Rules Get Broken (3 page)

“Sure. If that’s the best you can do. Eleven o’clock? Is that what you said?”

“That’s right, Mrs. Herbert. Eleven o’clock tomorrow.”

“Fine. I’ll see you then.”

“All right, Mrs. Herbert. Bye-bye now.”

Peg got up from the kitchen table and hung up the receiver. “Damn,” she said to herself, suddenly feeling despondent. “I’ve got things I wanted to do today, but I feel like I’m slogging through quicksand.”

“What’s the matter, Mommy?” Jennie asked, looking up from her crayoning for the first time in several minutes.

“Nothing, sweetheart,” Peg said, rubbing her forehead with her fingertips, trying to push away the fatigue that threatened to overcome her. “Mommy’s just a little tired. That’s all. Nothing to worry about.”

She was trying to be patient, she told herself. She really was trying.

I mean, it’s not like I was supposed to be here today
, she thought. She looked around the waiting room Tuesday morning at the twenty or so other people waiting with her.
I’m the one who’s being squeezed in, not the rest of these people. And it’s only been what?
She looked at her watch.
Thirty-five minutes. So there’s no reason to be upset.

She was sitting in a leather wingchair in the far right corner of the North Shore Medical Group waiting room next to a small end table piled high with year-old, dog-eared magazines. She looked down at the magazine in her hands and continued to flip through it as she had been doing since she arrived, going through the motions of reading without seeing a single word.

Somewhere a telephone rang. No one answered it.

She took a deep breath and tried to regain her composure. She knew she wasn’t herself, that fatigue was making her uncharacteristically short-tempered.

I have to stay calm
, she admonished herself.
There was nothing that important I had to do today anyway. No reason to get upset.

“Mrs. Herbert?” a nurse half called, half announced. “Mrs. Herbert?”

“I’m here,” Peg answered, feeling for a moment like attendance was being taken. “I’m right here.”

She closed her magazine quickly, carefully placed it atop the pile and walked across the waiting room to where the nurse was standing.

“Right this way, Mrs. Herbert,” the nurse said, and she held open the door leading to the examining rooms and the doctors’ offices.

Peg followed the nurse down the hall until they reached an examination room with an open door. The nurse stopped, turned and indicated that Peg should enter the room. “Dr. Edwards will be with you in a few minutes,” she said, and she closed the door.

Peg stood in the middle of the little room and debated whether she should stand, sit on the one chair in the room, or climb up on the examining table. She decided to stand.

Two minutes later Dr. Edwards knocked on the door. He was a tall man, over six feet, and in his early forties. He always looked collegiate, almost preppy, with his over-the-collar, wavy brown hair, his round tortoise-shell glasses, brightly colored sport slacks and penny loafers. The slacks and the loafers were his attempt at informality, but were more than offset by a white button-down shirt, a tie and a crisply starched white knee-length lab coat. The nicest thing about him was that he always gave the impression of warmth and genuine concern whenever he spoke.

“Good morning,” he said cheerfully as he lifted Peg’s file from the Plexiglas rack on the outside of the door and entered the examination room.

“Good morning,” Peg answered.

“Why don’t you have a seat up there?” he said. He gestured towards the examining table and took the chair.

He waited until Peg had climbed up on the table before saying anything else. “So, I gather you’re not feeling too well today.”

“I feel like hell,” Peg replied, “but I don’t feel sick. At least not what I call sick. But all weekend and all day yesterday and today, I’ve been more tired than I’ve ever been in my life. A weird kind of tired. Not the kind you can push through. My husband and I were supposed to go sailing Saturday night with the couple across the street, but I bailed out a few hours before we were supposed to leave because I was exhausted. So tired I could barely move. And since then I haven’t been able to make myself do anything that requires the slightest bit of exertion. No matter how hard I try, I just can’t push through it.”

Dr. Edwards looked at Peg for a few seconds before he spoke again.

“Any other symptoms? Any pain anywhere? Nausea? Diarrhea? Anything other than the fatigue?”

“No, nothing. Just this overwhelming tiredness.”

“I see,” Dr. Edwards said thoughtfully. “Have you been out much this summer? Out in the sun, I mean?”

“Yes. All the time,” Peg replied, surprised at the question. “Why?”

“Well, you look very pale to me…” Dr. Edwards’ voice trailed off as he leafed through her file looking for something. When he didn’t find it, he looked at her again, deep in thought.

“Why don’t you get undressed,” he said, “and slip into that gown next to you? I’ll come back in a few minutes.”

When Dr. Edwards returned several minutes later, Peg was sitting on the examination table just as he had left her, but clad now only in a thin pale blue open-backed gown, her arms wrapped around herself in an attempt to stay warm in the air-conditioned room.

He walked over to her, gave her a quick smile and took her hands in his. He looked at the top side of each of them, then turned them over and looked at her palms and wrists. He felt her neck under each side of her jaw and down her neck on either side of her throat. He slid the gown off of her shoulders, allowing it to fall to her waist, lifted each of her arms and ran his fingers under her armpits and around and under her breasts. He placed his stethoscope on her chest and back and listened to her breathe and tapped on her back in several spots. He asked her to lie down, and he pushed and prodded her stomach and abdomen and ran his fingers up and down the inside of her thighs. He told her she could slide her arms back into the gown, and when she had and was once again covered, he took her pulse and looked in her ears and her mouth. His manner was unhurried but efficient, without wasted motion or effort, and his skilled hands gave him the information he sought.

When he was done, he sat down on the chair at the foot of the examining table, folded his arms across his chest and looked directly at Peg for several seconds, as if he were reviewing in his mind one more time everything his examination had revealed to him.

“Well, two things are very apparent. First, judging from your color and your fatigue, I think you’re suffering from anemia, so I want you to make an appointment with the lab for a blood test. Second, a number of the lymph nodes in your neck and under your arms are swollen. We need to find out why. But we’ll start with the blood test. Okay?”

“Of course,” Peg replied, as Dr. Edwards began to fill out a form for the lab detailing the tests he wanted done. “Then what?”

“That’s going to depend on the results of your blood test,” he said when he was finished, and he handed the form to her.

Peg gave a little shrug and looked down at the form in her hand, not overly comfortable with his answer.

“I suggest you go to the lab when you leave here,” he continued. “If you do, we’ll have the results by tomorrow morning. Then give us a call some time after ten o’clock, and my nurse will let you know what we need to do next. Okay?”

“I guess so,” Peg replied.

Dr. Edwards gave her a warm smile and stood up. Then he wished her a good day, shook her hand and left the examination room on his way to his next patient.

Wednesday morning, July 30th, eight minutes after ten.

I’ve been here before
, Peg thought. The phone in Dr. Edwards’ office rang for what had to be the twenty-fifth time. Finally a voice on the other end of the line. “Good morning. Dr. Edwards’ office.”

“Yes. Good morning. My name is Peggy Herbert, and I had a blood test taken yesterday afternoon at Dr. Edwards’ request. He told me to call you this morning and said you’d be able to let me know what I’m supposed to do next. Based on the results of the blood test.”

“Let me check, Mrs. Herbert. I’ll be right back to you.”

A minute passed, then another.

“Yes, Mrs. Herbert,” the voice on the other end of the line suddenly said. “We have the report from the lab, Dr. Edwards has looked at it, and he does want to see you today. Can you make a three-thirty appointment?”

“Yes, I can do that,” Peg replied without hesitation. “Did Dr. Edwards say anything else? About the report, I mean?”

“No, I’m sorry, he didn’t.”

There was silence on both ends of the line for several seconds.

“Is there anything else I can do for you, Mrs. Herbert?” the voice asked.

“No. Nothing at all. I’ll see Dr. Edwards this afternoon at three- thirty.”

“Have a nice day, Mrs. Herbert.”

“You too.”

The voice hung up, and Peg stood in the kitchen looking at the receiver in her hand.

She arrived early for her Wednesday afternoon appointment, at three-twenty to be exact, to be absolutely certain that when her name was called, she’d be there. But that was almost an hour ago. It was now four-fifteen, and for the last fifty-five minutes all she had done was chew on the sides of her fingers, first one hand, then the other. And each time she realized what she was doing, she very consciously clasped both hands together and placed them in her lap before starting to nibble on her lower lip. And when she realized she was biting her lip, she brought a finger to her mouth and repeated the process, over and over again.

Finally, at eighteen minutes after four, she heard her name being called. “Mrs. Herbert?” yesterday’s nurse again half called, half announced. “Mrs. Herbert?”

“I’m here,” Peg answered, louder than she had intended to. “I’m here.”

“I’m sorry you had to wait so long,” yesterday’s nurse said as she led Peg down Internal Medicine’s hall for the second time in as many days. “Dr. Edwards had an emergency over at the hospital this morning, and we still haven’t recovered. Here we are.”

She stopped at a closed door halfway down the hall, knocked softly, waited a second, then opened the door and stepped just inside. From where she was standing out in the hall, Peg could see she was being ushered into Dr. Edwards’ office and not an examination room. The nurse indicated with a small wave that Peg should come into the office and pointed to the leather armchair next to Dr. Edwards’ desk.

“Please. Have a seat. Dr. Edwards will be right with you.”

Peg did as she was told, and as soon as she was seated, the nurse left and closed the door behind her. She was just starting to take in the clutter of patients’ files, medical journals, lab reports, X-ray envelopes and “While You Were Out” messages that covered the desk, part of the floor and the top of a bookcase that ran along the wall, when the door opened and Dr. Edwards came in.

“Good afternoon,” he said, extending his hand to Peg for a gentle handshake. “I’m sorry I’m so late, but it’s been a difficult day.”

“So I gathered,” Peg replied with a small smile.

Dr. Edwards returned her smile, looked at her for a second or two longer than she would have expected, and sat down behind his desk. He rummaged through the pile of patient files stacked in the center of the desk, and when he found Peg’s, he removed the lab report clipped to the inside of the maroon folder. He looked at the report for several moments, then looked up and across the desk at Peg.

“Based on the results of your blood test,” he began slowly, “I’d like you to see another doctor. I have someone in mind, and I think I can arrange for him to see you this afternoon.”

Peg swallowed hard. “Today?”

Dr. Edwards nodded.

“What kind of doctor?”

“An oncologist,” Dr. Edwards replied, looking directly into her eyes, measuring the impact of his answer.

He waited a moment before continuing. “I think you have some form of blood cancer. I’m not an expert in this area, and I could be wrong, but your white cell count is very high, and your red cells are very small and underdeveloped. Which would explain why you’ve been so tired.”

Peg tried to swallow again, but she couldn’t. She said nothing. Questions at that moment seemed superfluous. She just sat quietly looking down at her hands in her lap, one placed flat on top of the other, and bit her lower lip. Finally, she raised her head and met Dr. Edwards’ gaze. “Okay,” she said with a weak and frightened smile.

Dr. Edwards turned to the Rolodex file on his desk and found the telephone number of a Dr. Goldstein, an out-of-group oncologist to whom he had referred patients before. He dialed the number and gave Peg a reassuring smile. She could hear the phone ringing at the other end of the line. Then it stopped.

“Yes, good afternoon. This is Dr. Edwards with North Shore Medical Group.”

A pause.

“I’m fine, thank you. I have a patient sitting here with me, a Peggy Herbert, and I’d like to make an appointment for her to see Dr. Gold-stein as soon as possible. When do you think that might be?”

There was silence on the other end as someone scanned another already overbooked appointment schedule.

“No, two weeks from today is not what I had in mind. Actually, I was hoping Dr. Goldstein could see Mrs. Herbert this afternoon.”

The person on the other end asked a question that Peg couldn’t hear.

“That’s right,” Dr. Edwards replied.

Another pause.

“I think that’ll be fine, but let me check.”

Dr. Edwards turned the mouthpiece of the receiver into his shoulder and looked across the desk at Peg. “Can you make an appointment at five-thirty tonight?”

“Yes,” Peg answered quietly.

“Yes, that’ll be fine. Mrs. Herbert will see you tonight at five-thirty.”

Another pause.

“Thank you very much for your help. I appreciate it.”

He hung up the receiver and began to write something on a prescription form. “Here’s Dr. Goldstein’s address and phone number. He’ll see you at five-thirty,” he repeated, and he handed the slip of paper to Peg. “I’ll fax your lab report over to him now so he has a chance to look at it before you get there.”