Hunting for Hippocrates. Warren J. Stucki

and subsequently took Joe to surgery the next week, performing a right radical nephrectomy on him. After surgery, Catherine distinctly remembered that Moe had assured her that Joe would do well, that it looked like they had gotten all the cancer, and that Joe was probably cured.

      That was a laugh. For two years Joe did do well, then he started having severe left-sided headaches, sometimes associated with nausea, projectile vomiting and fleeting parathesias. A CAT scan of the brain showed a large mass in the left frontal lobe, probably a reoccurrence of the hypernephroma, which had metastasized to the brain. From this point on, things moved fast, and within two months Joe was dead.

      Deep down, Catherine felt Moe was responsible for her husband’s death; obviously he didn’t get all the tumor at the time of surgery, even though he said he did. If he had, Joe wouldn’t be dead. Apparently, Moe had been careless, possibly to get back at her, and had left some tumor behind. She had never remarried and had never completely recovered emotionally or psychologically from Joe’s death. The lawyers had said there was no malpractice. Though Catherine thought otherwise, she never sued. Through the years, the bitterness lingered, punctuated occasionally by these feelings of rage. Damn that Moe Mathis!

      Still angry, Catherine slammed the first slide in the microscope, and focused the eyepiece. There were rather uniform glands, though some were in chords. The epithelial cells showed deeply pigmented nuclei, but still fairly abundant cytoplasm. There was also obvious peri-neural invasion. She dictated it as a poorly differentiated adenocarcinoma of the Prostate, Gleason grade IV. Then she picked up the second and third sets of slides and examined them in order under the microscope. They were totally negative.

      Briefly, a wicked smile of indulgence crossed her face. With a spiteful glow of satisfaction, she considered how much trouble Moe would be in if she were to switch the slides. That would be sweet revenge for Joe and the chauvinistic son-of-a-bitch deserved it. But should she? Catherine drifted off into that sweet stupor brought on by the opiate called vengeance.

      “Hey, Catherine, could you give me a verbal report?”

      As Catherine jumped, her hand jerked and collided with the stack of specimen slides. The harsh sound of glass slides clattering on the desktop filled the room. Sheepishly, she swiveled in her chair, turning to face the door. Immediately, her embarrassment was replaced by anger.

      “Don’t you ever knock?” she hissed.

      “I’m sorry Catherine. I thought you heard me coming,” Moe said, as he continued through the door.

      “What do you want?” she demanded, starting to re-stack the slides.

      “Since I was in the hospital anyway, I thought I would check on a biopsy. Howard Swensen. He’s the father of a friend of mine.”

      “You have friends?” Catherine said icily.

      “Come on, Catherine, be charitable.” Moe said, managing one of his disarming smiles.

      Catherine toyed with the stack of slides. “Haven’t seen it yet.”

      “But it’s been four days.”

      “I don’t care if it’s been four months, I haven’t read it yet,” Catherine growled through clenched teeth. “When I do, you’ll be one of the first to know. My secretary will fax you a report as usual.”

      “Catherine, I wish there was something I could do.”

      “Do? What are you talking about?”

      “Something I could do to repair our friendship.”

      “We never had one,” Catherine snapped, hunching over her microscope again. “Anyway, you’ve done quite enough already.”

      When she heard the sound of Moe’s retreating footsteps, Catherine turned around and watched him leave. When he was out of sight, she fingered the slides for a moment and let her mind wander, thinking about the possibilities. Men didn’t control everything. There was a way to get back at him. She smiled, then she carefully sorted the slides in three stacks, one for Howard H. Swensen, one for Robert E. Robinson and one for Joseph P. Kuck.

      Later that day, Catherine dictated the reports, giving the tape to her secretary for transcription. By the end of the next day, the same white-coat courier delivered the completed reports to Urology Associates.

       FOUR

      Two days later as he checked the day’s patient schedule Moe noted that Howard Swensen was due back at 4:45 p.m. He was the second to the last patient of the day and was coming in to get the results of his prostate biopsy. Moe smiled. His nudging of Catherine had produced results. Howard’s report had arrived a couple days earlier than expected.

      Moe’s pulse quickened as he thought of Connie. He wondered if she would accompany her father. Perhaps, he should have Sally call and subtly suggest she come. With a positive biopsy report, Howard might need some moral support and decisions would have to be made. Quickly, Moe gave Sally instructions to call Connie and remind her of today’s appointment, then trudged to the back office to face a sullen Diane and four exam rooms that were already stuffed with patients.

      The day went pretty much as expected. Moe had been in the business long enough that he rarely saw any new pathology, any unusual disease, or anything he’d never seen before. Just an endless parade of prostatitis, chronic UTI’s and impotence (now tactfully and forever labeled erectile dysfunction by Bob Dole). And by now, he was pretty much used to Diane’s attitude, though her surliness was getting monotonous. When Howard Swensen finally arrived, Moe was happy for the change of pace.

      Moe entered the exam room still feeling tired. Somewhere in his medical studies he had read that depression was a leading cause of fatigue and of course, over work was an obvious major cause as well. He was sure both factors applied to him.

      “Hello, Mr. Swensen,” he said wearily, then noticing Connie in the chair in the corner, he continued with a bit more enthusiasm, “Oh, hi Connie. I’m happy you could make it.”

      “Well Doc, give us the bad news first, that always makes any good news seem even better,” Howard said, forcing a smile.

      “Unfortunately Howard, I’m afraid it is bad news. There is no good way to tell you this, but first let me say, I’m very sorry for having to deliver this kind of news and I apologize to you and Connie for being the bearer of bad tidings.” Moe watched Connie and Howard closely for a reaction.

      “Not your fault. I was kinda expecting it, and Doc, you don’t have to apologize. Nowadays, we don’t kill the messenger,” Howard said gamely. In the corner, Connie started crying softly.

      Moe melted. He always did when women started crying. “Let me take a few minutes and discuss prostate cancer with you, what it means and what your options are. When we do biopsies of the prostate, we collect little bits of tissue with a needle and send them to specialists called pathologists. The pathologists are the ones who actually make the diagnosis of cancer, and if they find prostate cancer, they grade it from one to five, depending on how mean the cancer cells look under the microscope. Grade I and grade II are the slow growing kind, the type that literally takes years and years to ever amount to anything, if indeed, they ever do. On the other hand, grade IV and V are the fast-growing variety, the type that grows faster and spreads faster in a much shorter period of time. Grade III is in the middle. It is neither fast nor slow growing. Howard, yours was read out as a grade IV, so it falls in the faster growing, more aggressive category.”

      “Is that what they call the Gleason Grade?” Howard interrupted.

      “I see you’ve been reading,” Moe said.

      “Yeah, I get on the internet from time to time,” Howard explained.

      “Yes, that’s what we’re taking about,” Moe answered, then continued. “Cancer of the prostate, as you may or may not know, has been a fairly controversial subject in medicine the past few years. Where the controversy comes from, a lot of people think we, as urologists, over-treat