Rapport

It was two summers ago when we last spoke. He told me that our relationship depended on trust, and that I had lost my trust in him. I agreed. I felt bereft when we hung up the phone. I was sitting in the living room of the house I was sharing with three fellow residents of an artists’ retreat upstate. A shy and thoughtful sculptor, who had been eating a sandwich in the adjacent kitchen, told me that if he hadn’t known better he would have thought I was breaking up with my lover. He asked if I wanted a beer.

I am interested, as ever, in what brings two people together. There is a protocol—ethics—for the doctor-patient relationship, but it is difficult to put into words the particular intimacy he and I shared. Currents of power ran in both directions, be it the paternalistic intersection of his expertise and my vulnerability or my consumerist sense of entitlement to his time and attention. We had a mutual goal in the health of my body, around which there was a protracted unknown (our narrative device). It would be easy to lean on the metaphor of eros given the life-affirming nature of our intentions and the complexity of our rapport. But my affection for him was much more surprising and subtle than a framework of misguided desire would imply. The stuff of human folly was present, to be sure. There was touch and empathy, waiting and disappointment, and routine laced with crescendos of startling communion. Within the set-piece of our visits in his corner office we exchanged lines so culturally ubiquitous that the experience of hearing and saying them felt scripted, a farce: I don’t like the looks of…; But my insurance won’t cover…; Statistically speaking…; The radiologist noted…; Your levels aren’t where I’d hoped.

Our relationship lasted for just over three years. I found him on the internet because he took my insurance and was conveniently located off the L. I liked him immediately. He is Peruvian, he has a gentle manner and very kind eyes. I was intrigued by his prosthetic arm, and how he would occasionally move it out of his way with his functioning arm. A year or so into our time together he told me that he had flown to New York City from Lima for surgery after his accident. I wondered to myself if he had been a victim of the Shining Path. He was a pediatric resident in Peru at the time, and to stave off boredom during his year as a patient he’d follow the NYU medical students on their rounds and sit in on their lectures. At least one of those students goaded him by saying that his Peruvian medical degree wouldn’t cut it in the States. I forget how it happened, exactly, but I think it was shortly after his time as a patient that he settled in New York and started to practice here. His father had offered him a nice car in exchange for staying in Lima. He has a college-aged daughter who I believe was born in the States. He told me once that no matter where he is in the U.S., people ask him where the bathroom is. He gets asked what aisle things are on when he stands in line at CVS. He gets mistaken for an orderly in his own hospital. Can you believe this, he’d say, smiling, as with his good hand he’d touch my throat.

For the first number of visits we met in an examining room that resembled a subway platform. He’d ask me questions and I would take notes on whatever he said. He told me that in medical school he was taught that there are three types of patients. Type A are god-fearing and don’t listen to the doctor because the doctor is not god. Type B think the doctor is god and therefore they don’t ask any follow-up questions. Type C don’t believe in god and understand that doctors are fallible, and are therefore the most likely to sue for malpractice. He told me approvingly that I am Type C. Over these first few visits I began to understand that we were collaborating over the investigation of a minor mystery. We had embarked on a process of elimination that doubled, for me, as a crash course in both the human endocrine and the 21st century United States health care systems. He began to chart a knowledge of me based on nuclear scans and biochemical rates of change, as well as on my demeanor and whichever facts of my life I provided him with. He met my sister and my girlfriend. He asked about my writing. We bonded over our similar shades of brown skin. I became more adept at—and wary of—deploying the interpersonal in the service of the bureaucratic. Institutions are made by man, after all.

In the course of two years we ruled out hypo- and hyperthyroidism, Grave’s disease and Hashimoto’s, and shifted our language from “goiter” to “nodule” to “unidentified mass” to “tumor.” We measured its protrusion toward visibility by the untrained naked eye. We listened for nuanced shifts in my voice, and I rated the itch in my throat on scales of one to ten. We took to meeting in his office and catching up for a while before moving on to the business of lab results and next steps. When I was a kid I would sometimes pretend to be blind. I’d exaggerate a twisted ankle and ace-bandage it for days. I’d feign the flu, and tell my classmates elaborate stories of having witnessed a murder or of having been nearly abducted. I’d read novels about young girls with leukemia and fantasize about bone marrow transplants and the Make-A-Wish foundation. Nearly thirty years later this imagination of mine still lurked, colluded perhaps with a more rigorously indoctrinated belief in meritocracy and exceptionalism. Of course I didn’t want it to be cancer, but I was struck by a sense of validation when a second biopsy revealed the tumor to be malignant. I traveled by ferry, rail, subway, and foot to receive the news. His secretary had called me back to the city from a just-out-of-town vacation. It is a compelling drama, being ill. In his corner office that morning, my sister by my side and taking notes, I felt the unlikely relief of a well-defined identity moving in to eclipse all the ambivalences that typically racked me. I felt certain as his patient, perhaps his favorite patient, even. I was fortunate to find myself suspended in a manageable narrative: my cancer is minor—practically malapropistic—yet just disruptive enough to warrant the pathos and clarity of “the kingdom of the sick.”

I broke up with my doctor because he failed to realize that a biopsy of one of my lymph nodes was actually a biopsy of fatty tissue in my neck. By the time he called me at the artists’ residency with the good news that my cancer had not returned, I had sent his pathologist’s report out for a second, third, and fourth opinion. My cancer in fact still lingers biochemically and, had I not gone behind his back, I likely wouldn’t have the slightest idea. The hospital where he works and where I underwent treatment was operating at a one hundred and fifteen million dollar loss that year, I would later find out. The elevators in his building always seemed to be broken, and his already-harried assistant was constantly sweating from having to take the stairs. His caseload swelled as his support staff halved. The pathologist who originally diagnosed me and the surgeon who operated both jumped ship for better-run hospitals within a year of my treatment. The less-experienced pathologist tasked with biopsying my lymph node that summer rooted in my neck with her needle for ten uncomfortable minutes—pausing once mid-procedure to answer her phone—before declaring on the spot that there was no cancer. She had poked fatty tissue and my doctor was too overworked to look carefully at her report. Even now, I want to make excuses.

I can’t pinpoint exactly when I began to lose faith in him, but by the time we parted ways that August (two years after my initial diagnosis) I had a few other doctors researched and on the line. My consultations with these more prestigious specialists felt like rendezvouses, like cheating. I do not believe in god and did not think of my doctor as god-like. Rather, I felt loyal to his humanity—he had become my friend—and protective of our collaborative project, which is to say my health and my sense of agency in its maintenance.

What does it mean to feel attached to a person? I realize now that my shadow identity—wrought under cancer’s eclipse—formed in relation to him and the incidental details of his life that I gleaned and he shared. When I was diagnosed, I telephoned a friend who had had breast cancer. She told me that there are two realities of cancer, I needed to try to keep them distinct. There is the embodied (what happens inside your body) and the social (what happens in relation to everyone else). My self in sickness is at once impermeably private and profoundly, porously interpersonal. He, in whose office I came to know myself as ill, offered unique companionship from one reality to the next.

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