Hunting for Hippocrates. Warren J. Stucki

soon as we’re done here, we’ll have to do another ultrasound on Mr. Robinson.”

      “Damn it!” Diane exploded. “Will Sally ever learn to schedule? We should never have two procedures back-to-back. Give me about fifteen minutes to get the room and patient ready,” She grabbed a patient gown for Mr. Swensen, then added derisively, “I suppose you’re going to use more Proscar now.”

      “I just might,” Moe snapped as he followed Diane into the procedure room. He was getting a little tired of Diane’s attitude.

      Moe told Mr. Swensen to relax, then he inserted the rectal probe. Mr. Swensen, only half-joking, noted that this was somewhat akin to a rapist asking his victim to relax. Rotating the probe ninety degrees, Moe obtained a sagittal view of the prostate, then he rotated it back again for a cross-sectional image. There was a small hypoechoic area, mid-gland, left side, in the transitional zone. After taking a biopsy of the suspicious area, Moe handed the needle to Diane, who dislodged the tissue from the needle and placed it into a small specimen container half-full of formalin. She then set the container on the blue, laminated counter-top next to the ultrasound machine, and swivelled her stool back to help Moe.

      Finishing with Mr. Swensen, Diane cleaned the procedure room, then brought Mr. Robinson back to a room that was now saturated with the aroma of PineSol. After having Mr. Robinson strip from the waist down, she had him put on a white, disposable paper gown. As with Mr. Swensen, Moe found a suspicious lesion in Mr. Robinson’s prostate, also requiring a sonograph-guided biopsy. Again, the tissue was submerged in formalin by Diane, who then placed the specimen container on the same counter-top adjacent to Mr. Swensen’s container.

      Moe and Diane then left the procedure room, giving Mr. Robinson some privacy to clean up and dress. There were still more patients to see. Starting the cycle over again, Moe ducked into room one to see an eighty-two-year-old man with hematuria, while Diane marched with grim face back to the lab to process his urine specimen.

       THREE

      Fortunately, there were no more procedures scheduled for the morning (damn that Sally for scheduling two back-to-back), but that did not mean they weren’t busy. With managing patient flow, doing laboratory tests like urinalyses and urine cultures, drawing blood, removing sutures, changing bandages and cleaning the exam rooms, Diane had been hustling. But that was a typical day in the office of Dr. Moses A. Mathis.

      Sometimes she wondered if it was all worth it. Why was she still here, working for Moe? Certainly, it was not for the money, even though Moe was more than fair with wages and benefits. Was it for some noble ideal, like she was doing something worthwhile with her life and at the same time helping people? Somehow, her ideals had vanished a long time ago, disappearing into the hoard of bad tempered, unappreciative, demanding and complaining patients. She hated to admit it, but Diane knew perfectly well why she was still at Urology Associates. She was in love with Moses A. Mathis.

      Moe was so different from the man she had married. In twenty years of marriage, Diane could not recall one single abstract or intelligent conversation she had ever engaged in with Dan, unless you considered discussing religion, abstract. And that wasn’t really discussing, but rather it was listening to Dan pontificate. In fact, lately their conversations seemed to be just a series of monosyllabic grunts. A high-toned soprano noise was taken as a “yes” and the deeper bass ones, a “no.”

      Dan was a handy man. He could fix anything from hair dryers to automobiles. At first this impressed Diane, and this was one of the major reasons she had fallen in love with him. But as the years, the junk, and the bills piled up, the knack of repairing discarded leftovers started to lose some of its luster. For years, Diane had convinced herself that she still loved him, mainly because he was the father of her children and they shared common religious values. And then, of course, he smiled a lot. But lately, even his smile, which was once so attractive, was becoming irritating and made him seem like an aging clown.

      Diane was depressed. She was in her early forties with her kids pretty much raised, and her good looks fading as fast as a hot oven with the gas turned off. More than once she had asked herself if this was all there was? Was life just an endless series of meaningless cycles? Going to work, coming home and cooking dinner, doing housework, paying bills while watching mind-crippling TV with Dan, then going to bed fatigued, only to have her rest interrupted by him constantly pawing at her in the dark bedroom and rolling his seedy, hairy, Simian body on top of her. Then to have this same sequence repeated day after unfulfilling day, it was almost more than she could take.

      To make her life complete, Dan was also of the old Mormon school, a dedicated chauvinist. Even with the twenty-first century here, he continued to believe that there was men’s work and women’s work, and never seemed to realize, or perhaps didn’t care, that the division of labor was far from equal. Dan accepted the Bible literally, including the Old Testament’s patriarchal order and he constantly reminded Diane that God had given man the Priesthood and made him master of the house. More than once Dan had taken out his Bible and read from Paul’s epistle to the Ephesians: “Wives, submit to your husbands, as to the Lord. For the husband is the head of the wife, as also Christ is head of the church.”

      In Dan’s mind, and without question in his own home, he was sovereign. His crude words constituted a binding decree from which there was no appeal. A couple of years ago, when Moe had come to the house to talk to her about working one Saturday morning a month at Urology Associates, which she definitely did not want to do, she was horrified, but not surprised, when Dan had declared, “She’s my wife, and she’ll do what I say.”

      Early on in their marriage Dan and Diane got into financial trouble. At best, Dan’s work was spotty. Occasionally, they could almost live on what he made, but that was before children were born. After the kids, they had to borrow money, more and more frequently, usually from her family. It was during this period of time Diane realized she would have to return to work. There simply was not enough money. Years ago, she had worked as an operating room scrub nurse and perhaps she could go back to that. But there was the problem with taking call. As a scrub nurse, there would be her nights on call, away from her kids and Dan. And Dan just could not put up with a wife who was not home every evening to make his dinner.

      With a fair amount of trepidation, she applied at the office of a young, new doctor in town, Dr. Moses A. Mathis, specializing in adult and pediatric urology. She had very little knowledge of what a urologist did, but within a week she was hired.

      At first, there were just the two of them in the office, as the practice was new and small. Diane was the receptionist, nurse, bookkeeper and accounts manager, and Moe was still a young idealistic, enthusiastic physician. He was kind and empathetic with the patients, and actually took time to explain medical and surgical options to the patients, as well as potential side-effects. In those early days, he would literally tell the patients that he was not in this business to get rich, but to take care of patients. And what was surprising, Diane had the feeling that he meant it. What a novel idea. One day she overheard him telling a patient who had no money or health insurance that the most important thing was removing his kidney stone and relieving his pain, the issue of payment was unimportant. God, how Diane missed those days.

      In retrospect, it was during those early years that she started to fall in love with him. Diane had thought Moe was the most handsome, sensitive, intelligent man she had ever met, and consequently, love germinated in the fertile soil of working closely with Moe, who needed her, and a growing disgust with Dan, who dominated her.

      Also, Moe was a good teacher, and Diane learned the discipline of urology on the job. Under Moe’s tutelage, she had mastered most office urological diseases, including treatment. Eventually, when Moe was in surgery or out of town, Diane basically functioned independently as a physician assistant. She diagnosed and treated most simple urological problems almost as well as Moe. The patients began to trust her, and she built her own sub-practice within Urology Associates, managing most of the urinary tract infections, the urethral dilations and the chemotherapy patients on her own. Inevitably they began to share confidences. During slack times, they would talk to each other about life’s disappointments, about their expectations and their dreams