I was staring at the ceiling and going over a little scene in which Anne went from door to door in patched shoes taking orders for greasy doughnuts that I baked at home and Joan skated in the street to show me how she could do a figure eight on her roller skates and was hit by a truck, when Kimi said, “I would rather have beautiful children I could see but once a month than ogly little monster I could see all the time.”
Kimi’s mother and father and brother came every visiting day, crowned with happiness and sagging with presents. New robes, sweaters, bed jackets, ribbons for Kimi’s hair, bath powder, toilet water, Japanese Sembi (a wonderful little shiny brown cracker, that tasted like a mixture of pretzels and peanuts), fried chicken in shoyu sauce, fruit, candy, apples and magazines. Although they always spoke in Japanese and I could not understand what they said, I detected a slight note of imperiousness in Kimi’s attitude toward her family.
That day she had lain back on her pillows, a pale yellow bed jacket tied close under her chin, a yellow satin ribbon holding back her thick dark hair, a great mass of white chrysanthemums by her bed, looking like a very beautiful Oriental princess directing her slaves. I asked her about this. She said, “Sometime they bring me the gift with little fuss. Sometime I have to twist their arm a little.”
Kimi was twelve years younger than I, but rooming with her taught me that intellectually we were equals, emotionally she was my superior. I was her superior in experience only. She said that this was not true. That it was just that she was Japanese and used to obeying without question. She said that as a first step in teaching me to emulate the Japanese, she would teach me the language.
She worked hard at this but eight months later, when I left The Pines, all I could say in Japanese were Good-morning, Good-night, How are you today and She is not my friend. I taught Kimi French and when she left The Pines she was reading Sans Famille and La Tulipe Noire, but her conversations with me were limited to “L’oiseau est sur l’arbre,” or “Où est le crayon?”
X
A Smile or a Scar
LESSON IX EXPLAINED the most common surgical methods used at The Pines to arrest tuberculosis. These were:
Artificial Pneumothorax—compression of the affected lung by the introduction of gas or filtered air into the pleural cavity (between the chest wall and the lung). Refills of air were first given every other day, then twice a week, once a week, once every two weeks, once a month, finally every four to six weeks. Pneumothorax was to be continued for a period of from two to four or more years.
Bilateral Pneumothorax—compression of both lungs by pneumothorax. Actually only a portion of both lungs was collapsed and patients taking bilateral pneumothorax, though short of breath, could lead moderately active lives.
Intrapleural Pneumolysis—cauterizing of adhesions between the chest wall and the lung. Such adhesions prevented a satisfactory collapse of the lung.
Thoracoplasty—removal of the ribs on one side of the thorax to accomplish a permanent collapse of the affected (diseased) part of that lung. This type of surgery was necessary when pleural adhesions prevented successful pneumothorax. The mortality rate in thoracoplastic surgery was so low as to be almost nonexistent.
Phrenicotomy—division or crushing of the phrenic nerve on one side causing elevation of the corresponding diaphragm, thus compressing the lower part of the lung on that side.
Extrapleural Pneumothorax—stripping the pleura from the chest wall (extrapleural pneumolysis) to form a pocket for pneumothorax or the use of oil (oleothorax). This operation, not altogether successful, is now seldom used, and was referred to by the patients as a “stripping,” and tactlessly explained by one of the nurses as “being similar to the operation performed by the butcher in making a pocket for stuffing in a roast.” Extrapleural pneumothorax was used when the involvement was not sufficient to warrant thoracoplasty but too many adhesions were present for intrapleural pneumolysis.
A successful collapse of the lung, whether it was accomplished by pneumothorax, thoracoplasty, phrenicectomy or stripping, favored rest for the infected part of the lung and facilitated healing of the disease. Collapsed lungs, being immobile, naturally healed more rapidly than working lungs, even though the working was kept at a minimum by complete bedrest. As the Medical Director had explained, collapsing a lung was like putting a splint on a broken leg.
Other forms of surgery now in use and new since my time include:
Pneumonectomy—removal of the entire affected lung.
Lobectomy—removal of an infected lobe of the lung.
When we were discussing the lesson on surgery, we were informed by Charlie, the store girl, or some other bad news distributor, that people with pulmonary tuberculosis could not take ether. At the time, as I remember, I made inquiry as to what anaesthesia was used in place of ether and was given the impression that the doctors merely knocked the patients down and ripped out their lungs, or adhesions or ribs, without benefit of anything stronger than an aspirin.
As The Pines commanded the services of the finest doctors in the city I knew that this was ridiculous so I asked the Charge Nurse about anaesthesia. She said that for pneumothorax and phrenicectomy and intrapleuralpneumolysis injections of novocain were given; that a few patients were allergic to novocain and took pneumothorax without anaesthesia which no doubt accounted for the no-anaesthesia-for-anything rumor; that for major surgery such as thoracoplasty or “stripping,” sodium pentothal and gas were used.
She said that thoracic surgery was a very wonderful accomplishment and without it many former patients now maintaining good health and living normal useful lives, would be dead.
The maxim on our supper trays that night was: “You are not dressed for work until you wear a smile.” “Or a scar,” Kimi added.
On October thirtieth, a month and two days after I had entered The Pines, a nurse appeared in our doorway at the beginning of rest hours and ordered me to get ready for a ride in a wheelchair. I asked her where I was going but she said only, “Shhhhh!” and left. There was probably some excellent reason for it, but the practise of coming for patients in wheelchairs and not telling them where they were going, or what was to be done to them, always seemed cruel and senseless to me. A wheelchair brought to your bed could mean the dentist, surgery, light treatments, examinations, x-ray, fluoroscope, the movies, a lecture, dismissal, moving to another hospital, a death in the family, any number of things, generally unpleasant but never as unpleasant as the not knowing, the speeding down corridors with racing pulse and rocks in your stomach.
I knew that a wheelchair during rest hours usually meant the treatment room. The treatment room for me! My hands quivered like springs as I tried to tie my robe. I sat weakly on the edge of the bed and phrases from the lesson on surgery swooped around my head in a horrifying circle like bats. “Phrenicectomy, thoracoplasty, bilateral pneumothorax, collapse of both lungs.” My heart pounded and my hands grew wet and clammy as I waited.
Kimi tried to comfort me. Her cheeks scarlet with excitement and apprehension, she said, “At least you know that anaesthetic have been discovered and whatever they do to you will be painless.” I said, “Yes, but just the fact that they are going to do something to me must mean that I’m not getting well. Remember the lesson: ‘There are cases that do not improve with rest, fresh air, and good food.’” We could hear the creak of the approaching wheelchair. Kimi said, “Breathe deeply quickly with both lung. It may be for the last time.”
The nurse came in, I fumbled my way into the wheelchair like a trembly old lady, we rolled down the hall past the Charge Nurse’s office, through large, double swinging doors and into the treatment room, where I was delivered wheelchair and all to the treatment room nurse, a Miss Welsh. Miss Welsh looked cheerful and proved both understanding and kind for she told me at once that I was to have artificial pneumothorax. She said, “For heaven’s sake stop looking so scared, there’s nothing to it.”
The treatment room, a very large old-fashioned operating r
oom, was divided into sections by white sheets hung on rods. Miss Welsh whispered that all new patients were started on pneumothorax by the Medical Director, that he was behind the curtains and was very irritable when operating. Indicating by rolled up eyes and a finger on her closed lips that I was to be absolutely quiet, or else, she disappeared behind the curtain.
The treatment room had windows to the ceiling, pure white walls and strong overhead lights and I sat in my wheelchair, absolutely quiet but blinking and squinting in the strong light and feeling like a mole that had suddenly burrowed out into the sunshine.
There were two other patients waiting. One was the blonde with the gold tooth, who had brought washwater on my first morning at the sanatorium. She wore the same maroon sweater and was tatting something shrimp pink. She smiled but said nothing.
The other patient was a young man with thick straight dark hair, very sunken brown eyes and feverish red cheeks. His navy blue flannel robe had a blob of egg on the lapel and I could tell that he was a very new patient because his fingers were still brown with cigarette stains. He showed not a glimmer of interest in me, the blonde or his surroundings, but stared morbidly at a large black framed motto which read, “It’s good to have money and the things money can buy—but it’s good, too, to check up once in a while and make sure that you have some of the things money can’t buy.” “Like tuberculosis,” I thought bitterly.
I was getting very sick of mottos and maxims and beautiful thoughts and as the minutes slogged by and there was no human sound from behind the white curtains, only occasional metallic clicks or the gushing sound of a faucet, I grew more and more apprehensive. “What were they doing behind there? Had something gone wrong? Why didn’t somebody say something!”
I moved my wheelchair back a little but this only brought me face to face with another motto, “Worry, the interest paid by those who borrow trouble.” I felt just like Eileen and wanted to shout rudely, “What knothead thought that up?” Just then the curtains parted and out came Little Miss Teacup Cavities of my first trip to the bathroom. She said goodbye to the Medical Director and Miss Welsh and was retrieved by a nurse from our ward who curtly took possession of my wheelchair.
Miss Welsh indicated that the feverish boy was next and that I was to sit down on a bench beside Gold Tooth. I was so scared I was practically in a coma. Pneumothorax! Collapse of the lung! I was sure that I would suffocate. I remembered with disconcerting vividness the time, when I was twelve years old, I had tried to crawl between the crossed supports of a diving platform and had become firmly wedged. I drew air into my lungs in great gulps as I recalled the horrible smothering sensation and the long breathless terrible minutes it took Cleve to free me.
I derived small comfort from the fact that everyone had told me that there was no sensation, no pain, to pneumothorax. Hadn’t everyone told me that having a baby was just like a little case of indigestion? Indigestion maybe, but the kind you’d get from swallowing a cement mixer. I could now see the wall that had been behind me and it framed another motto. “Let thy speech be better than silence or be silent.” Obviously somebody’s mother had been scared by Bartlett’s Quotations. I resolved to burn my copy the minute I got home.
The thin blonde began to cough, first, however, neatly laying down her tatting shuttle and covering her mouth with a paper handkerchief. When she had finished she put the used handkerchief into an envelope of heavy waxed paper, put the envelope into her sweater pocket, then picked up her shuttle again. I could feel a cough bubbling in my chest. I swallowed hard and concentrated on “a cough can be controlled,” for in my hysteria I had forgotten my waxed paper envelope and clean paper handkerchiefs. It was very warm in the treatment room and as I controlled my cough I could feel my face turning a dark unhealthy red. A nurse opened the outside door and looked in at us. Apparently neither the blonde nor I was what she wanted, for after looking at my red face suspiciously for a minute or two, she shut the door again.
I grew fascinated with the blonde’s tatting shuttle. It darted in and out of the shrimp pink like a dragonfly in a hollyhock. The pink thing was square and lacy and seemed to be some kind of a yoke. I had seen many such yokes displayed at county fairs and could easily picture it completed, its virulent color clutching the top of a too-short white cotton petticoat, cut on the bias and sucked in at the knees.
Miss Welsh finally emerged again from behind the white curtains and motioned to me. My heart gave a wild leap of fear but I got up and marched resolutely over to her. Whatever it was, I was willing to face it, to get it over. She helped me off with my robe and the tops of my pajamas and up onto an operating table. She told me to lie on my back with my left arm above my head, then painted the entire upper left half of me with mercurochrome.
The Medical Director was washing his hands over in the corner, his back to us. When he had finished washing the nurse handed him a pair of rubber gloves, which he put on without speaking. Then he poked me experimentally in the ribs, looked at my x-rays, examined my case history and said, “Yell if you want to but don’t flinch!”
I felt the prick of the hypodermic needle, just under my left breast, then an odd sensation as though he were trying to push me off the table, then a crunchy feeling and a stab of pain. “There now,” the Medical Director said, as he attached the end of what looked like a steel knitting needle to a small rubber hose connected to two gallon fruit jars partially filled with a clear amber fluid. The nurse put one jar higher than the other and I waited frantically for my breathing to stop and suffocation to start. There was no sensation of any kind for a few minutes then I had a pulling, tight feeling up around my neck and shoulder. The doctor said, “I guess that’s enough for today,” took the needle out, slapped a bandage on me and I got down from the table, dizzy with relief.
Climbing back into bed, I had a terrific, overwhelming desire for a cigarette. A cup of hot coffee and a cigarette. Laughing so that she would know it was just a little joke, I told the nurse but she looked disapproving and brought me two aspirin and some lukewarm water.
By suppertime I had sharp knifelike pains in my chest and had spit up a little blood. I excitedly reported these symptoms to the Charge Nurse and she immediately put my bed down flat and said that I was not to walk to the bathroom and was to eat all my meals lying down for three days. She then explained calmly that the pains were adhesions tearing loose, the blood was probably from my nose, that I was most fortunate to be able to take pneumothorax. She said the only reason I hadn’t had pneumothorax as soon as I entered was because of the shadow on my right lung. She said that this shadow had cleared and I was a very lucky young woman.
Lying on my back, spilling tea and little slimy pieces of canned pear down my neck, it was difficult for me to see eye to eye with the Charge Nurse, especially as I had felt perfectly well without a single pain of any kind before I got so terribly lucky and was given pneumothorax. The maxim on my tray was: “I would rather be able to appreciate some things I cannot have than to have things I cannot appreciate.”
From then on until I left The Pines, like all the great clan of “gas” patients, I was given a jigger of “gas medicine,” a brackish-tasting liquid, before every meal.
For three days and nights, each time I moved I had severe tearing pains in my left lung. I took aspirin and tried to concentrate on feeling fortunate but succeeded only in feeling very tubercular.
Friday morning, just after temperatures and pulses, a strange man stopped at our door, read my name from a list he was holding, told me to put on my robe and slippers, helped me into a wheelchair and started toward the elevators. “Now what?” I asked myself, my fear-addled brain trying to recall the various forms of surgery used if pneumothorax was not successful.
When the elevator door had clanged shut, the man said, “Ever been to fluoroscope before?” I said no, and he said, “You’ll like it. You can talk and you’ll see people from all over the hospital.” My sigh of relief almost collapsed my other lung.
B
efore we had rounded the second bend of the tunnel leading to x-ray, we heard what sounded like the chirping and twittering of thousands of nesting birds. “Fluoroscope patients,” the x-ray man explained. The noise was almost deafening as we rounded the last bend and came on about eighty patients, both men and women, but carefully sorted according to sex, sitting on benches along the walls of the tunnel and waiting to be fluoroscoped.
The x-ray man pushed my wheelchair to the door of the laboratory and callously left me facing the benches and the eighty strangers, who immediately stopped talking and unabashedly looked me over. Feeling like a pimply blind date and very conscious of my gray lips and uncombed hair, I lowered my eyes and examined the fingernails on my shaking left hand.
When the talking at last began again, I was sure much of it was about me but I was able to raise my eyes and observe. Most of the patients were young, in their teens and early twenties, and appeared robust and very healthy. The female patients from the Ambulant Hospital wore makeup and hair curled and arranged in slightly out-of-date fashions. The degree of out-of-dateness varied with the length of time the patient had been at The Pines and what had been in vogue when she entered. Most of the women were doing some form of fancywork and knitting needles, tatting shuttles, crochet hooks and embroidery needles flicked and darted as they talked.
The men just sat. This made them appear sadder and sicker than the women. All the patients were dressed in bathrobes or housecoats. The women’s were floor length and bright colored. Coral, turquoise, pale green, bright red, electric blue, lavender, yellow, and of course magenta. The men’s robes were short and drab. Dusty dark blue, maroon, earthy brown and gray. The men were combed and clean shaven and actually as fat, pink cheeked and bright eyed as the women, but they didn’t make the same effort to look healthy and happy. They sat in dejected attitudes looking as unemployed and beaten as possible, and coughing and spitting constantly. It made me wonder if any occupational therapy other than spitting was provided for male bedrest patients.