The patient reports never being well since an influenza two years ago. Her lymph nodes remain swollen, her throat chronically raw and shooting pain into her ears on swallowing. On examination, her tonsils appear inflamed, although there is no discharge. Her oral temperature is 98.3̊, and she experiences periodic flushes of heat. She suffers from a peculiar vertigo, with the sensation as if she’s floating. Floating. Interesting. Shoving aside my cold coffee, I reach for a reference book.
I make notes in the chart margins . . . Lachesis, Calcarea arsenica, Asarum europaeum, Lac caninum, Argentum nitricum, Nux moschata– snake venom, arsenate of lime, European ginger, bitch’s milk, silver nitrate, nutmeg. Any of those states could include a floating sensation.
During our consultation, the patient expressed great fear about her health. More so than her symptoms warrant, although to be fair, she’s not a well woman. According to her, her headaches portend a brain tumor, her frequent urge to urinate, bladder cancer. After an extensive series of tests had been negative, her primary physician had suggested a psych referral. Insulted, she had come to my office on the advice of a friend.
I pore over the file, searching for the one detail that will tip the scales towards the correct judgment, the key for the locked door. Her less recent health history is unremarkable. She does not particularly desire sweets. She did not appear spacy. Then I find it.
She sleeps poorly, sometimes waking from dreams of rats invading the house.
Rats. I smile. I live for this moment, the deep pleasure of perceiving the pattern, the recognition of the animating godlet’s features. Only one thing can address the floating sensation, the persistent throat symptoms, the apprehension, the disturbing dreams of vermin.
I will give her bitch’s milk.
“I beg your pardon?”
“I have issues around my liver, ” the new patient repeats.
I put my clipboard on my desk. “Could you be a little more specific?”
“I have issues around my liver!” She gestures vaguely towards her left abdomen.
I am the Quack, the one consulted when all else has failed, the receiver of the chronic, the anxious, and the dying.
“I see. Could you tell me how these issues manifest for you?”
She blinks at me.
She shakes her head.
“Bad taste in your mouth? Night sweats?”
“No, I just have issues around my liver, Kathy.” She frowns.
Katherine. As I mentioned in the front office perhaps ten minutes ago. Not Kathy, not Kate, not Kay, and especially not Kitty. Failing Katherine, I’ll always answer to Dr. North. Those are your options; it’s not terribly difficult.
“How about irritability? No?” Feeling more than a touch bilious myself, I smile. “May I examine your liver?”
She lies down in slow motion.
“And your knees up like that, yes, thank you. Now . . .”
“Wait. I need to center myself.” She inhales and exhales meaningfully, enveloping me in a miasma of garlic.
“Ready?” I percuss over her right ribs. Thump, thump. Thump, thump. “Let me know if there’s any pain.”
“Right now I’m feeling some discomfort in my neck, ” she announces, delighted to be so in touch with herself.
“Right. Any where I’m pressing now?”
“Let me check in with it.” Her eyes roll into her head. Pause. “No.”
The margins of her liver feel smooth, and don’t extend below her ribs or across her midline. Her skin and eyes appear unjaundiced. I straighten.
“Well, your liver seems normal, at least on external examination. We could run some tests, I suppose. Who diagnosed the problem?”
“An amazing medical intuitive. She saw it right away.” She beams, but her tone is accusatory.
I am not a believer in New Age, that ugly adolescent of philosophies. But its adherents infest my waiting room, transient and insubstantial as wood sprites, eager for aphorisms to heal their malaise. They expect earnest inquiry into the paper cuts of their psyche, and are alarmed by my discussion of pus, sputum, and blood. They crave shamanic intercession from the wise root-worker woman they imagine me to be, but a glance from my gods would turn them to stone. I despise their facile, cobbled pantheon. Not for me their laughing Buddha, their blissed-out Jesus, indulgent as a dope-addled parent. Sniggering Fortune has made me troll among pixies.
“A medical intuitive. Ah.” Neutral, clinical. “What problems led you to consult her?”
“The issues around my liver.” Her face widens into a practiced, mawkish innocence. Some guru has told her not to lose her childlike sense of wonder in this wicked, wicked adult world. How spiritual.
They deny the left hand of life, the demands of our barely contained animal selves. No, they see guardian angels and strawberries where there is only blood and fur on the grass. I hate them abstractly, as you would a stupid child.
What could the actual presenting complaint be? Ennui? I jiggle my prescription pad. Persistent fatigue, probably. Dull color, limp hair. Her muscle tone is poor, and her joints crack every time she shifts.
“Are you a vegetarian, by any chance?” Of course you are.
“Vegan. Well, mostly. Sometimes I just crave cheese.” She looks down, embarrassed at her failure of transcendence. Issues around the liver indeed. She’s not plethoric enough to muster a blush.
“Eat the cheese. And consider eating red meat.” I stab the pen to paper. Complete blood count with hematocrit. Thyroid panel. B-12 level. Oh, and liver enzymes. I’ll send a copy to the amazing medical intuitive.
“Red meat?” Aghast. The groovy alternative doctor is not prescribing a raw juice fast.
“Yes. I want you to strengthen your vitality. It’s weak.”
How do they always manage to look simultaneously thrilled and worried by that assessment? Yes, yes, I knew it, I’m weak, take care of me, I just can’t. Oh no, I’m weak, what’s going to happen, help me. I sigh inwardly.
“Here.” I put down my pen and gently take her arm. “Watch.” I straighten her elbow, and it hyperextends ten degrees beyond the midline. “That’s too far. It’s indicative of inherited poor fiber.”
“It’s not normal?” She smiles nervously. I knew I was special. I’m scared.
“No. This is normal.” I slide up my sleeve and straighten my own. “Elbows shouldn’t bend backwards. Five or ten degrees of flexion should remain.” I tap my cubital fossa for emphasis, and she looks askance at the thick muscles of my forearm. More evidence that I cling to a corporeal path. Quel scandale.
I re-button my cuff. “Although you can’t change your genetics, you can build your vital force, chi, prana, whatever you wish to call it. Red meat is very helpful, as is exercise like weight lifting.” She recoils as if I’ve suggested recreational dog beating, but I continue. “Vegetarianism is contraindicated in your inherited constitutional body type.” Yoga and mung sprouts are only going to make your natural wimpiness worse.
I hand her the blood work orders. “There’s a lab nearby on Browning, but if your insurance doesn’t cover it, any lab can do these tests. Typically the results come within ten days. I’d like to meet afterwards to discuss the findings and a treatment plan.”
She’s not listening. I’ll never see her again.
“Any more questions for today?”
She frowns. “Do you think an olive oil and lemon juice flush would detox my liver?”
It would certainly make you vomit all night.
“Can’t hurt, ” I say, brightly.
Watching from my window, I see her turn in the direction of the local health food market.
Four o’clock, I better hurry. Reaching for my coat, I pause. Did I imagine the sound of someone entering my waiting room? I fling open the interior office door, not waiting for a knock.
She startles, a magazine unopened in her hand. “Oh, hello. Sorry for barging in without an appointment. Dr. North?”
“Yes?” Clearly, the woman is seriously ill. Monochromatic, angular, as if she were a single splatter of zinc. I don’t like the jerkiness of her motions. M.S.? Parkinson’s? Some variety of heavy metal poisoning? My eye falls on the emptiness of her blouse. No. Breast cancer, no doubt metastasized somewhere in the central nervous system. She’s young. Has chemo made her gray?
She sees me looking and shrugs. “You helped Beth Golonski. They gave up on her, too. Yale told me to go home and put my affairs in order.”
Golonski. Not a referral that opens wide my door. I had only taken that case because the poor woman had been dismissed from mainstream treatment with three months to live– a remarkably aggressive infiltrating lobular carcinoma spread from her breast through her lungs, liver, spine and brain. Only thirty-six, without family, without insurance. I had hoped to palliate; certainly I could do no harm. Instead of dying, she wept a foul yellow-green matter from her mastectomy scar and her navel, the same color as theChelidonium majus preparations I continue to give her. Much to my astonishment, I attended her fortieth birthday party in August. I periodically receive hate mail from physicians she refuses to let cauterize the drainage, per my instructions. I am a charlatan, a menace, and ought to be investigated. I know that the future holds a registered letter from the ethics board. No good deed remains unpunished.
“I’m afraid I really can’t. I don’t normally take terminal cases, the legal liabilities . . . .”
“Please, Doctor.” A rumbling command, not a plea. Taken aback, I hesitate. I search her gaunt face for a long moment. It’s relentless as Fate. Perhaps she would live.
“You realize, of course, that I can’t guarantee results like the ones in Ms. Golonski’s case, ” I murmur. May the gods help me.
She nods, smiling.
“All right. Come in.” No dinner tonight.
She grins, exposing vivid, receding gums, and follows me into the consultation room.
I’m late. I pretend not to notice Mrs. O’Keefe look at her watch as I toss my coat and briefcase in a pew.
Sister Bernadette looks up from the score. “Ah, Katherine, I thought we wouldn’t see you tonight.”
I pull at an imaginary forelock. “In spiritu humilitatis, et in animo contrito, suscipiamur a te, gloriosa sorore.”
She snorts, but to cover a laugh. A few in the crowd stifle snickers. Mrs. O’Keefe coughs pointedly.
“Too bad I don’t have the power to absolve you, Katherine. You’ll just have to take it up with your confessor.”
I bow my head to hide my smile. She knows quite well I don’t have one.
She waves her arms. “A penance anyway. Rollend in schaumenden Wellen.”
Tilting my head to the clerestory, I close my eyes and sing.
Rolling in foaming billows,
Tumultuous swells the raging sea.
Mountains and rocks now emerge,
Through clouds their tow’ring summits rise.
I’m emptied, I burst like sparkling wine from an uncaged bottle. My quick hurtles, light now, ecstatic, into air.
“Thank you, Raphael.”
Face carefully neutral, I climb into the choir.
I’d raised eyebrows when I auditioned for the part, but Sister Bernadette chose me. Whether from artistry or perversity, I don’t know.
At her signal, the chorus shouts.
Sound the harp, strike the lyre!