Hektoen International

A Journal of Medical Humanities

One for science: nothing more, nothing less

Erin Duralde
Palo Alto, California, USA


On an ordinary day, just a routine checkup, Ruth’s left breast spoke up for the first time. Under the stiff press of the mammography machine, after 83 years of content silence, it cleared its throat and announced that today was the first day of its starring role in the drama of Ruth’s life.

Once the doctor had read the film, she called Ruth into her office to talk about the results. Ruth sat there in a baggy cardigan and loose leggings, waiting for fifteen minutes in silence. Knock, knock. The door swung open; in came an attractive young woman wearing only light makeup, her hair swept back in a high ponytail. She settled into the chair behind the doctor’s desk.

“Hi Mrs. Lieberman, I’m Dr. Johnson, an oncologist on staff here and I’ve called you in today to talk with you about the results of your mammogram.” She paused and looked up at Ruth, and, seeing that Ruth had nothing to say, proceeded, “I don’t want to scare you, but something has shown up on the images.” She spoke slowly but firmly, “It looks like cancer.”

A veil fell over Ruth’s head, and the hands of the world’s great clock came to a halt like a train on a steel track, hissing and screeching. “Now, it’s small, so hopefully we won’t need to perform a mastectomy, but I don’t want to take that off the table. We’ll need a biopsy to be sure.” The doctor pressed onward, flipping through Ruth’s chart as she rattled off millimeters of this, survival rates of that, and urged Ruth to be sure to schedule a date for the procedure. All the while Ruth’s heart thudded like a lump in her throat.

The doctor stopped. She looked up and took Ruth’s hands into hers and said, “It’s going to be ok. I know you are worried. Cancer is a scary word. But we are here for you, and we’re going to do a good job.” She paused. Ruth saw her microscopic pores, the gentle way her fringed bangs fell on her forehead, down toward the spidery, black eyelashes. She did not see her eyes, could not look at them. The doctor went on, “We’re lucky; we caught the cancer very early. Please don’t worry too much because nothing is certain until we have the biopsy results.” She flashed a respectful smile as she leaned in to make better contact with Ruth.

A faint thank you slipped out of Ruth’s dampened figure. Questions now flew frantically in her head, each one ricocheting off another as they leapt up for attention—How serious is this? How will I tell Herman and the kids? Am I going to die? When? How? What does this mean for today? Tomorrow? Am I doomed to the trenches of chemo? Will I live? What’s next?—and before she knew it she fell back into focus to hear the doctor repeating, “Are you sure you don’t have any questions?”

Overwhelmed, she shook her head and started to get up. How could she even begin to let loose that bristly yarn of anxieties tangling inside her? To let free even one bit would be too much to control and Ruth was not the type of person to make a mess of herself.

The doctor said goodbye and asked Ruth to stay in touch. But no sooner had the door closed than the doctor lurched back into the room, her ponytail swishing, “Oh! I almost forgot!” she proclaimed, darting to the other side of the exam room and quickly leafing through a set of pamphlets. “Here you go,” she announced as she handed them over, “I think you’ll find these resources helpful. Look at the purple one, that’s a new program we’re promoting called visualization therapy. The technique helps patients go into surgery calmer, more relaxed. And, it promotes faster recovery. I think you’ll enjoy the process too—”

“What does it entail?”  Ruth asked with squinty eyes.

“Well,” she began, “I should get you a copy of my book, but, long story short, a visualization therapist will help you focus on positive images that you can conjure. By focusing on the things you love, fond memories, and playing that filmstrip over and over in your head, you’ll develop a control that can be a very powerful tool in aiding a quick recovery.”

Ruth stopped listening. She thought for a second, Visualization? Is that like meditation, or one of those silly relaxation techniques Herman and I learned 5 years ago at the spa with the Madisons? Would I lie on my back, imagining leaves falling all over me, the autumn colors turning over and over, caressing and embracing me until I was just a warm ball? Well, I don’t want a spa retreat; I need a surgeon, damnit.

With a snap she returned to reality to hear the doctor affirming, “Early literature supports the use of visualization.” The doctor’s eyes proudly flashed as she talked about it, her jaw working to hide her smile. Visualization, after all, was the subject of her authorial debut. Everyone said she was one of the most promising thinkers in oncology today.

“Oh, ok sure . . . I’ll try the therapy if you think it’d help me. You’re the doctor,” Ruth said. Then, awash with a deep, indescribable fear, she slunk into her car and drove home, apprehensive of what was to come.

“Ruth, Ruth Lieberman?” the nurse called out. Ruth got up out of the waiting room chair. “Right this way, please,” the nurse motioned. “Dr. Tessa will be with you in just a moment, if you wouldn’t mind sitting here.”

Ruth looked back at her and sat down in the aged brown leather chair, surrounded by aged posters and large prints of the sort of clichéd inspirational sayings Ruth loved to hate. “How did you spell her last name?” Ruth asked the assistant with a sigh, pen in hand.

“Oh, no Mrs. Lieberman, Tessa is her first name. Her full name is Dr. Tessa DeSalva but she really prefers to go by Dr. Tessa or just Tessa.”

“Oh, ok. Well, thank you,” Ruth responded. She shifted in the chair and repeated to herself, You are in a hospital, it’s ok. When the nurse left, Ruth surveyed the room. The voluptuous ferns, their tendrils sprawling across the great desk, intrigued her.

There was a soft knock on the door, a pause, and then Dr. Tessa came gliding into the room. “Well hello Mrs. Lieberman, how are you doing today?” she seemed to breathe.

“So I see you’ve come in to learn some visualization techniques before your surgery. Excellent decision. I’m sure we can generate some real progress today even in our first session,” she beamed. “I’d like to start by telling you a little about myself. As I’m sure you’ve heard, my name is Tessa. I have a doctorate in nursing science and my dissertation research looked at the effects of cognitive-behavioral strategies on pain. What I like to do here is help you tap into the power of your brain to heal.”

Ruth sat there staring at her blankly. “Any questions before we begin?” Tessa smiled. Ruth shook her head. She had no idea what to expect; she preferred to just get started.

“I’m going to dim the lights just a little bit, let me know at any point if you feel uncomfortable.” Butterflies rose up in Ruth’s stomach. I thought the whole point of this was to make me comfortable? “Now just relax. Close your eyes and free your mind,” Tessa chimed in a hypnotic tone. Ruth appeared to follow orders, but under those heavy, shut lids, her mind was abuzz.

“Now tell me, Ruth what was a time when you were happiest?”

“When I was happiest?” Ruth stifled a laugh, “Well, I don’t know! You live as long as I do it’s hard to keep track of things like that.”

“Just think for a moment. Keep those eyes closed. Now, reach way back, think about your family, your friends, a vacation you took . . .”

“I’m drawing a blank here Tessa, could we move on to the next question?”

“No, I really want you to probe now. Successful visualization requires a rich setting for your mind to roam free in.”

“Ok,” Ruth sighed, “let’s go again.”

“Sure,” Tessa soothed, “Tell me about a time when you felt the happiest.” And she waited.

“I guess maybe the time my husband proposed to me.”

“Tell me more about that day.”

“Well, it was a long time ago, 1950 to be exact.”

“What else?”

“We were having a picnic in the park. He had brought a basket with cheese and crackers, ham sandwiches, and strawberries for dessert.”

“What was the weather like, were there people around?”

“I guess I’d say the sun was shining and the grass was still a little wet from the morning dew. We sat on a flannel blanket, I think, to keep dry.” And then Ruth laughed, “You know I could just be making all this up, I don’t really remember. Where are we going with this anyway?” She blushed.

“You’re doing great, Ruth. Keep going. Delve deeper.”

“That’s all I can remember.”

“No, really, imagine the setting again, go back into the scene, you’re doing great.”

“No, really, that’s all I can remember,” she replied.

“Oh,” Tessa paused, “Ok, no problem then” Tessa replied with a sweet tone. “You did a good job. I want you to just practice that and try to really put yourself in the setting when you’re at home. A really good place to practice is the bathtub where you are relaxed and comfortable, ok?” She smiled.

“Sure.” Ruth responded shooting the smile right back.

She looked at Ruth and paused for a second. “Ok, now for the next scenario I want you to close your eyes again. Imagine you are going into the surgery. All is quiet, you are under anesthesia. And now, after the procedure, you’re waking up. What do you say?”

Ruth shrugged, “Thank God it’s over?”

“No, no, no! That’s not the right attitude at all.” Tessa chastised shaking her finger.

What do you mean “that’s not the right attitude?!” Who are you to tell me how I should feel after I have a damn lump of cancer pulled out of my breast? Ruth wanted to shout out and tear those cheesy motivational posters off the wall. She had sat quietly waiting for this “Dr.” of dubious degree, tolerated the probing questions from a total stranger, but now enough was enough.

“Well, what do you want me to say?” Ruth challenged.

“I want you to say, ‘I feel wonderful! Today is going to be a new day!’”

Ruth was incredulous. Furious. This was completely absurd. She couldn’t see how visualization could ever be taken seriously. There was no way this woman Tessa should be working in a hospital. And what kind of doctor was this oncologist who promoted such mysticism?

“Alright,” Ruth played, hoping to move the session forward.

“Now,” Tessa began, “We’re piloting a new method that we’ve found to be very successful and I would love if you tried it.”

What now? Ruth thought to herself. At this rate just about anything seemed fair game.

Tessa continued onward, “I want us to generate a list of words that make you feel good.”

“What are we doing with the words?” she pressed.

“I’ll write the words down on an index card and that index card will be taped to your hospital gown. During the procedure the anesthesiologist will read these words back to you. We believe that even though your body is asleep, your mind is awake. Hearing these words will soothe you and help your body to heal faster.”

“Oh, no, no thank you,” Ruth responded with a look of distaste. Just cut the damn cancer out, sew me back up, and call it a day, she thought. At this point, Ruth realized that in order to endure the rest of Tessa’s program, she would need to keep quiet. At the end of the session, Ruth thanked Tessa for the visualization lesson, and fled to the safety of the hospital with its standards of cleanliness and orderliness.

“So you tried the visualization therapy last week,” the doctor said, “How was the experience?”

“Well,” Ruth stalled. She didn’t want to disagree with the doctor what with the treatment she was receiving. “Well,” she started again, slowly, eyes seeming to roam the room in pursuit of any words that could help her. The doctor smiled and looked at her expectantly.

“I guess maybe it wasn’t for me.” She blurted out.

“Really? How come?” The doctor seemed somewhat startled. “Most people really enjoy it.”

“I guess the whole, uh, therapy, just seemed a little bit like hocus pocus to me,” she said with instant regret. The doctor’s face changed, just slightly, from light and cheerful to maybe, Ruth thought, a little hurt. And seeing her face Ruth quickly added, “Oh, you know I don’t mean that. I think the therapy’s maybe just a little unusual for an old lady like me,” she suggested.

“You didn’t find the session relaxing and broadening?” The doctor asked.

“Well, you know, no I actually didn’t,” she cautiously opined.

“Really? I’m so sorry to hear that. What didn’t you like?” The doctor seemed surprised.

“I just felt a bit like I was going to a hippy spiritual healer or something.”

The doctor laughed, “Well yes, that therapy is supposed to be a bit of spiritual healing. We do that to tap into the power of your mind to help strengthen you,” she explained.

“Look,” Ruth gathered resolve, “I don’t want any spiritual healing,” she said, “I go to my rabbi for that. Please,” she softened, “just treat my cancer.”

The doctor looked away for a second. “I,” she started. “Well, I,” but she stopped. She shuffled the charts in her hand without thinking and after what felt like a decade, smacked her lips and said, “Ok then Mrs. Lieberman. Let’s pull up those x-rays again and talk about next week’s procedure.”



ERIN DURALDE is a junior (3rd year undergraduate) at Stanford University majoring in Human Biology. She owes this story to her professor and advisor, Dr. Larry Zaroff, who pushed her to explore the human experience of medicine through creative writing and encourages her journey to one day become a physician. This story takes inspiration from phone conversations Erin had with her grandmother during the time she was diagnosed with and treated for breast cancer. Her grandmother has in fact/thankfully had a profound recovery.


Highlighted in Frontispiece Spring 2010 – Volume 2, Issue 2

Spring 2010  |  Sections  |  Fiction

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