The False Cognate

Alicia Schaffer, MS2, OB/GYN

 

“Come with me.” She smiles, and the skin around Her eyes furrows. Her smile reflects and echoes in the creases. She looks kind, almost motherly, and Her words are soft. “This one will be good for you to see, I think.”  She turns and walks away quickly, more quickly than I had anticipated, and I rush along behind Her. The halls twist around one another; surely, we have passed by here before. We round the corner – to the waiting area? – but it has disappeared. I must have been wrong. How does She know her way around so well?  Every hallway has the same fluorescent light and the same laminate floor, the same bright white walls with the same horizontal scrapes and scars, vestiges of the nameless lives or deaths that have passed this way before us. The hallway opens into a small room, a holding area of sorts, with cheerful curtains separating the gurneys that cower a few feet from an imposing but abandoned nursing station. A woman sits alone on one of the gurneys and looks expectantly at us. I smile and slow down, but She turns left down another hallway and another. The woman on the gurney follows us with her eyes until we disappear around the corner.

Endless rows of closed doors stand sentinel and silently observe our passing until we reach a hallway that is different. One door is open. Aside from the enormous desk dominating its center, the room seems no different than the innumerable hallways that led there. It has the same white walls, the same generic décor. A young blond woman in a long white coat stands quickly, and asks if we are ready to go. A plastic name tag clipped to her coat sways with her as she rises. The picture is faded and peeling, but the word RESIDENT in black bold print is still visible at the bottom of the tag. She gathers the items on the desk, a sheaf of papers, a tablet computer, and tucks them under her arm. Her movements are efficient, deliberate, and no action is wasted, no effort extraneous. She brushes past us into the unvarying, labyrinthine hallway and knocks on an adjacent door.  She opens it before a reply.

The patient is not particularly petite, but she seems to shrink into the chair. Her shoulders hunched, she leans forward onto her knees as though threatening to imminently implode from the unbearable pressure of her own gravitational field. She looks up; she is afraid. A nametag pinned on her black blouse below the left collarbone reads “Ana.” The emblem next to her name is familiar, but I cannot place it: a bright green square with streaks of white forming a stylized letter “H.” The resident throws a stabbing glance in Her direction. “I actually speak Spanish fairly well,” she says. “I just felt like it would be a good idea to have you here because of the consent.” The patient’s eyes shift to Her, questioning our presence. She smiles softly and bows Her head, as if She knew this would happen.

“Of course. I will only step in if it is warranted.”  Turning to the patient, She speaks in velvety, melodious words that meld and swirl into one another. “This doctor will be speaking to you in Spanish, but I will be here as well to help. If you have any questions at all, please ask.” The patient nods but hesitates, and her already large, dark eyes widen into deep pools of murky apprehension. She gives the patient a tender smile, so subtle that I can barely see the upturned corners of Her mouth, and dips Her head imperceptibly in an encouraging nod. The patient faces the resident once more. I am invisible to everyone but Her, and She steers me backward toward the door to allow for as much privacy as possible within the cramped exam room.

With a final, sullen glance in our direction, the resident turns toward the patient and begins to speak in rapid, staccato Spanish. “You come 2 weeks ago. Then, we take a sample of tissue from the outside of your uterus.” It is the wrong word, a false cognate, and She offers a quiet correction. Though the corrected word is the appropriate word for “uterus,” it is still the wrong word for what the resident intends to say: “cervix.” I don’t say anything; it is not for me to speak. The resident nods absentmindedly in our direction and repeats the word.  “Do you understand? Do you remember that visit?” The patient’s cheeks tense as she draws herself up with a deep breath. She nods. “Do you know why we take this sample?”

The patient clears her throat. Her voice is gravelly and unused, scarcely louder than a guttural whisper. “No.”

We do a diagnostic test?” The resident’s voice rises in a silhouetted question, as her eyes dart toward Her. She is silent, impassive, but Her chin dips down slightly. The resident looks back toward the patient, satisfied. “We find a mass. It is cancer.” A fist of dread plummets through my chest and opens its cold fingers in my belly, a drop of ink unfurling in water. “It is early. We are going to do an operation called radical dissection. We are going take it out. Do you understand?” The patient is blinking rapidly and seems confused. She looks as though she has just woken from a deep sleep, unsure of the day and time. I don’t know what time it is either. Time has stopped, or perhaps just dilated, so that hours can cloak themselves in the hollow seconds as they tick by. Why is the clock so loud? We spend years in the silence, suspended at the apex of a breath, waiting for the inexorable recoil.

The resident exhales wearily and presses her lips together into a thin line. “One moment.” She pushes the papers off of the tablet and taps to open a blank page. Her fingers slide across the screen, sketching a clumsy representation of the female reproductive tract. She changes the ink color. “The cancer, it comes from cells here.” She taps the screen. “It is small now. We cut here, and here, and here…” Her finger slashes across the sketch, thick bands of red streaming behind it.  “It is very important we get it all. We do not want it to grow.” The resident appraises the drawing. She drags her finger across the screen, and a crimson ring encircles the diagram.  “We take out the uterus totally.” It is the wrong word again, the same false cognate. Without shifting Her mournful eyes from the patient, She murmurs the correction. The resident makes a small rasping sound in the back of her throat, a suppressed cough of a growl, and repeats the word. “It is important that we take all the tissue around it. We are going to take more. We cannot see the cells. We want to get all the cells. Do you understand?” The patient soundlessly opens and closes her mouth. She nods, and the doctor stands. “It is important that we do an exam today. We need to know where the cancer is before the surgery. I am going to go to the office. You can take off your clothes. The pants. You can cover with this.” She gestures without looking to a neatly folded sheet on the exam table behind her. “I am going to come back in a few minutes.”

We press our backs against the wall as the resident sweeps past us into the hallway. The door to the adjoining office opens with a metallic click of the locking mechanism. Pausing at the still-ajar door, She turns back toward the patient, “We will come back in with the doctor.” The patient stares down at the floor. Her toes turn in toward one another. There is a scuff on the toe of one shoe.

We close the door behind us and lean against the opposite hallway wall, facing the door. The office door is open and a clatter of clicks and taps spills out into the hallway. The resident must be writing the chart. Looking up at the fluorescent light above our heads, She draws in a deep breath. “We will stay for the exam, and then they will do the informed consent. Do you have any questions?” I glance over at the open door and shake my head. Leaning in, She addresses me in a hushed voice, “The words she uses are not always correct, but her Spanish is good enough that she is getting the point across, and I haven’t had to step in much. Do you understand the diagnosis and procedure she is talking about?” The icy fingers in my belly contract again, compressing into a dense knot. I nod, and my head spins with shifting nausea.

A rustle emerges from the open door, and a volley of echoing knocks in the empty hall ring out from the resident’s heeled boots. She pauses in front of the door, her back to us.   I rock forward onto the balls of my feet and balance there, waiting. The silence is broken by a boisterous, jarring laugh that reverberates and amplifies as it barrels down the hallway toward us. A steady tempo of muted thuds and punctuating squeaks intensifies, and the jovial voice chortles again. A man rounds the corner: another doctor, the attending. “Well alright then,” he roars into a cell phone, laughing. “Yep. Talk to you later.” The resident rouses from her contemplation of the doorknob.  “We all set, then?” the attending barks. His voice is strange. Its booming resonance is nonsensical in the context of his small frame. He should be kind and humble and soft-spoken, he should be solemn and somber, he should know. “Well, let’s go.”

The resident is flustered. She fumbles for the doorknob and clears her throat. She breathes in deeply, and an air of calm steals back over her face, smoothing the pink of her cheeks back to smooth stillness. Her face reminds me of the brittle, flesh-colored enamel inside an empty seashell. The attending brushes past her into the room as she opens the door, and she looks down as she flattens herself against the door to allow him passage. I trail in behind them silently and stand against the wall. The attending mutters half to himself and half to the resident, as he busily removes packs of clean gloves, neat squares of gauze, and flat wooden micro-spatulas from the drawers and cupboards lining the far corner of the room. I catch a word here and there: “manual exam,” ” hysterectomy,” “adenocarcinoma.” The patient perches on the edge of the exam table, tightly hugging the thin cotton drape around her hips. The door is still open. With a sigh, She gently pushes the door until it latches and moves to stand alongside the patient, Her hands folded in front of Her. The resident bobs her head up and down at the attending. He is deep in a technical description of appropriate instrumentation for a procedure he had performed earlier in the day.

The resident turns toward the patient. “I am learning still. This doctor is the teacher. You can lie down. Please, you can put your feet here.” She pulls a foot rest out from each side of the table with a clang. “Please, you can come to me.” She waves a hand toward herself, and the patient obliges, the waxy paper on the table crinkling as she positions herself on the edge of the table. “You are okay?” the resident asks. The patient nods, looking up at the ceiling. “I am going to start the exam now.” She inserts her fingers, and the patient inhales sharply, her breath catching in her throat. “I’m sorry,” she says. “I am going to try that I finish quickly.” The patient nods vigorously, a watery bead swelling out from the corner of her eye. The attending stares expressionlessly at the wall on the other side of the room and taps the tip of his toe against the tile floor. He does not look at Her; he does not look at me.  The resident rotates her hand, and the patient gasps. The resident’s expression softens. She leans forward and murmurs softly, “I’m sorry, I’m sorry mi amor. I know it hurts, mi amor. Breathe.” The words are meant to comfort, but they are all wrong; they are words for lovers and hushed, private moments in dimly lit rooms. The drop of water at the corner of the patient’s eye breaks free from her eyelashes and courses slowly down her temple into her hair. A muted, anguished wail escapes the back of her throat, but she swallows, and the sound stops. The resident removes her hand , and her outstretched fingers are coated with scarlet. She steps away, curls the bloodied fingers to her palm, and deftly removes the glove, balling it in her fist.

The attending stands just behind her, his right hand already gloved and raised to elbow’s height. His first and second fingers are extended out in front of his fist, rigid. It is the gesture little boys make when they are playing at soldier, policeman, gunslinger. The resident chatters away in a low voice at his left shoulder, describing her findings from the exam. The attending steps between the patient’s legs and looks over the top of her head at the corner of the room. The patient lets out a muffled shriek as he extends his right hand. “Sorry,” he chuckles. “This exam tends to hurt a little.” Tears stream from the patient’s eyes, and her chest heaves up and down. The paper beneath her tears as she claws at it with trembling fingers. He rotates his wrist and presses his left hand across her abdomen on top of the drape. The patient cries out again. The resident stares down at her feet, at the wall, at the sink. Stepping closer, She leans down to the patient’s ear. I cannot hear Her words; it is not for me to know. The patient sobs quietly, but she nods, and breathes in deeply, pursing her lips in a tiny “o” to exhale. The attending steps back. There is more blood than before. It drips off his middle finger and pools onto his palm when he curls his hand. “That tissue really is friable, isn’t it?” he asks of no one in particular. He slips off the glove and turns around. He washes his hands briskly and confirms his findings with the resident in quick, clipped words. As he dries his hands, he turns and faces the patient again, smiling. “We’ll go ahead and get you on the schedule for next week.” The patient lets out a strained moan. Her eyes are closed. The paper towel rustles as he drops it into the wastebasket behind the door on his way out of the room.

I am going to… um… You can get dressed. I am going to come back for to schedule the surgery.” The resident tucks her hair behind her ears and casts a pained look in the patient’s direction. The patient’s eyes are still closed, and her breath ratchets in and out in noiseless sobs. The door opens and shuts once more. We are the only ones left in the room. Slowly, She straightens her back and extends Her hand to the patient. The patient gingerly lifts her feet from the footrests and lets herself be pulled into a sitting position. She adjusts the sheet on her lap and tucks the edges under her thighs.

We need to step out again, since the doctor has left the room. Are you going to be alright to get dressed?” There is a rasp of hoarseness in Her voice, as though She too, has been crying. The patient nods slowly and wipes at the smeared mascara in the corners of her eyes. With a nod to me, She gently pats the patient’s shoulder. I pull open the door for Her, but She grabs the side of the door as it swings open and holds it for me,  guiding me into the hall ahead of Herself. Seconds pass, hours pass. It’s difficult to tell. She pulls a phone out of her pocket and scrolls through a list of emails. I breathe. I watch the silent door. I wait. I realize that I am exhausted and hungry, and my stomach twists at the thought of food.

The resident comes back, alone. “Ready?” She knocks and enters, and we trail behind. She takes up her seat on the stool opposite the patient and reaches the folder of papers. The patient’s eyes are rimmed with red, but her cheeks are dry. “We are going to do the… uh…” The patient looks up at Her, a silent plea.

You will be signing some papers that give permission for the surgery. It is called informed consent. Are you familiar with that term?” The patient nods, and She turns back to the resident and waits, unobtrusive, patient, forgiving.

The resident looks at Her and dips her chin slightly, a restrained tip of the hat. “So, this page, it says what the surgery is,” the resident continues. “It is what I showed you earlier on the computer. The picture. Sign here to say you understand that.” The patient squints down at the page, then picks up the pen and scribbles on the indicated line.  The resident takes back the paper and flips over the page. “This page, it talks about risks of surgery. You can bleed, but probably no. You can be painful. You cannot…” The resident pauses and shuffles through the papers, flipping each one back at the corner. “I don’t remember. How old are you?

The patient swallows hard. “Thirty-seven.

The resident narrows her eyes beneath raised eyebrows, evaluating the patient as though she has never seen her before. “You have children, yes?” The patient nods and holds up two fingers. “Okay. You will not be able to have more children after the surgery.

I know,” the patient mumbles softly. “I understand.

Sign here. And here. This is a form so that we can use the tissue for science. For research. Is this okay?

For the first time, the patient smiles. Her face lights up; she is a different, glowing person, unburdened by science or statistics or prognoses. “Yes. I would like that. If it can help you learn more, that would be wonderful.”

The resident permits herself a small, tense, tight-lipped grin. “Yes.” She waves toward the calendar on the wall next her. ”I have time to do the surgery this day.” She taps on a square, a Thursday. It is less than a week away. The patient hesitates, then bows her head in assent.  “You will need to take off 6 weeks from work.

Instantly, the patient’s eyes fill with tears. They spill down her cheeks and drop from the edge of her jawbone, leaving circles of slightly darker black on her shirt. “I can’t do that. I have children. I need to take care of them.

Do you have a husband or family here, they can help you?” The patient gives a frantic shake of her head. “Is there anyone who helps you with your children?

“I have a friend, a neighbor. She takes care of them after school when I am working.

The resident lifts her hand from her lap, changes her mind, and places it back down. She shrugs her shoulders, a slow and undulating movement. “It is a big surgery,” she says indifferently. “You will need to rest.” The patient’s face crumples, and she hangs her head. The resident stares at the papers in front of her. “Do you have any other questions for me?” The patient sniffs and lifts her head, wiping the tears from her cheeks and silently mouthing the word “no.” “I will see you next week, then. Thank you.” The resident stands and holds out her hand to the patient. She pauses and opens her mouth, but she says nothing and presses her lips back together, holding in the sound. The patient stands and clasps the extended hand with a tiny, forlorn smile.  Hitching her purse up over her shoulder, she unsteadily crosses the room; she doesn’t look back at us. I hear her footsteps grow fainter and fainter, until I cannot hear them anymore. The resident sighs and straightens the stack papers on top of her tablet. We follow her out of the room.

In the hallway, the resident hesitates at the open office door. The attending is gone, and we are alone in the hall. “Thanks,” she says wearily. This voice should not belong to her. It is not young, it is not disciplined, it is not cool and distant and analytical. This strange, new voice is old; it is tired and weighted down with grief. Her shoulders sag as she turns and shuffles back into the office. I stand uncertainly in the middle of the hallway until She taps my shoulder and motions toward the hallway, with its neat symmetrical rows of closed doors. Before we round the first corner, I can hear the soft click of computer keys, an army of skittering beetles bidding us farewell.

We turn, and turn, and turn again. The woman on the gurney is gone. I don’t know where we are, or where we are going. We round another corner and burst from the fluorescent tunnel into the main hospital lobby. Late afternoon sun streams through the large windows. I wonder if the patient knew her way out, or if she is still back there, navigating the twists and turns of the unending hallway.

“Are you understanding everything? Are you seeing what you are supposed to learn?” She looks at me, and Her eyes are sorrowful, imploring. I hang in the balance for a moment, teetering on the ledge of not knowing what to say, not knowing what I am allowed to say. There is so much I have seen, but my words have abandoned me. I open my mouth, praying that the words will appear, concerned about the torrent they could become. “They change the, uh, curriculum so often,” She interjects.  “I just want to be sure this experience benefits you.” I feel the painfully hard tile floor beneath my feet, pulled back from the edge of saying what cannot be said or unsaid. I am indebted to Her for releasing me from the conversational obligation to respond. She smiles a kind, knowing smile. “You’ve had a long day. I know how much you have learned. Why don’t you head home?” She takes my hand and wraps it in the warmth of her own. “I enjoyed meeting you. I will see you again soon, I’m sure. I am always here in the hospital.”