Placebo

I have never cried for my dying patients. Once I was close, but really… never. It is not your death anyway. It feels almost statistic, as if you would hear it on the news or see it in a terrible movie.
No, I am not a heartless person, I just... I think that probably you simply get used to death.

○○○

Work was hectic that day, as always. Even more so, because I was absent for two weeks because of my own illness. I wasn’t feeling so good already, but I had to come back. It seemed everything was breaking apart without me in the hospital.

After probably twenty patients in an outpatient clinic, I had to run to my office in the chemotherapy ward. Maggie said she could manage it alone, but I was not so sure. After all, she’s just a first-year resident, she understands a lot less than she believes she does.

The waiting room was full of patients greeting me and trying to get hold of my arm or my attention, but I managed to slip past them and into my office.

After shutting the door, I found Maggie sitting calmly at my desk and scribbling something in a patient card. She looked as she was in no hurry. I felt a swoop of annoyance under my skin.

“Maggie. ”
“Yes, professor? ”
“Have you finished on their chemotherapy? ”
“Yes, I did. I only need your signatures. ”
My heart slowly began to calm down.
“Okay. And the clinical trial patients? ”
“First woman already left, but the man seems to be late. ”
“Which visit it is? ”
“For the guy? 101. I told him about everything yesterday, he signed all the forms and today he has to come for the first dose. ”

I inhaled slowly. How does she do it? With such calmness she finishes everything when I run and still don’t manage. Unless she does everything carelessly and later I’ll have to fix her mistakes.

“Maggie, please go to the pulmonology ward and finish everything where we left off. ”

She nodded and walked out. I sat down on a seat warmed by another human being and started to look through the pile of patient cards, stamping them, as I read through. Well, at least every one of them seemed to be doing relatively well. On their way to death, but other than that – fine. No major complications of chemotherapy, no other significant medical problems.

At the end of a pile, I found two cards of my clinical trial patients. I was the principal investigator, but I haven’t seen them up to now. Only Maggie did. However, I already knew a lot about them by just seeing they are in the trial. I knew all I needed to know – they met all the inclusion criteria. It was the clinical trial of advanced lung cancer treatment with a new drug. First one was a sixty-two-year-old woman: Third stage, functional status – one. That is - fine. The second one, forty-year-old male, third stage, name Martin...

His surname was familiar. Where have I heard it? Oh! I remembered. Could it be the same Martin? It would be too much of a coincidence if he wasn’t – the same surname (strange one, one, said to be Italian, if I remember it well), same birth date... Well, to be exact I didn’t recollect the full date, but I knew it was in July, the same year as my birth date.
A knock on the door made me lift my head from the papers. It opened slowly and I saw a face appearing out of the hallway. Dark haired head of a man, which, with a soft voice and a kind of British accent, said,

“Hello, I think I should be looking for Maggie, is she... ”
I knew I saw that face somewhere recently.
“Are you her patient? ”
“I’m Martin... ”
“Oh! Then come in, please. Maggie is my resident; I’m the doctor in charge of this trial in our hospital. ”

Blue eyes looked at me puzzled, but he came in. I wonder what words Maggie used to convince him to participate. Maybe she did not say “trial”. I gestured for him to sit on a chair in front of my desk. Trial patients are V. I. P. patients. I have to have more time for them.

“Maggie said, she told you everything about the treatment, didn’t she? ”, I smiled, trying to look helpful and friendly, while still analyzing his looks, his movements, trying to understand if he’s the one I believed him to be.

I now remembered where I’ve seen that face before – he was a drummer for a kind of punk rock band I saw once. A little too old for that kind of music I thought. Though that being obvious, I was probably too old for listening to it, also. I never imagined that this drummer could be Martin - the boy I once knew. His looks on stage were deceiving. But there he was. Now I was sure of it – without that strange on-stage makeup, making him look a bit more girlish, I seemed to find more and more features that this forty-year-old man shared with the boy I used to know.
He nodded.

“So you understand that this is a clinical trial carried out in order to find out, whether a new drug is better than the current chemotherapy for lung cancer? In order to do so, this is a blind trial – meaning that you will get two kinds of drugs: usual chemotherapy used to treat your disease, and a new drug, or a placebo. You will not be able to know if you get a real new drug or just an inactive compound. Even I will not know. But the fact is, that you will surely be treated – I just cannot tell you if it will be with one or with two active drugs. ”
He nodded again but seemed to be more interested not in my words, but in a name card, pinned onto my lab coat. His face lit up with a smile as he lifted his eyes to my face,

“Suzy! I immediately thought it was you! Do you remember me? We used to be friends in school before I moved away. Remember, I saved your dog out of the river. ”

I shivered out of surprise. He remembers me? How? I tried to pretend I was thinking, trying to recall, and then, as if it just came up from memory, I smiled back. I smiled at the boy, who once was my first unhappy love, smiled at the man, who now was my dying cancer patient.

○○○

Martin was a bother. He made me lie to my monitors, lie in papers. It was impossible to conduct a trial in an orderly fashion with him: to draw blood at exact time, to make him come early and not to be late, to act as he was just a normal patient–machine - the one, who does not talk in excess, who does everything on a doctor’s orders. I wanted to let Maggie take care of him, but he refused to talk with her now when he knew who I was. I tried to reason with him, but he understood quite well, that I really needed for him to participate, so it was me, not him who had to agree to terms.

“How are you feeling? ” I asked the first question.
He lifted up his shoulders:
“If I didn’t know better, I’d say that I am healthy. ”
“No coughing? No dyspnoea? No coughing up blood? ”
His head shook in denial:
“Maybe, you’re just doing a good work treating me, doc, ” he said with a smile.

I lifted my head. It was a month in the treatment and I could still not tell, but I had my doubts. He tolerated the treatment very well, and because of that... It is often misleading: the ones who get all kinds of adverse reactions are usually the ones who get better, not the other way around. Maybe he’s just getting placebo.
He made me call him by his first name.

“Martin... ” I started. His blue eyes pierced through mine and I suddenly forgot the words I wanted to say. What was it? Did I want to warn him not to have his hopes up?

“You know, I’m not afraid of dying. My life was good while it lasted, ” his lips drew a smile. “It’s just... I just feel disgusted that I always have to be reminded of it. You know, before this, me and my love split up. And after it got known that I have this... Well, it seems that cancer is a good trait for lovers. Though, it really hurt to be separated, it… probably hurts even more to be with someone, who is with you only because of pity and the sake of his own conscience. ”

I looked back at my papers.
“So, after today, our next meeting will be next week. Will you be able to come? ”

○○○

I felt forgotten again. Kate changed her plans at the last minute. For a second time in a row. We were supposed to meet in this club half an hour ago and she just texted me now, that she will not make it. Ah, to hell with her! Always something, always no explanation! After I cleared up my schedule for this evening, just for her. Should I go home? Home to the screaming children and a grumpy husband? Or should I stay here and drink alone? Professor of medicine, getting drunk in a club on Friday evening alone?

I ordered another tequila shot. I seemed to need it. Did not know why, though.

Club was filled with music and people. Why did we have to agree to meet here? I looked around, suddenly thinking with anxiety, that I could meet some of my students, but I did not recognize any of these faces. I ordered another.

“Hi, Suzy, ” I heard, as a dark figure took a seat at a bar near me. I shuddered, then turned to my right and saw him. It was Martin. Martin as the drummer, not as my patient: his blue eyes highlighted with black, his hair tousled up with hair gel, collar of his dark shirt unbuttoned. He definitely did not look like he had third stage lung cancer. Yet.

“Hello, ” I muttered. Now I was feeling even more uncomfortable being here.
“Waiting for someone? ”
“I was, but... ”
“But now you’re not, because you’ve met me? ” he laughed. I wasn’t amused. His smile dissolved.
“Sorry. I sometimes make stupid jokes. But I always got away with that, up to now. So, who was that stood you up? ”
“Just a colleague. I should get used to it - it’s not the first time she does this. ”
“Could I, then, invite you to spend the evening with me and my friends? “
I shook my head:
“Thanks for the invitation, but I should really be going now. ”
His hand reached out to my shoulder:
“Come on, Suzy, you know you should not. There will be no talk of hospitals or cancers today. Let this be just a Friday night with friends. This evening was planned by you, you said yourself. Please. ”
I looked to his face with strong feeling of doubt. I was not sure it would be a good idea.
“Doctor – patient ethics? ” He inquired. “This does not apply to us. We were friends long before we were this. ”
His hand slid down my arm and grabbed my palm.
“Come, I’ll introduce you. ”
I gave up so fast.

Maggie shocked me. At first glance I didn’t even recognize her – she looked like another gothic girl in the club, all with her dark makeup, her anarchy seeking teenager smile and a dress much too short for my liking. Only with her voice and Martin’s introduction I did understand who I was seeing. She smiled a huge happy smile to me and slurred with a drunken tongue something about “what happens at the club, stays in the club, professor”. I almost ran again, but Martin would not let go of my hand. I felt more and more like a character in an absurd movie – this was too strange for me – to be sitting like this with my drunk student, who looked like she was sixteen and shouldn’t be drinking at all, her all-black chubby boyfriend, my patient and two other guys who were so friendly, that from the moment I saw them, I could definitely say that they were gay. Martin ordered me another drink as he explained how he knew Maggie – she was a girlfriend of that chubby guy, who happened to be his friend.

“We are one big gang of friends, ” exclaimed one of the gay guys happily, putting it all in summary.

Two minutes into conversation Maggie put down her head on her boyfriend’s shoulder and closed her eyes. With her sleeping, my heart was more at ease, but I still wanted to get out. Glass rang for another time.

“Cheers darlings, ” - shouted another one.
Alcohol soothed my nerves a little. DJ put on another song, and suddenly they all looked at Martin, as his eyes lit up. He grabbed my hand again.
“Let’s go dance! ”
I shook my head:
“I don’t dance. ”
“Why? ”
“I can’t dance. “
“Afraid that people will think your dancing is not that good? They don’t care. They really don’t, Suzy. You should stop thinking about what people think. ”
“No, go with someone else. ”
“Like who? Patrick? ” he looked at Maggie’s boyfriend. I smiled, “Oh come on, Suzy. ”

He didn’t wait anymore; he just got up and pulled me with him.
Those dance floor lights, alcohol in my blood, loud sounds of music, his blue shiny eyes; it all got into one big intoxicating mix. Suddenly I almost forgot who I was. I was no longer a doctor, professor Suzan, was no longer forty-year-old mother and a wife. I was just a human being, almost floating in time and universe. I smiled. He smiled. That smile reminded me of those times. Old gone times of my teenage years, when my only true friend was four-legged canine companion when all classmates believed me to be just a boring bookworm. And that cold autumn day when Martin saved my dog out of the river. Martin - the boy, who risked his life for a dog of an unknown scared girl. This was the first day of us being friends and I think I fell in love with him from the first. Though I never told him, I never believed that he knew. Two years of my life, and that was all. Then he moved away. It was over. And now this.

Martin took my hand and made me turn around. Too much alcohol - I got dizzy, and to stay up, I grabbed on to his shoulder. Suddenly his arms folded around my waist and pulled me closer. Too close. I could feel his chest rising as he inhaled - his chest eaten by cancer from the inside. I felt his lips on my cheek. Fear struck as lightning and I pulled away.

“Martin, what... I’m married. You’re my patient. ”

His blue eyes looked at me with an ocean of sadness, and through the drumming I heard,
“Suzy, I lied to you. I am afraid of death. I don’t want it. I want to be alive. This sucks so much. There was a time long ago, when I thought of suicide, but that was different - then death was a choice, now it is not. ” His hands reached out to me again, “I’m sorry, I don’t want to seduce you, I just want you to want to heal me. Please, I trust you. ”
I shivered.

○○○

Days got colder. Martin sat in front of me in my office. Still he succeeded a smile, when I looked up to his blue eyes. His lips were also blue. His once spiky dark hair now covered with a black hat even indoors. It was not the cold, it was the disease. I took the pulse-oximeter off his finger.

“You need supplemental oxygen. ”
He shook his head,
“I don’t feel so bad. ”
“Martin, I know you need this... ”
“Shush, enough about that. How does the CT look? ”

I looked at his greyish face. What did he expect to hear? Did he believe I was going to tell him something positive? It was all downhill: tumor was almost closing up his main right bronchus, his liver full of metastases. Should I even mention it is now stage four? Does he care? Stages were not so important to me as well, to continue treating him his functional class had to be less than two. In human terms, that meant he had to be functioning almost as well as a healthy individual. Martin did not look healthy anymore.

“I cannot lie to you. ”
Fear exploded in his face and his shoulders trembled. His hand reached out to my arm.
“No, lie to me, please. ” He almost shouted to my face, pressing my forearm with his fingers. I felt numb, but managed a whisper,
“Chemotherapy, trial therapy will kill you if we administer it further. ”
His head shook:
“No, it will not, cancer will kill me, not the treatment. You cannot stop. ”
“No, Martin. With your condition... ”
“No, Suzy, you cannot stop. I can handle it. I will not surrender. You cannot surrender. I will never say that I beat cancer, I will say, that you beat cancer, I will say the drugs did it, not me, but please, don’t give up on me. You can do it. ”

I inhaled trying to find words:
“You do not understand. There are rules and recommendations, based on thousands of cases; this is not just my opinion. Giving chemotherapy to a patient with your condition does not improve survival... ”
“No, it is you who does not understand! I am not one of those thousand cases! I am me, and I would better die fighting than waiting for this to slowly devour me. Even if drugs kill me, I would die without giving up. Giving up is shit! I refuse to do it. You should too. ”

His fingers were hurting my arm; his eyes, drilling through my scull. I could not look at them anymore. I never learned how to talk to the ones who were dying, how to...

“Martin, you don’t have a choice. ”

I did not see his face as his fingers let go of my arm. I only heard his breathing quicken as he stood up and slammed the door behind him.
He managed to stir everything, to leave a cold shiver inside, that lasted until the end of the day and bruises on my skin that were visible for a week.

○○○

It was a couple of days until Christmas, the last working day, before my vacation. I had so much to do at home, but could not finish up at work. They called me up to the emergency ward at the last minute – seems that one of my patients have been brought in for pneumonia, and Kate wanted me to see if she should hospitalize her to my ward.

Emergency was a chaos as always. I could not understand how Kate does not lose her mind working there, and I was almost running away just as soon as I told her that my patient could be discharged home, but then I saw a man, who looked familiar.

He was standing amidst all this chaos numb, with eyes full of panic and at the point of breaking up with tears as he was talking to one of Kate’s residents:

“He just collapsed. I don’t know. He was feeling much better today. He went to the clairvoyant in the morning, you know, a really good one. She said he would get better, that he would heal, and... ” the man started to cry.
“Oh, and you are his...? ”, resident asked.
He tried to calm himself a little:
“I’m his boyfriend. ”

Then I remembered where I saw him. This was one of the guys that were with Martin the evening at the club.

I was about to head out anyway, but I still wanted to say goodbye to Kate. I looked about. Here she was, with a patient in an intensive therapy room. I walked in and opened my mouth for a goodbye.
But then my words froze on my lips. I came closer. It was him. Not of the realm of the living anymore, a flagpole of death and suffering, but still. The resident came in after me. Kate looked at her with fleeting questions:

“His boyfriend is of no help. He cannot even say the diagnosis. Though to me he looks as if he’s - palliative care. ”

Kate looked at her younger colleague with irritation. My friend was one of those humanistic doctors, the one who doesn’t give up on her patients no matter how ill. Only then she noticed me in the room. I walked up to him. Oxygen mask on his skinny face that did not do much help anymore, heart racing its last meters... It was all hopeless.
And then his eyelashes lifted. I thought he was out of consciousness, but he wasn’t. Only these eyes reminded me of the old-days-Martin. Those eyes looked around in terror, and then, stopped griping onto mine. He recognized me. I was sure he did. I felt as if he would scream out for me if he could. I was not thinking with my rational mind anymore as I reached out for his cold fingers. They shivered and touched my hand so lightly. His gaze was still holding on.

“He’s one of my patients, ” I said to Kate, still looking in that ocean of fear, “alpha anti-trypsin deficiency, awaiting lung transplantation. ” I lied. I lied that he was not palliative care, that he was not someone hopeless, dying from common forth stage cancer.

And then it came. The heart rate alarm went off. For the first time in my life I saw it from so close. Hundreds of times she came silently, stopping the hearts of my patients - statistical death lurking behind every corner; death, that did not scare me anymore, as the creature being always around. And today, she looked at me straight in the eyes, straight from his blue dimming eyes as his body gave up, as his breathing gave up, and I saw her winning. I let go of his hand and stepped away.
Kate shouted usual commands for resuscitation. Her resident started chest compressions. I walked away. I knew they would fail to save him, but at least they would try.