The tea stirred his appetite, and Anil realized he was ravenous. He checked the fridge again, then the freezer. Even the kitchen cabinet was depleted of its usual supply of canned chickpeas.
Anil returned from the Indian grocery store with a half-dozen boxed dinners, a tub of yogurt, and fresh onions, tomatoes, cilantro, and limes for a salad. On impulse, he’d also bought a bag of frozen samosas and a quarter pound of freshly made sweets. He called to let Mahesh know he was preparing dinner, then went to check the mail. Resuming this habit felt like a small but necessary step. Their box was crammed full, including three large brown envelopes addressed to Mahesh and adorned with Indian postage. Anil smiled, realizing that Mahesh’s future wife might be awaiting discovery in one of these packages. He took the envelopes to Mahesh’s room, where the desk held a neat stack of similar envelopes, at least seven or eight of them, all unopened. Anil added the new envelopes to the pile and pulled the door closed behind him.
“THAT IS a lot of food.” Mahesh surveyed the dishes Anil had spread out over their dinette table. “You got used to eating like a king back home?”
“Too much?” Anil said. Undoubtedly it was, for just the two of them. He reached for the radio. It was quiet without Baldev. “Maybe I should go next door and see if Amber wants to join us?” He’d thought about knocking on her door since coming home, just to see how she was.
“Bhai . . .” Mahesh hesitated. “She came by to tell you herself, but you’d already left for India.” He wrapped his fingers around the top of a chair. “Amber moved out.”
Anil pulled out another chair and sat down. “Oh.”
“She wanted you to know it had nothing to do with you,” Mahesh continued. “It was them . . . those guys.”
“Did they bother her again?” Anil asked.
Mahesh shook his head. “She said she just couldn’t live here anymore. She felt like it was her fault, what happened to Baldev. Which it wasn’t, of course. I tried to tell her . . .”
Anil nodded. The infection of guilt had spread farther than he knew.
“She has a roommate now, and a security guard at the gate where she lives. Bhai, you okay?” Mahesh asked him in Gujarati.
Anil served himself matar paneer and handed the plastic tray to Mahesh, who was still standing, watching him. “Yes, fine,” he said, trying to end the discussion. He reached for the tub of yogurt. “Speaking of love interests,” he shifted gears, “you got a few packages in the mail today. I left them on your desk.”
Mahesh sat down and served himself some rice. “Okay.”
“Any interesting prospects? Have you found the future Mrs. Shah yet?”
Mahesh shook his head, scooping up rice and curry with his fingertips. “I haven’t had time to look, I’ve been so busy at work. We have a big release coming up next month—they’ve just put another development team on it. Now we have eight people working on it, but it’ll still be a stretch to hit the release date.”
“Another team? You have to manage all those people?” Anil asked. Mahesh preferred to work alone; his anxiety level correlated with the number of colleague interactions he had.
Mahesh added another dollop of yogurt to his plate and mixed it with the rice. Unlike anyone else Anil knew, Mahesh always finished off his Indian meals with a few tablespoons of rice and tart yogurt, like some unsweetened pudding. Mahesh shook his head again. “The other team has its own leader, so we coordinate with each other.”
“I guess I did make too much food,” Anil said, taking in all the dishes left on the table. “You want to take it for lunch tomorrow?”
“No, that’s okay,” Mahesh said. “We’ve been going to this place near the office, Dosa Palace. Really good; I’ll take you there some time.”
“Since when do you go out for lunch?” Anil asked. “I thought you didn’t like to leave your desk. And who’s we?”
“Just . . . Yaalini,” Mahesh said. “She’s the other team leader.”
“Yaalini?” Anil smiled. “Really?”
Mahesh shook his head. “Nah, it’s not like that. We have nothing in common. She’s from Tamil Nadu, she speaks Telugu. It’s just work.” He stood up and carried his plate to the kitchen. “Hey, why don’t we take this stuff to Baldev in the morning? He’s always complaining about the hospital food.”
PARKVIEW’S REHABILITATION ward was in the east building, on the opposite side of the hospital complex from where Anil usually worked. Patients stayed there for anywhere from a week to a few months, until they regained enough mobility to be at home. The rehab ward had a different layout from the others. Across from the elevators was an enormous open room, covered with floor mats and equipment. Sunlight streamed into the space through long vertical windows lining the outer wall. And notably, the cinder-block walls here were painted a cheery yellow rather than the drab pastels elsewhere in the hospital. It was the most hopeful space at Parkview. Although these patients were badly injured, they all had the capacity to get better. That knowledge alone must have been reassuring: rather than teetering on the edge of death or severe illness, they could move slowly toward progress.
In his room, Baldev was sitting up in bed, holding the remote control at an awkward angle toward the television. “Anyone want a samosa?” Anil asked, holding up a plastic bag as he entered.
“Hey, Anil—welcome home, man.” Baldev dropped the remote in his lap and reached out his good arm. The bruises on his face had turned to a lighter olive green, and only the deepest lacerations were still visible. Both his casts had been removed, though his right arm remained in a sling. He’d made tremendous improvement in the past couple of weeks.
“You look good, man.” Anil took Baldev’s hand and gave it a gentle slap. Mahesh pulled two chairs over and they sat next to the bed.
“I feel good,” Baldev said. “Starting to get my strength back, you know?” He held up his arm in a weightlifter’s pose. “I’ll be back causing trouble in no time.”
“Oh, he’s already causing trouble.” A female voice came from the doorway, and Anil turned to see a young woman dressed in deep-purple scrubs. She had a fringe of sandy-brown hair across her forehead, and the rest was held back in a ponytail. “Mahesh, good to see you.” She touched Mahesh on the shoulder. “And you must be Anil.” She smiled at him. “Or should I call you Dr. Patel?” She indicated the badge clipped to his white coat.
“Oh no, Anil’s fine.” There was a tiny diamond stud on the left side of the woman’s nose. She was pretty in that natural way of girls in soap commercials, all glowing skin and bright eyes.
“Well, it’s a pleasure to finally meet you. I’m Trinity,” she said, extending her hand. “Baldev’s physical therapist.”
“Good to meet you too.” Anil shook her hand, noting she’d pronounced all three of their names correctly.
“And how’s my second-favorite patient feeling today?” She walked over to the far side of Baldev’s bed and stood back to assess him.
“What?” Baldev threw his good arm up in the air. “I got bumped down again?”
“Sorry,” Trinity said. “But until Mr. Naderi goes home, I have no choice.” She winked at Anil and Mahesh. “His wife brings me baklava. I have a weakness.”
“Understandable,” Anil grinned. “Frankly, I’m surprised Baldev is even in second place.”
“Oh, come on, don’t gang up on me.” Baldev slapped Anil’s knee. “Now, hand over that samosa, will you? I’m starving for decent food in this place.”
“Samosa?” Trinity said.
“Yes, and if you’re very good to me, I might let you have one.” Baldev reached inside the greasy bag.
“Well, you better build up your energy, Mr. Kapoor, because I have a serious regimen in store for you today. I’ll be back for you in an hour, okay?” Trinity headed toward the door. “And don’t forget to save me some chutney,” she called over her shoulder.
After Trinity left the room, Baldev grinned as he chewed. “I think she likes her men spicy too, if you know what
I mean.” He moved his eyebrows up and down, and with that single gesture, Anil recognized his friend again.
24
AFTER THE MORNINGS TURNED CHILLY AND THE TREES HAD dropped their leaves into great piles of ocher and crimson, Anil was assigned to an elective rotation in Oncology. The Oncology ward was populated by chronically ill patients: the nineteen-year-old student whose brain tumor resisted radiation, the young mother whose bilateral mastectomies rendered her unable to hold her toddler, the businessman diagnosed with advanced colon cancer the year he finally retired. The few good stories were quickly usurped by the hopeless ones. It was also Anil’s first chance to work alongside Sonia Mehta again since the death of Jason Calhoun during his ICU rotation, and he was eager to redeem himself.
“Mrs. Templeton,” Anil said, entering a patient’s room. “How are you feeling today?”
“Good, doctor, but please call me Marilyn.” The patient, an older woman in her seventies, smiled brightly at him. Her short gray hair was growing back after her second round of chemotherapy for breast cancer. “‘Mrs. Templeton’ makes me feel old,” she whispered.
Anil smiled. “Okay then, Marilyn. How’s your appetite today?”
“Oh, fine,” she said. “Isn’t the snow beautiful?” She gestured at the fluffy white flakes falling outside. “So nice to have a window room.”
Anil followed her gaze outside. It had started to snow during the night while he slept. On his drive to work, the radio broadcasts had been full of school closures and traffic warnings. No one was prepared for snowfall in Texas except the emergency room, which already had seen a sharp increase in injuries from motor vehicle accidents. It was the first time Anil had ever seen snow. “Yes,” he agreed with Mrs. Templeton. “It is beautiful.” He glanced around her room and noticed her lunch tray untouched. “Did you eat breakfast this morning?”
“Oh, well, I didn’t really feel like eating today. I’m not one to complain, doctor, but the food here isn’t very tempting, you know?”
Anil checked her chart. “Looks like you haven’t been eating much the last few days.”
“I’m sorry, doctor.” Marilyn looked remorseful. “I tried. It’s just that nothing tastes quite right.” She was a small woman with a sturdy frame and a soft drawl that reminded him of sitar music. Even her negative words landed softly.
Anil gestured to the lunch tray. “Well, I’d like you to try to eat something so you can keep up your strength. I’d rather not have to put you on an IV.” He noted her thin arms and barely visible veins. “I’ll be back to check on you later this afternoon, Mrs. Templeton.”
“Marilyn!” she called out as he left the room.
ANIL FOUND Sonia at the nurses’ station. “I’d like to get a CT scan for Mrs. Templeton,” he said. “She’s three months out of chemo for stage-two breast cancer, and I think she may be having some new neurological symptoms.”
“You think?” Sonia asked as she wrote in a chart.
“Loss of taste sensation. She hasn’t eaten a meal in days, just sips juice through a straw.”
Sonia looked up at him. “Have you done the neuro exam yet?”
“No,” Anil said. “I thought I’d do the scan first.”
Sonia collected her papers and began walking down the corridor. “Why?”
Anil scrambled to catch up. Why? Because we always scan first. “It’s faster, more accurate.” In more than two years at Parkview, no one had ever questioned the diagnostic superiority of a CT scan.
“See if you can figure it out on your own first, Patel,” Sonia said. “Do a complete neuro exam—all five components, no shortcuts—to determine if and where there’s a lesion. Then you can do a CT to confirm.”
“But that’ll take an hour, and I still have eight patients—”
“At least an hour, if you do it right,” Sonia interrupted. “And not enough physicians are skilled at doing it right.” She lodged a pencil behind her ear. “Don’t look so glum, Patel, you’ll still get your scan. I just want you to have an opinion first. And if you’re right,” she called over her shoulder as she walked away, “I’ll buy lunch.”
ANIL HADN’T done a full neurological examination since practicing on a classmate in medical school. He started with the cranial nerve section, testing Marilyn’s sense of smell, vision, and eye movements, all of which appeared normal. He went on to assess the sensory functions of her face, stopping when she didn’t seem to feel the sharp end of a cotton swab he touched to her left jaw. He repeated the test, with the same result. She also had trouble moving her jaw from side to side. Although she didn’t appear to have any facial asymmetry, Anil went through the steps of testing every facial nerve for dysfunction. He tested her hearing and her gag reflex, and the mobility of her tongue.
Marilyn was an agreeable patient, cooperating as Anil progressed through the lengthy sensory and motor examination, testing the reflexes in her feet, ankles, knees, and arms, and finally evaluating her coordination and walking gait. “Honestly, doctor, if I knew I’d be putting you through all this, I would’ve eaten the tuna sandwich.” Marilyn smiled, her eyes twinkling. Anil had a hollow feeling in his stomach when he left her room.
He found Sonia in the break room. “I think she has a lesion between the mandibular branch of CN5 and CN7,” he said. “It must be small because she hasn’t lost any facial nerve function, just the taste sensation on the anterior of the tongue, and some motor function in the masseter. Everything else on the neuro exam had a normal finding, so I think it’s localized to that one site. Likely metastasis from the breast cancer.”
“Okay, Patel,” Sonia said. “Go do the scan and see if you’re right.”
When Anil returned with the CT scan, it showed a pea-sized lesion between the fifth and seventh cranial nerves. Sonia handed the scan back to him. “Good work, Patel. Call her oncologist, then let’s go.” She clipped her pager onto her belt. “I’m hungry.”
“FOR SOMEONE who enjoys being right, you certainly are morose, Patel.” Sonia sat across the cafeteria table from him. They’d both chosen the grilled-cheese platter, but Sonia’s was largely finished while Anil’s remained on his plate.
“I wish I were wrong in this case.” Anil said. “What a depressing specialty. Everybody’s dying.”
“Everybody’s dying anyway.” Sonia reached over and took a few of his french fries.
“Oncology just seems so hopeless. At least in cardiology you can do something to help most people get better—stents, angioplasty.” Anil stabbed at a thick slice of cucumber, breaking his plastic fork.
“Cardiology?” Sonia asked.
Anil nodded. “I decided to apply for a fellowship in interventional cardio. You think I have a shot?”
“Honestly, I don’t know, Patel,” Sonia said. “But you should think about whether that’s the right specialty for you. Is it the best use of your skills? Is that how you want to help people? I know it’s easy to get seduced by all the technology we have here, but look at what you did today.” She leaned across the table. “You diagnosed a brain tumor using only your eyes and hands.”
“CT scan would have been faster,” Anil said. “Why’d you have me do it that way, anyhow?”
Sonia shrugged and sat back against the bench seat. “When I was a junior resident, a huge tornado struck Dallas. Power went out all over the city. The hospital was running on backup generators, but we were told not to overload Radiology with nonurgent cases. So I had to rely on all the skills I had systematically unlearned my first year here.” She shook her head. “I found a peripheral nerve dysfunction in a chronic diabetic patient that day. I don’t know who was more surprised, me or my attending.” She drained her glass of iced tea. “The thorough physical exam is a lost art, Patel, but done properly, you can diagnose more than you’d think.”
“So why this case, today? You think this snow’s going to take down the power grid?” Anil nodded toward the window.
“I don’t take bullets from the firing squad for just anybody,
” Sonia said. Anil stared at her, not comprehending. “You’ve got your flaws, Patel, that’s for damn sure. But you’ve also got the potential to be more than just a technician, which is what most of your peers will be. I know you’ve got a chip on your shoulder, coming here from India, but at least you learned how to perform a full physical exam, since you didn’t have a scanner on every ward.” She chewed on a crust of her sandwich. “Patients always want a solution and we like to feel invincible, but medicine is not a perfect science. If you want to be a truly great physician, you’ve got to learn the art as well.”
Anil’s pager buzzed in his pocket. He glanced down at it and let out a deep breath. “Her oncologist is here. God, I really wish there was something else we could do for her. She’s such a sweet old lady. The last round of chemo really wore her down, and now we have to ask her to go through it all again.”
“Well, maybe you shouldn’t ask her.” Sonia stood up, carrying her tray. “Maybe that’s not the right question.”
“What do you mean?” Anil followed her, taking half his grilled-cheese sandwich with him. An elevator ride had become an adequate length of time to consume a meal. “Isn’t that the best course of treatment for this kind of metastasis?”
“This is a woman who’s been living with a terminal illness for years. You can ask her if she’s thought about how she’d like to spend her remaining time,” Sonia said. “You might get a different answer.”
LATER THAT afternoon, Anil sat with Marilyn Templeton while her oncologist explained that the cancer had metastasized to her brain. He showed her the CT scan and presented her with treatment options, recommending she start a third round of chemotherapy immediately. Before leaving the hospital for the night, Anil returned to Marilyn’s room and found her sitting by the window, staring outside. The snow had stopped falling, and what remained on the streets was a slushy mess.
Marilyn’s dinner tray remained covered. Anil handed her the bottle of juice he’d brought and sat down in a chair next to her. “Marilyn,” he said deliberately, and she smiled. “What do you think about the options Dr. Heasley laid out?”