“Non Iron” Image courtesy of Dariusz Klimczak

At the door to the procedure room the smell of blood comes into my nose. Ever since I lost a rock fight at age six and went home with blood streaming from a gash in my head, my body has given this warning sign whenever my brain senses danger.

The room in front of me, though small, dim and cold, doesn’t seem particularly threatening: gray and white walls, cabinets, counters, floor. It could be a medical room anywhere; it has the same expectant efficiency as anything made from stainless steel. Near an examination table in the center of the room is a small, wheeled cart holding a battered monitor that reminds me of the oscilloscopes repair shops used to use to test television tubes. The anachronism is almost funny, like visiting the cockpit of a jet to find the navigator using a sextant.

The nurse who led me here is standing near the middle of the room, looking back at me in the doorway, waiting with diminishing patience, confusion beginning to cloud her expression. I’ve hesitated too long; it’s time for a decision.

There’s still time to flee. How would I do it? I could just say, “Sorry, I’ve changed my mind,” turn on my heel, and go. No one would stop me. They might be pissed; what do I care? Sure, it would mean choosing ignorance, rolling the dice, betting the pot on a hidden card. It would be dangerous, but the danger would be imagined and therefore, for a time at least, unreal, not believable. There is freedom—from dread, from responsibility, from necessity—in ignorance.

There’s one thing I do know: that by stepping forward I would start down the twisting path prescribed by modern medicine, a path that could lead from this room to others like it. A hospital room, an operating room, a radiation treatment room. Like tipping the first in a line of dominos, crossing this threshold could sweep me along in an accelerating rush to the final tumble. On this path, knowledge can bring confusion rather than understanding, false comfort instead of certainty, slavery in place of freedom.

My pause at the door to the room is becoming uncomfortable for both the nurse and me. I’m embarrassed, then angry for being embarrassed. In the end I can’t make another choice: I follow the nurse into the room.

“You can take off your clothes in here,” she says, pointing to an open door on the other side of the room. “You can keep your socks on but take off your shoes put on this gown and lie on the table on your side.”

Now that I’ve committed, there’s a perception of things slowing down. My mind becomes sluggish. As though drugged, I struggle to separate the nurse’s words into sentences that make sense. I try to remember the symptoms of shock, and crosscheck them in my head: a dazed state, narrowing of attention, inability to comprehend stimuli, disorientation.

Slow-walk to the small changing room, relieved to see that it includes a sink and toilet. I pee as soon as the door is shut, then again three minutes later after changing into the standard gown, opening in the back. The fabric is rough against my skin and smells of disinfecting detergent. I wonder how many people have briefly worn this gown—and the dozens of others I glimpsed in the closet—for similar reasons. I imagine a number in the thousands. Now it’s my turn, my uniform; putting it on I give up my uniqueness, become one more in those anonymous ranks.

When I open the door the nurse is waiting for me.

“Lie-on-the-table-on-your-left-side-bend-your-knees-slightly-would-you-like-a-blanket.”

“No, thanks,” I answer. Why is she talking so fast?

My response was too quick, too eagerly compliant; I want to be the perfect patient. I realize that I’m bargaining mentally for a better test result, and feel ridiculous. Lying on my side on the table, gritting my teeth to keep them from chattering from a mix of cold, nervous energy and dread, I think about the nurse’s words. Has she said them ten times this morning to ten other patients? Will she say them again, in exactly the same way, another ten times this afternoon? Is her rapid-fire delivery intended to imply brisk professionalism—something I’m supposed to find comforting—or bored disinterest? Does my over-eagerness endear or disgust her?

My back is toward the door to the room; my near-naked rear end, peeking through the limp gapping edges of the gown, will be the first thing the doctor sees when he comes in. I tug ineffectively at the rough fabric, trying to cover up. Everything here is a struggle; maintaining even a shred of dignity is a struggle. I should have said yes to the blanket.

Noises of the nurse going about her business: taking medical devices and instruments out of drawers, tearing open plastic bags of metal tools, clanging them onto a small roll-around metal table, all (purposefully it seems) just outside of my field of vision. Are the items on the table so frightening that I’m not  allowed to see them? Now that she’s behind me, I try to remember what she looks like. Wanting comfort, her short plumpness immediately transforms my image of her into a memory of my mother. If I ask her, will she pat my arm, place her hand on my forehead, tell me everything is okay? Is it something I could ask of her?

I realize I don’t know her name.

“Woodjew-likkapillo-foururhed” she says.

What’s she saying, what’s she saying, what’s she saying? I chant to myself.

“Um… sure,” I answer out loud. She gently lifts my head to place the pillow underneath. It’s something.

Suddenly the door flies open, the end of a loud conversation in the hall.

“Okay, we’ll talk next week!” the voice booms. I recognize it as belonging to my doctor; he sounds cheerful.  I decide to be cheerful too. The door swings closed and latches, returning us to dim isolation.

“Good morning! How are we today?” Brisk walk around front, quick handshake, my grip already tentative, weakened by uncertainty, then the sound of rolling metal wheels as he sinks onto a short round stool and slides across the floor behind me.

How are we? What a stupid question! You’d have to be brain dead not to be terrified of what’s going to happen here.

“Um… fine!” I wonder how many of us in the room I convince.

“Good!” Snap of latex gloves. “I’m just going to start with a digital exam.”

His index finger is in and out in a matter of seconds.

“Okay!” – to the nurse – “I think we’ll do 8 needles.”

Then to me: “This is the ultrasound wand.” He waves a metallic-looking stick about an inch in diameter and ten inches long in front of my eyes. A cord exits the end he holds in his hand and is connected to the monitor I noticed earlier on the small table. “I’ll be using it to get an image of your prostate on this.” He pats the ancient box. “It will help me get the needles to the right spots.” For emphasis he works a small button near his thumb, and a thin needle pokes out of the other end, retreats.

“Are you ready?”

“Um… I just want to mention that when I get anxious I have to pee.”

“You’re not anxious now, are you?” Big laughs from everyone but me. “Well, this won’t take long; we’ll be done before you know it!”

Yuk it up!  I don’t tell him that already this morning I had peed when I got up, again before I left the house, once when I arrived for my appointment, once more before I was called into the procedure room, and two times in the changing room. By my count that was six times in about two hours, the last time now at least ten minutes ago. I figure I have ten minutes, max.

The insertion of the ultrasound wand is surprisingly easy.

“OK –when I take a tissue sample you’re just going to feel a little pinch and hear a ‘snap.’ Are you ready?”

I can’t even imagine what being ‘ready’ for this would mean.

There’s a click-snap, and I feel a piece of my insides snatched away. I’m shocked at the idea that the needle’s tiny hook has punched through tissue walls, membranes, organs that are supposed to be separate from each other. I feel the trembling that betrays a ballooning anxiety begin in my shoulders and legs. I know that if I don’t do something to stop  the shaking, it will become violent. Almost immediately I feel the need to pee.

“That’s as bad as it gets,” my doctor is saying. “Are you going to be okay?”

There’s a metallic shuffling of needles in and out of the handle end of the probe going on behind me. Can I make it through seven more needles without peeing all over everything?

“I have to pee,” I answer.

“OK, we’re going to be done here in a minute. Can you hold on?”

I weigh the urge growing within me—like a wave building to its break—against my mental clock, which seems to have come to a complete stop. I know he’s lying about the “one minute” estimate.

“I don’t think so.” I feel a flush of shame at my admission of failure, at my inability to control myself. Immediately the urge becomes stronger.

“We can’t have a wet operating table.” Annoyance is creeping into his cheerfulness. “Grace, do we have a urinal in here?”

Grace! I think. Of course.”

Cupboard doors open and close. I catch a glimpse of the plastic vessel in the nurse’s hand.

“Don’t worry,” my doctor says. “Grace has a two-year-old boy.”

I’m too desperate to try to understand his logic as Grace’s chubby fingers reach under the front of my gown and find my shrunken penis.

Grace, Graciella, Gracia mi salvador I chant in my head as my urine streams into the plastic bottle.

§

The diagnosis comes two days later. I’m standing on my back patio when the doctor calls.

“I want to give you the results of the procedure we did the other day.”

This is going to be bad. He can’t say the word ‘biopsy.’

“Sorry to give you this information over the phone, but I’m afraid the pathologist found cancer in two of the eight cores. Twenty percent of each of the two cores is involved. All the cancerous cores are from the right lobe.”

I realize I’m not breathing. As I look east across the valley, the sunlight and sparse clouds, like karma-dealing shadow puppets, create changing patterns on the mountains. The day is warm for March; the heat is teasing the scent of sage out of the winter-toughened leaves of the canyon brush. Fragile, lemon-green shoots carpet the normally powder-dry and odorless soil that a recent rain has turned dark, moist, and fragrant.

I draw a deep breath through my nose as the doctor continues. Suddenly the air feels cooler, and I recognize the metallic smell of danger as fear causes the tiny veins in my nose to fill with blood.

I have cancer I say to myself. Another breath: cold iron. The doctor’s voice drones on in my ear, talking statistics, grade, Gleason score. I stare across the valley toward the nearest hills, wooly with a coat of new green that looks farcically unrealistic. The next row of peaks is darker; the blues, blacks, and purples like massive bruises, unaffected by the changing sun and clouds. The third row of peaks is faint, hardly discernable; it’s difficult to tell where the earth vanishes and the pale blue-gray sky begins.

I wonder if today is the beginning of my own slow vanishing, of the gradual diminishment I’ve watched in a lover, then one parent, then the other; the relentless but almost invisible daily wearing away of personality, of vitality, of hope. I wonder what accommodation I’ll have to make for the disease: will my life be ruled by drug schedules, chemotherapy appointments, radiation treatments?

“Do you have any questions at this time?”

I stare at my feet, where large cracks vein the concrete patio like crazing in an old teacup. It looks unstable. I imagine the cracks widening, becoming ruts, ditches, gorges, and struggle to keep my balance, to avoid collapsing into them.

I realize this silence is my turn to speak, though I catch the perfunctory tone of the question. He’s busy. He wants to move on.

I imagine this topic being covered in the fifth week of year two of medical school: How to Deliver Bad News. “Explain the situation clearly and completely,” the textbook would say. “Give the patient the opportunity to ask questions, though there may not be any during the first conversation.”

I listen to the white noise of my doctor waiting, breathing, waiting.

It’s to be the twisting path, then.

In my mind I imagine the sound of one domino falling against the next.

“No,” I say. “No questions.”

 

 

Jim Brega earned his BA from San Diego State University and an MFA from the University of Illinois. His work has been published in A Year in Ink 5 and Foliate Oak, where his story “Little Red Bird” was selected for their 2012 “best of” anthology. He lives in San Diego with his spouse, John Castell. The two recently created the catalog for a large local corporate art collection. You can follow Jim’s progress on his blog, jimbrega.com.

Read an interview with Jim here.