The Diagnosis

Parish

Chapter 21: The Diagnosis

The waiting room at Natchez Regional Medical Center is cold. This is the first thing Clem notices, the cold, the air conditioning set to a temperature that is appropriate for a building in which the people are wearing professional clothing and lab coats and the temperature is set for their comfort, not for the comfort of a man who has been working outside in August heat and whose body has adapted to the heat the way a body adapts to all the things it cannot change, by recalibrating, by resetting the thermostat, the internal thermostat that says: 98 degrees is normal, 78 degrees is cold, and the cold in the waiting room is the first indication that Clem is not in the parish, not in the truck, not in the field, but in the other world, the medical world, the world where the patient is not an animal but a person, and the person is not the farmer but the veterinarian, and the veterinarian is not treating but being treated.

He is here for a routine physical. Annual physical. The physical that he has been putting off for fourteen months, the putting-off being the delay that busy people perform, the delay that is not fear but scheduling, the scheduling being: When does a man who is on call twenty-four hours a day, seven days a week, find the time to sit in a waiting room and wait to have his body examined by someone else? The answer is: He finds the time when Renee makes the appointment and tells him the date and the time and says: Go, the saying being the instruction that carries the weight of thirty years of marriage and the concern that the marriage has accrued and the concern being: You take care of everyone else's animals, go let someone take care of you.

He went. He is here. He is sitting in a plastic chair with a magazine he is not reading, the magazine being an issue of Time from seven months ago, the seven months being the waiting room's temporal delay, the delay that says: The world has moved on but the waiting room has not, the waiting room existing in its own time, the time of the wait, the wait being the waiting room's primary product.

Clem is not good at waiting. This is the one patience he does not possess, the patience of being the patient, of sitting while someone else prepares to examine him, of being the body that will be touched and assessed and diagnosed, of being on the other side of the examination. He is the examiner. He is the man whose hands do the touching. He is not the touched. The being-touched is the reversal, the reversal that the waiting room enforces, the reversal that says: Today you are not the veterinarian, today you are the patient, and the patient waits.

He thinks about all the times he has told a farmer to take an animal to him. The times he has said: Bring the horse in, or: Let me look at that cow, or: Something's not right, let's check it out. The farmer's hesitation. The farmer's delay. The farmer's putting-off that is not fear but scheduling, or that is fear disguised as scheduling, the fear that the checking-out will find the thing, the thing that the farmer suspects but does not want confirmed, the thing that lives in the suspicious lump or the persistent limp or the weight loss that does not have an obvious cause, the thing that the farmer knows is there but that the farmer can ignore as long as the thing is not named, and the naming is what the veterinarian does, and the naming is what the farmer fears.

Clem fears the naming. He sits in the plastic chair and fears the naming the way any person fears the naming, the naming being the diagnosis, the diagnosis being the word that changes the thing from the suspected to the confirmed, from the maybe to the yes, from the thing-that-might-be to the thing-that-is.

He does not know that there is a thing. He is here for a routine physical. Blood work. Blood pressure. The stethoscope on the chest (his chest, this time, not the horse's barrel, not the cow's side, his chest, the chest that holds his heart, the heart that has been beating for fifty-five years and that has not been listened to by a professional in fourteen months). The routine physical is the routine, the routine that is supposed to confirm the ordinary, the ordinary being: You are fine, your blood work is normal, your blood pressure is acceptable, your heart sounds good, go back to the parish and continue.

But the routine does not always confirm the ordinary. The routine sometimes finds the thing. The routine is the net, the net that catches the thing that the body has been harboring, the thing that the body has been carrying in its depths, in the dark interior that is as dark as the interior of a cow, the dark where the things grow unseen, unfelt, undiagnosed until the net catches them, until the blood work reveals them, until the numbers say: Something is off.

The nurse calls his name. Clem Boudreaux. The name spoken in the waiting room the way a name is spoken at an auction or a roll call, the name being the summons, the summons being the beginning of the examination.

He follows the nurse. He is weighed. He is measured. His blood pressure is taken: 138/86. The number is higher than it should be. The number should be 120/80 or lower, and the higher-than is the first finding, the first number that is not the ordinary, the number that the nurse writes on the chart with the neutrality that nurses have, the neutrality that says: I am recording the number, I am not interpreting the number, the interpreting being the doctor's job.

He sits on the exam table. The table is covered with the paper that exam tables are covered with, the paper that tears when he sits and that is the medical world's equivalent of the palpation sleeve, the single-use barrier between the body and the surface, the barrier that is hygiene and that is also the signal, the signal that says: You are in the medical space now, the space where bodies are examined and the examination is performed on the disposable surface that will be replaced when you leave.

The doctor enters. Dr. Anil Prakash. Fifty, Indian-American, educated at Tulane, practicing in Natchez for twenty years. Clem has been his patient for twelve of those years, the twelve years being the relationship, the doctor-patient relationship that is the inverse of Clem's relationships with his clients, the inverse being: Clem is the client, Clem is the one whose body is being examined, Clem is the one who will hear the findings.

Dr. Prakash does the physical. The stethoscope. The reflex hammer. The abdominal palpation (and Clem, lying on the table, feeling the doctor's hands on his abdomen, thinks about his own hands on the abdomens of a thousand dogs, a thousand cats, the palpation that he performs and that is now being performed on him, the performing being the same act, the same touch, the same searching through the surface for the thing beneath, and the thing beneath is what the hands are looking for, and the looking-for is the same whether the hands belong to the veterinarian or the physician, the looking-for being the practice, the practice being the same).

Dr. Prakash orders blood work. The blood is drawn by the phlebotomist, the needle entering Clem's arm, the arm that has been inside a thousand cows, the arm that reaches into the dark, and now the needle reaches into the arm and the blood comes out, the blood that is the text, the text that the laboratory will read, the reading being the numbers, the numbers being the diagnosis or the confirmation of the ordinary, the blood telling the truth that the body has been carrying, the truth written in the cells and the proteins and the enzymes, the truth that the body does not volunteer but that the blood reveals when the blood is taken and tested and read.

The results will take three days. Three days of the wait. Three days of the not-knowing that is the space between the test and the result, the space that is the medical world's version of the two-week wait for the pregnancy test in cattle, the wait that Clem understands from the other side, from the side of the person who orders the test and waits for the result, the waiting being the same from either side, the waiting being the uncertainty, the uncertainty being the not-knowing, the not-knowing being the human condition that medicine tries to resolve and that the resolution is the number, and the number is the truth, and the truth is three days away.

Clem drives home. He crosses the bridge. The bridge over the Mississippi. The bridge that connects the high side to the low side, Natchez to Vidalia, the medical center to the parish. The crossing is the return, the return from the examined to the examiner, from the patient to the practitioner, from the man-on-the-table to the man-at-the-chute, the return being the transition that the bridge provides, the bridge being the threshold.

He resumes his practice. The three days pass. He treats a cow with mastitis at a farm outside Clayton. He vaccinates a litter of puppies in Vidalia. He trims Marie-Claire's horse's hooves (eight weeks, on schedule, the schedule being the rhythm, the rhythm being the practice). He checks Earl's cow with the hoof abscess (healing, the bandage removed, the hoof closing, the closing being the body's work, the body healing itself once the obstacle has been removed). He drives the parish roads. He opens the veterinary box. He reaches for the tools. He does the work. The three days pass inside the work, the work being the container, the container that holds the three days the way the hoof holds the abscess, the three days of not-knowing enclosed inside the work's structure, the structure being the days filled with the animals and the farmers and the roads and the truck, the filling being the work's gift, the gift of occupation, the occupation that prevents the thinking, the thinking that would fill the three days if the work were not there to fill them first.

The phone rings on the third day. Clem is in the truck, parked at a farm outside Ferriday, writing an invoice on the clipboard. Dr. Prakash's office. Not Dr. Prakash — the nurse, calling to schedule a follow-up.

"Dr. Prakash would like to see you," the nurse said. "He'd like to discuss your blood work."

The sentence. The sentence that Clem has spoken a thousand times. The sentence that he has said to farmers standing beside animals whose blood work he has drawn and sent to the lab and received and read and interpreted: I'd like to discuss the results. The sentence that is not: Everything is fine. The sentence that is not: Your blood work is normal. The sentence that is the other sentence, the sentence that says: Something in the numbers requires a conversation, and the conversation is the discussion, and the discussion is the thing the farmer dreads, the thing that means the ordinary has not been confirmed, the ordinary has been denied, the denial being the number that is not where the number should be.

Clem knows this sentence. He has spoken this sentence. He knows what it means from the inside, from the speaking side, and now he knows what it means from the outside, from the hearing side, and the hearing is different from the speaking the way the touching is different from the being-touched, the difference being the position, the position being: On which side of the examination are you? And Clem is on the other side now. Clem is on the farmer's side. Clem is the man standing beside the animal hearing the veterinarian say: The blood work is off. Let's discuss it.

He makes the appointment. Tomorrow. 2 PM. He writes it on the clipboard, on the margin of the invoice, the appointment written beside the invoice the way the medical and the veterinary are written beside each other in Clem's life, the two practices coexisting, the human body and the animal body, the treatment and the being-treated, the examining and the being-examined.

He drives home. He does not tell Renee. The not-telling is not deception. The not-telling is the waiting, the waiting for the information that will make the telling meaningful, the information that the follow-up will provide, the information that will be the diagnosis or the reassurance, the diagnosis being the thing or the reassurance being the not-thing, and the not-knowing which it is is the reason for the not-telling, the reason being: Why burden Renee with the uncertainty? Why share the not-knowing when the knowing is twenty-four hours away? The not-telling is the carrying, the carrying that Clem does, the carrying of the weight until the weight is defined, until the weight has a name, until the name can be spoken and the speaking can be meaningful.

He sits on the porch. Renee sits beside him. The evening. The chairs. The fan. The sweet tea. The ordinary evening that is the practice's reward, the reward being the evening, the evening being the rest, the rest being the time between the work and the sleep, the time that the porch provides, the porch being the place where the day is set down.

Clem sets the day down. But the day does not fully set down, the day hanging in the space between the setting and the holding, the holding being the blood work, the blood work being the thing that the day contains that the evening cannot set down, the thing that will ride with Clem through the night and into tomorrow and into the appointment and into the doctor's office where the numbers will be spoken and the speaking will be the knowing.

He looks at his hands. The hands that have palpated a thousand lumps. The hands that have felt the tumors in the dogs and the cysts in the cattle and the abscesses in the hooves. The hands that have felt the things that should not be there and that the feeling has detected and the detection has named. The hands that know what finding feels like. The hands that are now on the other side, waiting to hear what someone else's hands have found.

The evening deepens. The parish settles. The river moves in its channel. The levee holds. The gauge reads thirty-eight feet, the river dropping, the summer's water passing, the passing being the relief that the dropping gauge provides, the relief that is the opposite of the rising, the dropping being the good direction, the direction that says: The water is receding, the danger is lessening, the margin is increasing.

Clem's margin is unknown. His margin is the space between the blood work and the diagnosis, the space that is twenty-four hours wide and that contains the not-knowing, the not-knowing being the space that Clem occupies tonight, on the porch, in the chair, beside Renee, the not-knowing being the condition, the condition that he has imposed on a thousand farmers and that is now imposed on him.

He drinks his tea. He holds Renee's hand. The holding is the practice. The practice continues. The continuing is the thing.

Tomorrow he will know. Tonight he does not know. The not-knowing is the night. The night holds the not-knowing the way the dark holds the unborn calf, in the warm space where the thing is developing, where the thing is becoming what it will be, where the thing is waiting for the light that will reveal it, the light that will be the doctor's words, the words that will be the numbers, the numbers that will be the truth.

The truth is twenty-four hours away. The twenty-four hours are the night and the morning and the drive across the bridge and the waiting room and the exam room and the doctor's face and the doctor's words.

The words are coming. The words are always coming. The words that name the thing. The words that the veterinarian speaks to the farmer and the doctor speaks to the patient and the parish speaks to itself in the language of the gauge and the levee and the river, the language of numbers, the language that says: This is where you are. This is what the blood says. This is what the body carries. This is the truth that the examination has found.

Clem sits on the porch. The truth is coming. The porch holds him while the truth approaches. Renee holds his hand while the truth approaches. The parish holds them both while the truth approaches.

The truth approaches.