Twelve Patients: Life and Death at Bellevue Hospital by Eric Manheimer
Authors: Eric Manheimer
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smooth, two centimeters in diameter, feigning innocence. That evening I went through my mail. A fresh copy of the
New England Journal of Medicine
came with the stack. A “State of the Art” review article on “Head and Neck Cancer” was listed in bold black type halfway down the cover page. My diagnosis was in hand courtesy of the U.S. Postal Service. I sat by myself in the living room and by the ebbing northern light read through the article line by line.
Unconsciously, I shifted gears. Splitting my personality neatly in half, like the hemispheres of my brain, I buried myself in technical jargon and Kaplan-Meier survival curves. Like my Russian and Romanian ancestral burial grounds, I had an apparently infinite cellar in my head that teemed with childhood demons, maternal warnings about the inevitable next pogrom, warnings issued before I could walk; and with demons from a medical career, dead patients who were more alive in their graves than they ever were in life.
The raspiness and voice fatigue sent off an insistent internal buzz. I ran through the range of diagnostic possibilities and came up empty.
Except for cancer.
It never occurred to me to ask
Why me?
There was no anger and no regret. It was a fact of life. I knew the details—up to a certain point—of what had to happen next: I had to get started on therapy, and quickly, to prevent progression of the disease and to prevent the abyss of anxiety that lay beneath my conscious awareness fromoverwhelming my family. I knew what I didn’t know. The extent of the hole I was going to enter was uncertain. No one could lead me there or prepare me for that part of the journey to come. I would have to go there mentally alone.
As a physician, I knew all too well that a delayed diagnosis would allow the tumor stage, size, and metastatic status to change—and each bit of growth would drop my survival rate by 25 percentage points like a plunge in the stock market. I had seen it happen for breast, lung, ovarian, melanoma, and other cancers. Ordinary symptoms, a negative exam, a reassuring comment, a trial of medications, a pat on the back, and delayed follow-up equaled a recipe for disaster for many patients. I didn’t consider my diligence luck. I have a suspicious nature.
The biopsies were simple and painless. Guided by ultrasound, the needle found the liquid center of the node, and the blood-tinged fluid was hurried off to the pathology lab. My doctors’ faces were expressionless, the waiting room full of anxious couples. The secretary wanted to update my insurance information. I walked out plotting the next steps while shifting into autopilot.
I stopped at the East Bay diner on the way back to Bellevue to deliberately linger in solitude in the few minutes I had before the diagnosis was official. Like a guilty man waiting for the deliberating jury’s verdict, I had a finite period before hearing my sentence. Before my colleagues in pathology peered into their microscopes and found the traitorous cells with a Rorschach nucleus of inkblot mitotic spindles in disarray. Before the ICD-9 official diagnostic codes entered the computer system. Through the large windows fronting First Avenue the red-brick men’s shelter, Bellevue’s former psychiatric hospital, sat in moldering decay, littered with garbage, water stains resembling stalactites hanging from the window edges. Ageless bearded black men with long dreadlocks loitered on the corner bumming cigarettes. Their grocery carts overflowed with scavenged high-tech backpacks and bulging transparent plastic garbage bags. The collected detritus of New York City’s excrescence of garbage oozed from its pores, piled in front of the condos and co-ops in Kips Bay.
It was comfortable inside, familiar waiters, the owner chattingbehind the register, a buzz of conversation. I sat sipping coffee by myself, brooding over where I was heading and what would follow. The diner filled up with hospital staff in their multicolored
New England Journal of Medicine
came with the stack. A “State of the Art” review article on “Head and Neck Cancer” was listed in bold black type halfway down the cover page. My diagnosis was in hand courtesy of the U.S. Postal Service. I sat by myself in the living room and by the ebbing northern light read through the article line by line.
Unconsciously, I shifted gears. Splitting my personality neatly in half, like the hemispheres of my brain, I buried myself in technical jargon and Kaplan-Meier survival curves. Like my Russian and Romanian ancestral burial grounds, I had an apparently infinite cellar in my head that teemed with childhood demons, maternal warnings about the inevitable next pogrom, warnings issued before I could walk; and with demons from a medical career, dead patients who were more alive in their graves than they ever were in life.
The raspiness and voice fatigue sent off an insistent internal buzz. I ran through the range of diagnostic possibilities and came up empty.
Except for cancer.
It never occurred to me to ask
Why me?
There was no anger and no regret. It was a fact of life. I knew the details—up to a certain point—of what had to happen next: I had to get started on therapy, and quickly, to prevent progression of the disease and to prevent the abyss of anxiety that lay beneath my conscious awareness fromoverwhelming my family. I knew what I didn’t know. The extent of the hole I was going to enter was uncertain. No one could lead me there or prepare me for that part of the journey to come. I would have to go there mentally alone.
As a physician, I knew all too well that a delayed diagnosis would allow the tumor stage, size, and metastatic status to change—and each bit of growth would drop my survival rate by 25 percentage points like a plunge in the stock market. I had seen it happen for breast, lung, ovarian, melanoma, and other cancers. Ordinary symptoms, a negative exam, a reassuring comment, a trial of medications, a pat on the back, and delayed follow-up equaled a recipe for disaster for many patients. I didn’t consider my diligence luck. I have a suspicious nature.
The biopsies were simple and painless. Guided by ultrasound, the needle found the liquid center of the node, and the blood-tinged fluid was hurried off to the pathology lab. My doctors’ faces were expressionless, the waiting room full of anxious couples. The secretary wanted to update my insurance information. I walked out plotting the next steps while shifting into autopilot.
I stopped at the East Bay diner on the way back to Bellevue to deliberately linger in solitude in the few minutes I had before the diagnosis was official. Like a guilty man waiting for the deliberating jury’s verdict, I had a finite period before hearing my sentence. Before my colleagues in pathology peered into their microscopes and found the traitorous cells with a Rorschach nucleus of inkblot mitotic spindles in disarray. Before the ICD-9 official diagnostic codes entered the computer system. Through the large windows fronting First Avenue the red-brick men’s shelter, Bellevue’s former psychiatric hospital, sat in moldering decay, littered with garbage, water stains resembling stalactites hanging from the window edges. Ageless bearded black men with long dreadlocks loitered on the corner bumming cigarettes. Their grocery carts overflowed with scavenged high-tech backpacks and bulging transparent plastic garbage bags. The collected detritus of New York City’s excrescence of garbage oozed from its pores, piled in front of the condos and co-ops in Kips Bay.
It was comfortable inside, familiar waiters, the owner chattingbehind the register, a buzz of conversation. I sat sipping coffee by myself, brooding over where I was heading and what would follow. The diner filled up with hospital staff in their multicolored
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