Recessional by James A. Michener
When Andy asked: ‘Which one would you use if it were your wife?’ the answer came loud and clear: ‘Dr. Sam Bailey. Practices here in Tampa, none better.’
When the time came for Laura Oliphant, seventy-six years old, to consult with the new man, she insisted that Dr. Zorn accompany her. Dr. Bailey, a man in his mid-forties, was not pleased with the prospect of counseling a patient when another doctor was present, but Zorn explained that he was there simply as director of the Palms and thus a kind of custodian of the woman.
‘No husband?’ Bailey asked, and when Laura said: ‘No,’ he asked: ‘No trusted lawyer? No grandchildren? Well, you really are alone. Stay with us, Zorn.’
And then began one of the travesties of American medicine, a forgivable one that does little harm and some good. For a fee of four hundred and fifty dollars, Dr. Bailey simply told Ms. Oliphant what she already knew, but he did it in such a thorough, skillfully organized manner that she could understand each step in this intricate and frustrating battle with breast cancer. Even Zorn was amazed at the complexity and the routine guesswork facing any woman with the affliction, no matter how intelligent she might be.
Dr. Bailey sat in a straight-backed chair with no desk in front of him, in an office that resembled the living room of a genteel, middle-class suburban family. Ms. Oliphant was given a comfortable chair with armrests and Zorn was allowed to bring in a chair from the waiting room. The room was subtly lighted, hardly enough for reading, and decorated with three Winslow Homer prints of marinescapes. His consultation consisted of a thorough lecture on breast cancer in American females.
‘It is one of the disgraces of American medicine,’ he began, ‘that research in this field has been left primarily to men, and they’ve treated the subject almost with nonchalance. Very little real work has been done, in the opinion of many, with the result that how you are treated, Ms. Oliphant, or women like you, depends largely on where you live when you consult your surgeon. In the conservative Mississippi River Valley and to the west it’s radical mastectomy and cutting out every lymph node—what you had some years ago. In the more sophisticated Northeast it’s now mostly lumpectomies. In the South, except for Florida and its geriatric specialists, it can be heavy surgery on the principle that if the patient isn’t well cut up she’s not getting her money’s worth. Same way with radiation, very heavy in the West, not so heavy down here. Some favor chemotherapy as the follow-up, especially in cases of recurrence. And with Tamoxifen, it depends on which doctor you go to among the six on the same street.’
He apologized for this confusion, pointing out that much of medicine was influenced by the region in which the doctor had been reared and educated, and said: ‘But the variety of recommended treatments for breast cancer excels all other diseases.’ He coughed, took a drink of water and asked: ‘So which of these seemingly endless variables is best? Let me explain the immutable fact, the one that overrides all else. If a young woman is diagnosed as having breast cancer and refuses to do anything about it, rejects her doctor’s advice, regardless of which part of the nation he practices in, she dies at a young age. She dies. In her stubbornness she dies. I will admit no debate on that salient point because I help to bury them, year after year.
‘The same rule governs your case. If you refuse to take any steps, you will die six, eight, ten years prematurely. You have the option to do nothing, but you must be aware of how you’re endangering yourself.’
Allowing this mournful truth to sink in, he changed his tone of voice to a much brighter one: ‘So what are the avenues of escape?’ and in a brilliant summary of current knowledge he reviewed the pluses and minuses of each of the acceptable procedures, making the evidence so forthright and unequivocal that any attentive listener could have understood: ‘It seems to have been proved a hundred times over that tracking down cancer cells that may have escaped into the lymph nodes and destroying them there, either by surgery, chemotherapy or radiation, saves lives. The terrible word in cancer therapy is metastasizing. If the cells break loose and are left free to attack other organs in the body, and they have time to take root there and multiply, all hope is lost. That’s when you hear the awful words: “They cut him open, looked around and sewed him right up again. Three months to live.” ’
He smiled at Ms. Oliphant and said reassuringly: ‘I used the pronoun he because that sentence is used most often about men. They allow a cancer of the prostate to spread its cells to the liver and the spleen and the lower stomach, and by the time we get to the mess, nothing can be done. “Sew him back up.” ’
He told her that metastasizing in women’s breast cases was less virulent or immediately deadly because the fugitive cells did not find so easily and rapidly an organ like the liver or the lower bowel in which to multiply at some horrendous rate: ‘With you, it’s slower but in the long run just as deadly. So what can we do to track down and destroy those vagrant cells that become such killers? Well, in the old days, like thirteen years ago, we cut out not only the breast cancer but also the places to which the wandering cell might have fled. Tough on the patient, as you know, but also very tough on those merciless cells.’
And he proceeded with case histories in the newer treatments. He said that lumpectomies, if followed by rigorous radiation or chemotherapy, were producing good results, but also had some drawbacks. He was not overly enthusiastic about Tamoxifen: ‘Because there haven’t been enough studies of possible side effects. That it slows down the migration and even the growth of cancer cells there can be no doubt, but at what cost we really don’t know.’
When it was apparent that he was concluding his lecture, Ms. Oliphant said: ‘You make it so clear that even I can understand it. Don’t you agree, Dr. Zorn?’ When he nodded, she said to the two doctors: ‘So what course am I to take? I want to live as long as possible, because there is so much left to be done.’
Dr. Bailey then gave her the most dismaying news: ‘It is not in my capacity or knowledge to tell you specifically what to do.’
‘Damn it, who can?’ she almost screamed.
‘No one. We’re in a dark alley of human experience where the rules of procedure are not yet known, so I cannot prescribe.’
‘Who can?’
‘Only you, relying on such counsel as your dearest friends and your doctors can give.’
‘That’s why I came to you, Dr. Bailey.’
‘And I can give you these guidelines to help you decide. If you do nothing, as I said at the beginning, you are doomed. If you take any one of the defensive steps I’ve outlined, your chances are markedly improved. And if you elect all three, I can tell you without hesitation that you will enjoy a ninety-seven percent chance of survival till something else finishes you off. If you’re sensible, your chances are extremely good.’
‘You mentioned “defensive steps” but you didn’t specify them.’
‘Mastectomy or lumpectomy. Radiation or chemotherapy. Tamoxifen.’
‘And doing only two?’
‘The odds in your favor diminish.’ When he saw her blanch he quickly added: ‘But not catastrophically. Look at your case. Years ago you had only two choices, yet you lived a good life for many years.’
‘Are you married, Dr. Bailey?’
‘I am.’
‘If this were your wife consulting you, what would you advise?’
He reflected, then said: ‘I’m constantly asked that question, Ms. Oliphant. It’s sensible and inevitable. And I know exactly what I’d do, I’d listen carefully to everything I’ve said, and then I’d consult the three best doctors I knew, and maybe my lawyer and accountant, and one night at four in the morning I’d sit bolt upright in bed and shout: “Rachel, this is what we’re going to do, if you’re brave enough to go the route.” And I would pray that she’d say she was ready.’
‘And what would that route be?’ she asked and he had to confess: ‘At this stage in my life, and with the imperfect knowledge we have, I honestly don’t know.’
When he led her
When Zorn trailed behind, Bailey told him: ‘We all need counsel. Don’t hesitate to help her because of some legality.’
But when he caught up with Laura, she looked at him with dumb despair, tried to speak and ended in a shriek: ‘Damn it, damn it! I consult the wisest men in Tampa and they can tell me nothing. Dear God! Why do you all desert us, leaving us to figure everything out for ourselves?’
Throwing his arm about her shoulders to calm her, Zorn took her to his car and drove her back to the only refuge she had left, her circle of friends at the Palms. But when they reached the fortress gate and could see the handsome center dedicated to health and rehabilitation, he thought not of her confusion but of his own: How strange that because of fear of litigation medicine has fallen into this state when notable experts like Dr. Bailey are afraid to give simple recommendations as to what a patient ought to do. We shy from the great tasks and occupy ourselves with the petty. Wrong, wrong, but how can we correct it?
Later in the spring when Dr. Zorn had cause to believe that he had the Palms on a road to ultimate solvency, he launched a campaign that was to prove frustratingly futile. As he wandered through the three segments of his realm, he stopped to chat with residents, eager for them to know that he was watching out for their interests. He was increasingly greeted as ‘Dr. Andy’ or referred to as ‘Our Dr. Andy’ to whom questions of deep concern could be addressed.
He did his best to provide solutions to general problems or to help when the appeal was from an individual who needed help in his or her private concerns. Thus he lengthened the hours in which books could be taken from the library and arranged new starting hours for the films that were shown twice a week. He also helped a widow solve a bewildering problem with her taxes and found extra quarters when some couple was visited by three grandchildren instead of two. In this way he helped bind the residents into a closer-knit group while at the same time helping himself understand the complexities of a retirement center.
One afternoon when he was inspecting the savanna he passed the spot where Judge Noble sat on the bulkhead, his fishing pole out in the water and his congregation of birds standing like some Greek chorus about him and the tame pelican in the water yapping for his share of whatever fish the judge might catch that day. And the thought came to him like an epiphany: That good man is an adornment to this place. He and his birds must bring untold delights to our residents, and I must do something to show my appreciation.
Heading directly for Ken Krenek’s office, he asked: ‘Could I scrape up the funds to provide Judge Noble with a proper chair for his fishing? One with a wide band of wood across the back so we could have his name painted across it?’
‘You’d have to check with Miss Foxworth to see how her petty cash stands.’ But when he discussed the matter with her she asked, as always: ‘What kind of money are we talking about here?’ And he said: ‘I think maybe fifty dollars would cover it, plus maybe fifteen for the lettering.’
She could not control her amazement: ‘Andy! Are you out of your mind? There’s a secondhand furniture shop down the road where you can find a good chair for nine dollars, and I have a great do-it-yourself lettering kit, if you provide the black paint.’
She found pleasure in driving him to the secondhand shop, and on the way she said in a conciliatory tone: ‘It’s a great idea, Andy. You’ll make the old judge feel like an honored guest.’
They found a sturdy old chair for seven dollars and a small can of paint for one fifty. Back at the Palms, Zorn spent part of a morning sanding the chair and tightening the screws, after which Miss Foxworth did the lettering in a style as professional as she had promised.
When Zorn saw the finished chair he was enthusiastic: ‘It’s handsomer than I expected. That’s the chair of a real fisherman,’ and he and Krenek alerted some of the residents to be ready to accompany Judge Noble when he left Gateways that afternoon to go out for his fishing: ‘Don’t trail along with him. He’d be suspicious. But when he sees the chair, rush out and give him the big hello!’
Then, about an hour before the judge customarily went for his fishing, Zorn and Krenek carried the chair to the spot where the judge usually sat on the bulkhead and placed it in position. A score of people watched from their balconies as the white-haired judge left Gateways with his rod, walked down the path as birds clustered about him and came to the chair on which a heron was perching. There, at the feet of the great blue, stood his name in fine blue lettering: JUDGE NOBLE.
He was deeply touched, especially when the group of residents who had quietly followed him rushed out to surround and congratulate him. Watching from the channel, even Rowdy the pelican seemed to be applauding.
Two days later when the judge walked down for his fishing, the chair was gone. At first no one had any idea of who might have taken it, but later a woman on the third floor said that the previous night she had been on her balcony because she was unable to sleep and had seen two men come from the landing at the river, creep down the path and steal the chair. Why had she not reported this sooner? She said: ‘I’m reporting it now, first chance I’ve had.’
Zorn was outraged, especially since the thieves could have bought such a chair for only a few dollars. He went back to Miss Foxworth and said: ‘I can’t allow hoodlums to ruin a great idea. Take me back to the furniture store. We’ll get another chair. And I’ll pay you five bucks for lettering it like last time.’ As they drove back to the Palms he explained his strategy: ‘This time we bind the four legs with wire straps to sturdy poles three feet long, and we sink those feet deep in the ground. We’ll put a flange at the bottom of each leg so that when the earth is tamped back in, the leg can’t be pulled out.’
This solution worked, for when the legs were well sunk into the earth, with the flanges securely anchored at the bottom, the chair with its fine lettering could not be stolen, and the various people who had helped Zorn in this adventure applauded when the chair remained in place with its festoon of birds each afternoon.
But Zorn’s triumph did not last long, because on the fifth or sixth night the woman who could not sleep telephoned the main desk: ‘The same people, I think it must have been, brought saws, and cut off part of the legs and carried the chair away.’
Zorn declared war: ‘Ken, phone around and find a place where I can get four steel pillars. We’ll sink them in concrete four feet down, and build us a chair seat between the parts that are above ground.’
‘That would work, but we can’t do it from petty cash.’
‘I’ll pay for it,’ and under his direction a very solid engineering job was done, leaving no wooden parts that could be sawed away because the seat itself was made of the steel seat of an abandoned tractor, and now the judge had a seemingly indestructible chair. But not quite, because some nights later the same watchdog called again: ‘They’re beating it to death with hammers!’ Running out with a flashlight Andy saw that the woman had reported correctly. The tractor seat had not been stolen but simply smashed to pieces as it remained bolted to the steel pillars.
Back in his office at four in the morning with hot cocoa that Krenek had made, Andy asked in deep frustration: ‘Ken, what’s going on out there? If the chair could be used, then I could understand stealing it, or even stealing half a chair that might be added to, but simply to destroy a chair for no good reason, that by damn I cannot fathom.’
‘Andy, you’re a good, kind man, but you really are naïve. Time to face facts. In a top-quality place like this, there are people all around us who hate our guts. They tell one another: “The place is crowded with millionaires, let’s wreck it.” We’ve had a lot of damage around here that I haven’t bothered you with.’
‘But why do they do it?
‘Why did that quiet young man on Long Island murder eleven young women? Why did the guy in Sausalito murder his wife and four kids? Why do they paint ugly words over our sign, no matter how many times we clean it up? I’ll tell you why. Because this world contains an irreducible minority of sick sons of bitches, and sooner or later one of them is going to impinge on your life, and mine. The chair destroyers? They’re your initiation to the breed, and there’s lots more like them lurking out there.’
‘You have a harsh view of the human race, Ken,’ and the older man replied: ‘More of their horse manure has piled up in my front yard. You’re just beginning to get your share.’
And four mornings later Zorn received an enormous dumpload of the stuff right in his face when he left his apartment in Gateways and walked down to his office to what sounded like a buzz saw operating close to the oval. He ran out to investigate and found a team of men in the process of cutting flush to the earth the handsome Brazilian pepper trees whose red berries formed such a lovely counterpart to the great palm trees along the entry drive. If they were cut down, half the beauty of the place would be lost.
‘Hey! Hey!’ he shouted, running up to the men who could not hear him because of the deafening whine of their saws. ‘Stop that! Stop it now!’ And he informed the man in charge that he was the director of the Palms and the trees were absolutely not to be tampered with.
The foreman asked incredulously: ‘Hasn’t anyone told you, Buster, that these shrubs are a pest and the Florida agricultural people have passed a law they can’t be planted around a house. They run wild and destroy native plants.’
‘But these aren’t running wild. Look, they’re in a neat line. We keep the grass trimmed around them. It’s like a park.’
‘It’s the seeds, mister. Millions of them. Look at those birds. They eat the berries, the seeds pass right through the intestines and out onto land that hasn’t been contaminated yet. Look at that wilderness out there on your doorstep. It’s lousy with Brazilian pepper bushes,’ and when Andy looked, he did indeed see a wealth of the green-and-red bushes.