76
THE NEUROLOGIST’S WAITING room was done up in blond wood wainscoting, neat as a pin, with a rack of the day’s newspapers, a box of politically correct wooden toys, copies of Highlights and Architectural Digest, and comfortable leather sofas and chairs complementing one another at the proper angles. A row of windows, with translucent curtains, allowed in a pleasingly diffuse natural light. A large Persian rug, dominating the floor, completed the picture of a prosperous and successful practice.
Despite the overactive air-conditioning, Gideon felt a stickiness in his palms as he nervously opened and closed his hands. He walked up to the receptionist’s window and gave his name.
“Do you have an appointment?” the receptionist asked.
“No,” said Gideon.
The woman examined her computer screen and said, “I’m sorry, but Dr. Metcalfe doesn’t have any openings today.”
Gideon remained standing. “But I need to see him. Please.”
For the first time the woman turned and looked at him. “What’s it about?”
“I want to get the results…of an MRI I had done recently. I tried calling, but you wouldn’t give them to me over the phone.”
“That’s right,” she said. “We don’t give any results over the phone—positive or negative. It doesn’t necessarily mean there’s a problem.” She perused the computer screen. “I see you missed an appointment… We could schedule you for tomorrow morning, how’s that?”
“Please help me to see the doctor now.”
She leveled a not unsympathetic gaze at him. “Let me see what I can do.” She rose and disappeared into an inner warren of offices. A moment later she came out. “Through the door, a right, and a left. Examination Room Two.”
Gideon followed the instructions and entered the room. A nurse appeared with a clipboard and a cheerful good morning, seated him on the exam table, took his blood pressure and pulse. As she was finishing up, a large figure in a white lab coat appeared in the doorway. The nurse bustled along, handed the figure the clipboard, and vanished.
The doctor entered, a grave smile on his kindly face, his halo of curly hair highlighted from behind by the bright morning sun that streamed in the window. It made him look curiously like a large, jolly angel.
“Good morning, Gideon.” He grasped his hand, giving it a warm, brief shake. “Have a seat.”
Gideon, who had stood up when the doctor entered, sat down again. The doctor remained standing.
“I have here the results of the cranial MRI we performed seven days ago.”
From the tone in the neurologist’s voice, Gideon knew immediately what the man was going to say. He felt himself in the grip of a fight-or-flight reaction, his heart pounding, his blood racing, his muscles tensing up. He struggled to calm his body.
Dr. Metcalfe paused, then eased himself down onto a corner of the table. “The results of the test show a growth of blood vessels in the brain we call an AVM, or arteriovenous malformation—”
Gideon rose abruptly. “That’s it. That’s all I needed to know. Thank you.” He started for the door but was arrested by the doctor, who placed a gentle hand on Gideon’s arm to steady him.
“I gather, then, that I’m your second opinion and you already knew about this?”
“Yes,” said Gideon. He wanted nothing more than to head for the door.
“Very well. I believe, however, you could benefit from hearing what I have to say, if you’re willing to listen.”
Gideon remained standing. With effort, he overcame his impulse to run. “Just say it then. Don’t dress it up. And spare me the expressions of sympathy.”
“Very well. Your AVM involves the great cerebral vein of Galen and it is both congenital and inoperable. This type of malformation tends to grow with time, and the indications are that yours is growing. An abnormal, direct connection between the high-pressure artery and the low-pressure vein is causing the steady dilation of the vein and enlargement of the AVM in general. In addition, part of the AVM involves a venous anomaly downstream, which appears to be constricting blood flow, leading to further dilation of the vein.”
He paused. “Are my descriptions too technical?”
“No,” said Gideon. In a way, the technical terminology removed some of the horror. Even so, the idea that this was going on in his brain made him sick.
“The prognosis is not good. I would estimate you have six months to two years to live—with the most probable mortality rate being somewhere around a year or slightly less. On the other hand, the annals of medical history are sprinkled with miracles. No one can say for sure what the future will bring.”
“But the survival rate after, say, five years is…what?”
“Vanishingly small. But not zero.” The doctor hesitated. “There is a way for us to know more.”
“I’m not sure I want to know more.”
“Understandable. But there’s a procedure known as a cerebral angiography, which would tell us a great deal more about your situation. We insert a catheter into the femoral artery in the groin area and thread it up to the carotid artery in the neck. There we release a dye, or blocking agent. As it spreads through the brain, we take a series of radiographs. This allows us to map the AVM. It would tell us more accurately how much time you have…and, perhaps, show us how we might ameliorate it.”
“Ameliorate it? How?”
“Through surgery. We can’t take out the AVM, but there are other surgical options. One can work around the edges, so to speak.”
“Which would do what?”
“Possibly prolong your life.”
“By how much?”
“It depends on how fast the vein is dilating. A few months, perhaps a year.”
This led to a long silence.
“These procedures,” Gideon said at last. “Are there risks?”
“Significant risks. Particularly neurological. Operations like this have a ten to fifteen percent mortality rate, and an additional forty percent possibility of causing damage to the brain.”
Gideon looked the doctor in the eye. “Would you take those risks in my position?”
“No,” the doctor said without hesitation. “I wouldn’t want to live if my brain were compromised. I am not a gambler, and fifty-fifty odds are not attractive to me.” The neurologist returned Gideon’s gaze, his large brown eyes full of compassion. Gideon realized he was in the presence of a wise man, one of the few he had met in his short and relatively unhappy life.
“I don’t think the angiogram will be necessary,” Gideon said.
“I understand.”
“Is there anything I have to do in the meantime, any way I should alter my life?”
“Nothing. You can live a normal, active life. The end, when it comes, will probably be abrupt.” The doctor paused. “This isn’t really medical advice. But if I were you, I’d do the things that are really important to you. If it involves helping others, so much the better.”
“Thank you.”
The doctor gave his shoulder a squeeze and dropped his voice. “The only difference between you and the rest of us is that, while life is short for everyone, for you it’s just a bit shorter.”