PART 2, CRADLE TO GRAVE, BABY
DON’T YOU DARE ROLL THE DICE, YOU SON OF A BITCH
MAY 26, 2011. Peer pressure, which is to say, family and friends, is a major force in the medical world.
It’s really a piece of the model.
It can work this way. Patient A is diagnosed with disease B. Actually, B isn’t a disease at all. It’s a nutritional deficiency. But the medical cartel is always looking to expand its dominion, like any ambitious church, so it labels whatever moves, wiggles, or vibrates a disease or a disorder.
“Hey, we throw a lot of stuff against the wall and see what sticks.”
It’s the infomercial pattern. “So you get the 12 knives at $39.95. That’s a $300 value. But hold on. If you order in the next five minutes, we’ll give you two sets for the same price, can you believe it? And the pork-intestine slicer. And the sharpener, plus the 50 napkins, and season tickets to the Opera is My Life lecture series at the Biloxi 7-Eleven…”
Patient A has been diagnosed with disease B, and therefore receives treatment C, which is a powerful drug that causes a little thing called DNA chain termination. Normal cell reproduction is disrupted.
The patient, on drug C, finds he can’t get out of bed in the morning without an overhead crane. His sister pours him into the car and takes him to the doctor, who says, “The disease is disrupting your cells.”
“What?” the patient says.
His sister pats him on the arm. “Listen to what the doctor is telling you.” she says.
The patient shakes his head.
“Doctor, I’ve read that the drug disrupts cells.”
The doctor smiles and nods.
“Yes, in rare cases, but this is different. It’s the disease doing it. We’re going to have to escalate the treatment. Increase the dose and add another drug.”
The sister nods sagely. She has a degree in house-sitting from a junior college.
The patient closes his eyes. A few tears leak and dribble down his cheeks. Which, of course, prompts the sister to say, “Do you think my brother should see a counselor, Doctor?”
“Might not be a bad idea,” he says. “I can set up an appointment with social services. I think they’ve straightened out the billing scandal down there.”
Flash forward a week. Patient A, who is now on a higher dose of drug C and a new drug, D, which favors disrupting immune-systemcells, is laid up with three infections. A phone call to the doctor, and another appointment, introduces patient A to drug E, an anti-viral, for which, in clinical trials, no efficacy has been established.
Two days later, the patient is vomiting and has diarrhea.
The social services counselor welcomes the pale sweating patient into her office. He is accompanied by his sister and her husband, for moral support. The husband does payroll for a local medical testing lab. He’s now on the case, assuring the patient the doctor has been handling his drug treatment properly.
The conversation with the counselor lasts 20 minutes. The counselor establishes that serious disease can trigger depression. The brother-in-law concurs. This astonishing insight about depression has, of course, consequences. A psychiatrist will probably prescribe one of the SSRIs. Prozac, Paxil.
“I started on Paxil four years ago,” the sister says. “It’s changed my life.”
She smiles and nods at the counselor.
The sister’s husband concurs.
“We had a little problem with the social stigma attached to these…disorders,” he says. “But we got past that. And never looked back.”
“Well,” the patient says, “I was on Paxil after the boating accident. Remember? A week later, I tried to burn down the flag pole in the back yard.”
“I’m glad you mentioned that,” the counselor says. “The psychiatrist will probably try Prozac instead.”
Flash forward again. The patient has been having hallucinations. His sister and brother-in-law tell him Prozac could not be the cause.
The patient says, “But I don’t usually think our dead mother is Big Foot dancing upside down on the ceiling.”
His brother-in-law gives him a hard stare.
“Listen, Bob, tough love isn’t usually my thing, but I’m going there now. You have to keep up the protocol. You can gut it through. We’re with you all the way, but you have to do your part…”
To which the patient replies: “Appreciate the pep talk, bro, but this isn’t friggin’ Afghanistan, and you aren’t my lieutenant.”
The patient’s sister frowns and shakes her head. She calls the psychiatrist later and says she thinks her brother is going over the edge into psychosis.
…Three months into this multi-drug treatment, the patient has another appointment with his doctor. The doctor tells him that despite these heroic pharmaceutical measures, what he suspected all along has come to pass. There is nothing more he can do. The disease has spread. He gives the patient two months to live.
After breaking down and weeping, the sister says to the doctor, “But he should continue taking the drugs, correct?”
The doctor offers a noncommittal shrug. “Research just hasn’t caught up yet to where we are.”
Two days later, the patient, through a herculean effort, staggers from his bed to the computer on his desk and begins to read about disease B.
It turns out there is a clinic in the Bahamas where doctors are using nutrients to treat even advanced cases—there are claims of success in some cases.
The patient makes a call and speaks with one of these doctors. The conversation lasts half an hour. Afterwards, the patient feels better. He feels hope.
Back in bed, he plans how he’ll get himself to the clinic.
Unfortunately, his sister, her husband, and a cousin, who’s flown in from Detroit, recognize patient A is smiling and seems a little better. This sends up red flags. He finally confesses he’s booking a flight to Freeport.
All hell breaks loose.
This is war.
The brother-in-law (who does payroll) handles the money-rip-off scenario aspect. “They’ll bleed you dry. Then they’ll leave you on the side of the road like a dog without a license.”
The cousin, who is a retired prosecutor with chronic shingles, adds the American-alone-in-a-foreign-land-without-a-support-system-they-can-do-anything-they-want-to-to you-and-there-is-no-recourse mantra.
The brother-in-law comes back for an encore with the they’re-just-a-bunch-of-quacks-they’re-not-real-doctors-if-they-had-anything-don’t-you-think-it-would-have-been-approved-and-everybody-would-be-using-it rumba.
Then the sister drops the you’re-crazy-what-will-people-think-you’re-thumbing-your-nose-at-the-only-family-you-have-left-I-always-knew-something-like-this-would-happen-from-the-time-you-were-a-kid you-thought-you-were-different-from-the-rest-of-us tonnage on her brother’s head.
A call comes in from the patient’s uncle in Fresno. The uncle is 92 and has good days and bad days in the nursing home. He tells the patient, “If they’re big men, stand near a doorway. They might give you a badge with a different name on it, if you ask them. Lace up your shoes after surgery.”
When the hubbub finally subsides in the patient’s bedroom, he closes his eyes and lies there in a rancid puddle of shame, resentment, and fear. His relatives go into the living room for a pow-wow.
The phone rings. It’s his friend Allan, a retired loan hustler.
“Listen,” Allan says, “I know what you’re going through. We have a group. I want you to come to a meeting. Every session starts with a member saying, “What’s the last stop on the train track?”
The patient mumbles, “Do they all go choo-choo then?”
“Just trying to help you, pal,” Allan says.
The patient dangles the receiver in his hand, holds it for a minute, then lets it drop on the rug.
Something is taking shape in his mind. Something that’s never occurred to him before.
The thought is interrupted as his sister raises her voice in the living room. She’s saying, “The shame he’s bringing on us. How can I tell my friends about this? We have to stop him from going. Look, here’s his plane ticket on he table.”
Now, it all comes clear.
He realizes that, even though he’s been diagnosed as terminal, he’s supposed to follow the advice of his doctor—who has nothing for him. It’s protocol. Social protocol.
Take the drugs, or stop them, but don’t do anything else. Don’t roll the dice. Rolling dice would be abhorrent.
The real message of his family is, just close your mouth, do what the doctor says, even if it’s nothing, and DIE.
He nods.
That’s it.
Don’t rock the boat.
Don’t switch tracks.
Don’t leave the bus.
The Bahamas. Sunny days. Lying on the beach with a cold vodka- soda, a little paper umbrella.
Maybe that’s just a pipe dream.
The chemo, the Prozac, the other drugs, or nothing—that’s the consensus.
He bangs his fist on the wall behind him.
His family comes rushing in.
“What’s wrong!” his sister says.
He holds up his hand.
“Nothing,” he says. “It’s all right. I want to talk to you.”
The sister, the brother-in-law, and the cousin quickly gather in a little semicircle by his side.
“What is it?” his cousin says.
“I’ve made a decision,” the patient says. He pauses. “I just want you to listen. Don’t interrupt me.” He starts to choke up, but brings himself under control. His face slowly settles into stone. “I’m…not going to Freeport. I…want to you to make sure my plot is ready in the cemetery. It’s supposed to be. Just check on it. I don’t want a big funeral. Family and close friends.”
His sister wails and drops to her knees. She grabs the carpet with her nails and tries to tug it off the floor. Her husband restrains her, pulls her back to her feet.
The cousin frowns and nods slowly.
“Everything’s been paid for,” the brother-in-law says.
The sister screams once. Then she covers her mouth with her hand and bends down and takes her brother’s limp hand. She kisses it over and over.
“I’m sorry,” she whispers. “I’m sorry. We didn’t mean to be cruel, darling. We’re just so…concerned about you.”
The patient nods.
“I understand,” he says.
His face is composed.
“You want me to die so I’m not going to try to do anything else.”
Silence.
JON RAPPOPORT