he said, “we have a new computer system, a little confusing, you know?” I didn’t know, but he was the doctor.
I looked over at the two in the back of the room. One of them had taken out her phone and was laughin’ under her breath, “thumbin” it like my grandson Bobbie. The other one looked like he was sleepin’ standin’ up.
“Doctor Butler’s your referring?” he asked me, still squintin’ at that screen.
“You mean my doctor?” I asked.
“Yes, yes,” he said, and whipped out ‘bout 20 more keystrokes, the last one with his right hand—liftin’ it up and snappin’ it down like a conductor stoppin’ the orchestra.
He looked over at me smiling like he had done somethin’ clever.
“You have pancreatic adenocarcinoma,” he said and looked over at the two in the back of the room. The fella’ on the left was still sleepin’, and the girl looked up from her phone.
“Ms. Valdez,” can you tell me anything about the presentation of pancreatic adenocarcinoma, say, one located in the head of the pancreas, near the common bile duct?”
I had no idea what any of those words meant. I understood pancreatic must have to do with my pancreas, and that the word endin’ in “oma” might have meant cancer, but the rest sounded like Momma’s goulash.
“Yes,” she replied, “elderly, thin, painless jaundice, perhaps Courvoisier’s sign.”
I was old and a little skinny, but I didn’t speak no French.
“John?” the doctor said to the other one.
“Yes?” he replied, startled awake all the sudden, “What?”
I was thinkin’ that these two was students of some sort, and I decided right there that the fella’ that was sleepin’ had some work to do to make a doctor. I hoped that he was just tired from workin’ too hard, and that it wasn’t that he was just short of grain in his silo.
The doctor looked back at me, “Do you understand what this all means, Mr. Jones?”
His voice sounded a little bit like the fella’ that read the news on the radio.
“Well,” I said, “it ain’t good, right?”
He looked back at the computer, and started typin’ again. I noticed that both of the students was thumbin’ on their phones now, not payin’ any attention what-so-ever.
“That’s right,” he said, “nothing that we can do for you surgically, with metastatic disease. You could consider chemotherapy, with some investigational agents. I’m looking up some biologic agent clinical trials now . . . . Yes, there is a monoclonal antibody trial up in Boston, you should consider that. I have to admit that the biologic underpinnings are sound.”
He was smiling again. I had no damn idea what he was talkin’ ‘bout, except the part ‘bout me not havin’ no surgery.
“So let me get this straight, doctor,” I said, tryin’ awful hard not to sound too worked up, “There ain’t no surgery option, but there might be some medicine I can take to make this go away?”
Both of the students stopped thumbin’ at the same time, like they was on cue, and looked at me, a little anxious.
“Well,” he said, “there are other options, like the trial in Boston.”
“Boston, Massachusetts?” I asked, “What’s the chance that this “anti-body” medicine there will work?”
“Hard to say, clinical trial,” he answered. I had no idea what a clinical trial was, but it sounded like an experiment of some sort, and this doctor wasn’t soundin’ too optimistic.
“Listen, doctor,” I said, “I’m not a stupid man. I know a lot ‘bout animal husbandry and fair bit ‘bout farmin’. That all bein’ said, I don’t know nothin’ ‘bout doctorin’. Now, what’s the chance I can beat this thing?”
He kept lookin’ at the computer screen, but took his hands off of the keyboard and put them in those stiff white pockets of his lab coat.
“Hard to say,” he replied. I waited for the next shoe to drop, but it didn’t even come off the danged foot. I decided to press my bet.
“Okay, is it better than five in ten?”
“No,” he replied.
“Okay then, how’s ‘bout two in ten?”
“Probably not,” he replied again, glancin’ over his shoulder, lookin’ for some sign of agreement from his students, both of which was still thumbin’ around on their phones.
I sat there and looked at him for a long moment, not knowin’ what I was supposed to ask now.
He finally looked over at me. “Do you have any other questions?” he asked, not really lookin’ any which way—not happy or sad, just like he was done.
“No, sir,” I replied, “I think I get the picture, I get it just fine. What you’re tellin’ me here is that I drank downstream from the herd.”
I could tell that I had turned the table on him by the confused expression on his face. He got up and put some more of that alcohol shit on his hands.
“Thanks for coming in, Mr. . . .”
“Jones,” I said. “Jones.”
He and the students left the room, the smell of that damn cologne still hangin’ in the air like fog on the riverbank in the mornin’.
I kept sittin’ there for a minute or two, and figured since no one had said nothin’ otherwise, that I could leave. I started walkin’ down the hall to the exit door, when a nurse came and grabbed me by the arm.
“Mr. Jones,” she laughed, “you can’t leave yet, you have a co-pay that you have to take care of.”
The back screen slammed shut as I closed the wooden door behind me back at the house.
“Hi, Papa,” Momma called from the kitchen. I could both smell and hear salt pork gettin’ browned in the skillet.
I changed into my work boots in the bedroom, and went over to the kitchen and kissed Momma on the cheek. She smiled, but was focused on dinner. She was a serious cook—not fancy, but serious.
I looked over my shoulder as I left her there and walked out the back door again. She was a beautiful woman.
I always liked it when her cheeks turned red, like now when she was cookin’ over a hot stove, or other times when she laughed a little too hard ‘bout somethin’ we both thought was funny. When she was younger, her cheeks would look like that when we got frisky.
We had been together now for 50 years. It pained me powerful when I thought ‘bout havin’ to tell her the bad news, but I had a little time. Not tonight.
I walked through the backyard, ducked under the newly-twined clothesline, and stopped at the big peach tree over in the corner. Standin’ this close to a peach tree at this time of year is like bein’ baked right into a pie. It was the heat, and the smell—some on the ground that are in various stages of sweet rottin’, and those on the tree that are gettin’ ripe, fragrant and juicy.
I reached up and plucked one, and kept walkin’ out of the yard and into the fields. The sky in Texas at times in the summer takes on a real pretty pink-orange color, reflectin’ off of the bottoms of clouds, standin’ out against the late afternoon cornflower blue sky.
Tonight the clouds looked like great big angel’s wings, turned upside down.
I could smell the warm musky black earth of good farmin’ country beneath my feet and the clean green grass smell of the corn plants.
The evenin’ heat felt real good on the back of my neck after the air conditionin’ at the hospital.
Goddamn it, I love this place, I thought to myself. I took a bite of the peach. It was perfect—sweet and tart and crunchy. I wiped the juice off of my chin with the back of my sleeve and cried.
I just stood there and cried until I couldn’t see the clouds any longer, and the moon rose just above the horizon in the darkened sky, a brilliant white sliver of an “eights” moon, as my granddaddy used to call it.
That night, Momma and I laid in bed, and she turned over on her back kinda’ quick—like when she was gettin’ ready to talk ‘bout somethin’.
“Papa, what did the doctor tell you anyway?” she asked, with just a touch of worry in her voice.
I cleared my throat, and tried to sound like I wasn’t bothered by any of it, “He has to run some more tests, won’t know for a while, but he didn’t seem worried,” I replied. “You know, them doctors—they look good, but they don’t know much.”
She laughed, “Yeah, but it’s good to have ‘em when you need ‘em.”
“I guess,” I replied. “You know, it was funny today. I think I got through the whole damn visit at that fancy cancer center without anyone touchin’ me except the nurse that took my blood pressure.”
“Really?” she asked.
“Yeah, and there was two students in the room with the doctor that acted like I wasn’t even there. Neither one said nothin’ to me—not ‘hi’, ‘bye’, or ‘kiss my ass’ for that matter, and all three of ‘em walked around like they had oil wells in the backyard.”
“Too bad,” Momma replied, yawnin’, “You oughta get some sleep now, Papa.”
I stopped a minute, thinkin’.
“Say, Momma, do you remember when we used to lie in bed and wish our two little ones would never grow up, you know, stay little?”
“Sure,” she replied.
“I guess that life just goes on, don’t it?”
“It sure does, honey,” she said.
She turned all the way over and snuggled next to me.
“Momma,” I asked, “when it’s my time, will you bury me under that big old peach tree out back and angle me just right, so I can see the sunset every day and smell all them peaches when they come out every year?
“Yes, Papa,” she replied and fell asleep in my arms.
W. ROY SMYTHE, MD is chairman of surgery for the Texas A&M Health Science Center College of Medicine and the Scott & White Healthcare System, as well as professor of surgery, molecular, and cellular medicine, and the holder of the Glen and Rita K. Roney endowed chair in surgery. He has been a prolific writer on diverse topics, writing and publishing manuscripts, editorials, essays and abstracts related to his clinical and research activity, as well as surgical history, education, health care delivery, and medical human interest. Read his blog at www.willandreason.com.