After the unfortunate episode with Bobby Richards, I suddenly found myself wanting to spend even more time with James Henry. Whereas in the past, I'd stop in if I had a long break in my consultations, now, even if I had only a few minutes between patients, I'd make my way into the living quarters. If James were awake, I'd join in whatever he was doing and, if he were napping, I'd at least step into his room and assure myself he was fine.
Today I was lucky in that, during my afternoon break, I found James sitting on the floor surrounded by a number of cloth and plastic toys. I counted a train, an elephant, a dog, a tiger, a spinning top, a truck, a boat, and two cars, along with a number of blocks covered with various letters of the alphabet. According to Louisa, he'd awakened from his afternoon nap only a short time ago, so was in a particularly good mood and anxious to play.
Louisa sat on the ground next to him, showing him each toy and identifying it by name. "This is a tiger. The tiger growls liked this – 'Grrrrr'." This caused James Henry to giggle and smile at her and I couldn't stop a tiny smile from appearing on my own lips.
"And this is a train," she said, holding it up for him to see. "Choo-choo. Choo-choo." James reached for the train and twisted it around in his hands.
Louisa glanced up at me and gave me a wide smile. "James, look, it's your daddy."
It was hard to explain the pleasure that rolled through me when my son turned his head and seemed to smile at the sight of me.
"Good afternoon, James," I said. I knelt down and, after arranging my trousers and jacket to minimize wrinkling, seated myself next to both him and Louisa. I took the train from her hands.
"Did you mum show you how the train rides along?" I asked. James, of course, only looked at me, probably wondering what I might do to his toy. I rolled the train along the rug, back and forth, then put his hand on it, helping him roll it.
"Choo-choo," Louisa called out as James and I rolled it forward. James narrowed his eyes and focused on the movement. Once I had his attention, I took the train and put it in front of him upside down. This time when we tried to roll it, it didn't move and James banged his hand up and down in frustration on the now immobile toy.
"Let's turn it right," I said, upending the train so that it was now back on its wheels. Once again we moved it back and forth.
"There you go!" Louisa said in encouragement. "Good job, James."
I tried the activity a few more times, hoping to show James the difference between the toy being upside down and right side up. Even though, I wasn't sure he understood the concepts, I enjoyed the feel of my large and rough hand covering his tiny, soft one and together making that stupid train roll across the carpet. A quick glance at my watch told me that our playtime was up – time to get back to my patients.
"All right, James, I'll leave you to your mum," I said, rising to my feet and straightening out my suit. "Sorry, I need to get back to the surgery. I have a full afternoon of consultations." Strange as it might have seemed to me a year ago, I would rather have spent the next few hours playing with a baby – my son – than seeing patients in my surgery. Nonetheless, duty called.
"Thank you, Martin," Louisa said, smiling up at me.
"For what?"
"For taking the time to play with him. He really enjoys playing with his dad."
"Yes, well, you're the teacher. You're much better at this than I am."
"It's not what you do with him, it's that you want to spend time with him."
"Of course I do. Why wouldn't I?"
"I . . . you . . . never mind." She gave me an exasperated sigh and I decided that, even now, after living with Louisa for almost a year, there were times when I didn't understand her. Or she me, for that matter. There were times when we would just have to agree to see the world differently, and I imagined we weren't the only couple who had to deal with that.
I walked through the passageway into the waiting room to find Morwenna chatting with Mrs. Walker. Bursitis, I reminded myself, and Lord knew what other ailments the woman had come up with since I'd last seen her.
"And how is your grandfather?" Mrs. Walker asked Morwenna. "He used to come to the rec center for bridge, but I haven't seen him in months."
"Getting along fine, thanks for asking. Got a bit of trouble with arthritis now and again so it's hard for him to get out as much as he'd like."
"I was getting worried when I didn't see him. He's such a lovely man. Such a gentleman," Mrs. Walker added, giving me a pointed stare.
"Well right now, Grandpa's all excited about a reunion coming up next month in Southhamptom – I think it's his mates from the war. He was in the RAF, you know."
"Oh, I just love reunions."
I tuned out the conversation as I went into the kitchen to pour myself a cup of tea. By the time I returned, the two women were still talking, although the subject of the conversation had changed.
"I still can't believe it about Bobby Richards," Mrs. Walker was now saying. "So sad."
"Yeah, breaking his neck. Who would have thought? And his mum being right there when it happened."
Mrs. Walker clucked her tongue. "I can't even imagine. It must have been terribly hard on her."
"Definitely."
"I haven't seen her since the funeral. How's she doing?"
"Not so good," Morwenna replied. "You know the doc had to sedate her when it happened." She lowered her voice. "And he's had to visit her almost every day since, poor thing."
"Morwenna!" I strode over to the desk and grabbed Mrs. Walker's notes. "Mrs. Walker, go through."
The older woman seemed disappointed and, giving me a dour look, made her way into my consulting room. As soon as she was out of earshot, I turned on my receptionist.
"Morwenna, you know better to discuss my patients with other patients."
Her expression made clear that she thought I was the one who was crazy. "Bobby's dead."
"His mother isn't." I put steel in my voice. "She's my patient and her medical condition is not to be a topic of discussion with anyone. Is that clear?"
"Doc, it's not like I'm not passing on anything I learned here. Ted, the lifeguard, told me what happened at the pool. And I was only guessing about the other."
"It doesn't matter. My surgery isn't a venue for gossip or speculation. If you can't handle that, find someplace else to work." Without waiting for a reply, I headed into my consulting room and the loquacious Mrs. Walker.
That evening, as I was closing up the surgery, there was a loud knock at the front door. With a grunt, I went to open it, prepared to tell whoever was on the other side that, unless they were dying, they could come back in the morning when the surgery reopened.
I was surprised to see Ethan Brown at my doorstep. He seemed smothered in his grey wool overcoat and shifted nervously from one foot to the other.
"I know it's after hours, Doctor, but I wondered if I might have a quick word with you."
I had a pretty good idea what he wanted to discuss and that this was one issue I'd need to stay late to deal with. "Yes, of course. Come through," I said, ushering him inside and directing him through to the consulting room.
After closing the door, I took a seat behind my desk and waited as Brown pulled off his coat and scarf. He wasn't wearing his usual suit and, instead, sported casual trousers and a pullover. Given how fastidious Brown had always been about his appearance, I was surprised the trousers had a stain running down one leg and the pullover was frayed at the sleeve.
Brown slowly lowered himself into the chair. "You've no doubt spoken to Dr. Ramsey," he started.
The pulmonologist. "Yes. I read her consultant's report and then spoke to her by phone. She told me she'd gone over the biopsy results with you. I'm sorry the news wasn't better."
"How long do I have?"
It was the question patients in Brown's position typically asked and one that I was usually ill-equipped to answer with the precision they wanted. "I'm sure Dr. Ramsey discussed with you the stage of your disease and the various treatment options—"
Brown raised a hand to stop me. "Yes, she went over everything in excruciating detail. Stage 4 non-small cell lung cancer. Which means that, even if I let them poison me for the next however many months, I'm still going to die much sooner than I'd like. What I want to know is, if I do nothing, if I skip the chemo and radiation, how long do I have?"
It was obvious that Brown understood the severity of his condition; his cancer was too far advanced for surgery to be effective. Thus, the only treatment option was a combination of chemotherapy and radiation that would hopefully slow the progression of the disease by a few months, if he were lucky. As for how long he would live . . . some patients tolerated chemotherapy well and lived for up to a year. Others were dead in less than a month.
I let out a breath. "It's hard to predict—"
"Try."
"There's evidence of metastasis to the liver." I sighed. "Dr. Ramsey said she told you that, with aggressive treatment started immediately, six months is possible. Without treatment . . . two months, maybe less."
He exhaled with resignation and I guessed that my answer had been in line with what the pulmonologist had said.
"What would you do?" he asked.
"Do?"
"Would you have the chemo and all that?"
"I can't say. There's no way I could—"
"I know. There's no way you can understand my exact position and you aren't me so there's no way you can . . . blah, blah, blah. Let me put it this way, Dr. Ellingham. Suppose someone told you today that you were going to die a miserable and painful death with cancer eating away at your body. Before that happens, you could spend a month or more in reasonably decent health with your wife, eking out what little pleasure might remain. Or you could spend six months mostly in a hospital hooked up to IVs getting weaker and weaker while she watches you lose your hair, develop sores, and puke your guts out every day. Now all I'm asking is which would you do?"
As his GP, I should encourage him to accept the treatment. It could give him longer than six months and, during that time, new therapies might come to light.
But the man had asked my opinion. I couldn't imagine myself lying in a hospital bed, hooked up to machines and tubes, fighting nausea and mouth sores, unable to enjoy anything from food to sex while Louisa sat next to me and held the emesis basin, changed my soaked and soiled bedclothes . . .
No, it was too horrible to imagine, and I found myself giving the answer from Martin Ellingham, not Dr. Ellingham. "I'd probably opt for the two months without treatment."
"Thank you. For being honest." He sat there silently for nearly a minute, then leaned forward and stared straight into my eyes. "You won't say anything about my condition to my Judy? You won't' tell my wife about my . . . about the cancer."
I couldn't completely hide my astonishment. "You haven't told her?" I could understand not wanting his clients to know but his wife? Surely she was bound to find out – and probably sooner rather than later.
"Told her what? That she married some old guy just to find out six months later that he's going to die on her before the year is out."
"She will . . . even without treatment, there will be symptoms." To experienced eyes such as my own, there already were in Brown's pallor, loss of weight, and lack of energy.
"I know that. And I'll deal with it in my way and in my own time."
"Right." It was, after all, his choice.
"I don't want you to say anything to her about this. Nothing at all." Brown's voice rose as if he'd suddenly found some inner strength. "Within my rights of confidentiality, I'm ordering you not to say a thing about my condition to anyone. Is that clear?"
My expression made clear that I had no issues with patient confidentiality. "There'll be no problems here."
He nodded, and dropped back into the chair. "Good." He let loose a long breath. "Good."
Medical Glossary
Stage 4 lung cancer: Most, if not all, cancers are staged. Lung cancer has four stages, some with sub-stages (e.g., Stage 3A). Stage 4 is the most severe and indicates the cancer has spread beyond the lungs. At this point, it is treatable (with chemo and radiation) but is no longer considered curable.
