The Results

Parish

Chapter 24: The Results

The exam room at Natchez Regional is the same exam room. The same paper on the table. The same fluorescent light. The same cold air from the vent above the door. The same plastic chair where Clem sat two weeks ago for the routine physical that was routine until it was not, the routine ending when the blood work came back and the blood work said: Something is off, and the off was the PSA, the prostate-specific antigen, the number that should have been below 4.0 and that was 7.2, the 7.2 being the number that brought Clem back across the bridge and into the waiting room and out of the waiting room and into the exam room, the number being the reason he is here, the number being the door through which the next conversation will enter.

Dr. Prakash enters. He carries a folder. The folder contains the results. The results of the additional tests — the MRI that Clem submitted to last week, the MRI being the machine that sees what the blood work suggests, the machine that looks inside the body the way Clem's hand looks inside a cow, by reaching into the dark, by imaging the interior, by producing the picture of the thing that is inside, the thing that the PSA number pointed toward and that the MRI has now found or not found.

Dr. Prakash sits on the stool. The stool is the doctor's chair, the rolling stool that every exam room has, the stool that allows the doctor to sit at the patient's level and the sitting-at-level being the posture of the conversation, the conversation that is about to happen, the conversation that Clem has had with a thousand farmers from the other side, from the telling side, and that he is now having from the hearing side.

"Clem," Dr. Prakash said. "The MRI shows a lesion on the prostate. Small. Consistent with the PSA elevation. We did the biopsy — the results confirm. It's prostate cancer. Gleason score six. Stage one."

The words. The words arrive the way all diagnostic words arrive, in sequence, each word adding to the picture, each word narrowing the uncertainty until the uncertainty is gone and the certainty is there, the certainty being the diagnosis, the diagnosis being the words, the words being: Prostate cancer. The two words that change the thing from the suspected to the confirmed, from the maybe to the yes.

Clem hears the words the way he hears all words. He hears them and he processes them. He processes them the way he processes a diagnosis in an animal — with the clinical part of his mind, the part that was trained to receive diagnostic information and to translate the information into practical next steps, the next steps being the treatment, the treatment being the response, the response being the action that the diagnosis requires.

He does not panic. He does not feel the panic that he has seen in the eyes of farmers when he tells them: Your horse has navicular, or: Your cow has cancer eye, or: The mass in your dog's abdomen is malignant. He does not feel the panic because the panic is the emotion and the emotion is behind the clinical processing, the processing being the wall between the information and the feeling, the wall that veterinary training builds and that twenty-eight years of delivering diagnoses has reinforced, the wall that says: Receive the information first. Feel it later.

"Gleason six," Clem said. "That's low grade."

Dr. Prakash nodded. "Low grade. Early stage. The lesion is confined to the prostate. No evidence of spread. No lymph node involvement. The prognosis is excellent."

The prognosis is excellent. The sentence is the sentence that Clem has spoken to farmers when the diagnosis is serious but the outcome is likely to be good, the sentence that says: This is bad news, but the bad news has a good prognosis, and the good prognosis is the counterweight to the bad news, the counterweight that allows the farmer to set down the panic and pick up the plan, the plan being the treatment, the treatment being the next steps.

"The recommendation is surgery," Dr. Prakash said. "Radical prostatectomy. We'll refer you to a urologist in Baton Rouge — Dr. Nguyen at Our Lady of the Lake. She's the best in the state. Recovery time is four to six weeks. You'll be back to full activity in eight to ten weeks."

Clem listens. He processes. He translates the information into the practical terms that his mind prefers, the practical terms being: Surgery. Recovery. Timeline. The terms that are the same terms he uses when he explains a surgery to a farmer — the procedure, the recovery, the timeline, the practical information that the farmer needs to make the decision and to prepare for the aftermath, the aftermath being the recovery, the recovery being the time, the time being the weeks that the body needs to heal.

Four to six weeks. Clem calculates. Four to six weeks of not working. Four to six weeks of not driving the truck. Four to six weeks of not making the rounds. Four to six weeks of not being the veterinarian who drives through the parish and treats the animals and hears the confessions and holds the hooves and carries the weight. Four to six weeks of not being Clem.

The not-being-Clem is the hardest part of the diagnosis. Not the cancer — the cancer is the medical fact, and the medical fact has a medical answer, and the medical answer is the surgery, and the surgery has a prognosis, and the prognosis is excellent. The hardest part is the four to six weeks, the weeks of absence, the absence from the practice, the absence from the parish, the absence from the truck and the box and the roads and the farms and the animals and the people.

"I'll need to arrange coverage," Clem said. "For the practice. While I'm recovering."

Dr. Prakash nods. This is the practical response. This is the response of a man who is a practitioner, whose first thought upon receiving a diagnosis that will require his absence is: Who will cover my patients? The patients being the animals. The patients being the parish.

Clem asks the questions that the clinical part of his mind generates. The questions about the procedure and the recovery and the risks and the long-term prognosis, the questions that are the same questions a farmer asks when Clem recommends a surgery for an animal, the questions being: What exactly will you do? What are the risks? What is the recovery? What is the outcome? The questions that are the patient's rights, the right to information, the right to understand, the right to participate in the decision by understanding the decision.

Dr. Prakash answers. He answers with the clarity that Clem appreciates, the clarity that is the physician's version of the veterinarian's clarity, the clarity that says: Here is the fact, here is the plan, here is the outcome, the clarity being the respect, the respect for the patient's intelligence, the respect that does not cushion or soften or euphemize but that speaks the truth directly, the directly being the kindness, the directness being the compassion, because the compassion is not in the softening but in the clarity, the clarity being the thing that allows the patient to understand and the understanding being the power, the power to act, the power to decide, the power to plan.

Clem decides. He will have the surgery. The decision is not difficult because the decision is the math, the math that Clem has done a thousand times for a thousand animals: The disease is treatable. The treatment is available. The prognosis with treatment is excellent. The prognosis without treatment is not. The math says: Treat. The math says: Yes. The math is the decision.

He schedules the surgery. Three weeks from now. October. The timing is the timing — October being the month when the parish's cattle work peaks, the weaning and the sorting and the selling, the month when the practice is busiest, the busyness being the worst time for the absence, the absence being the four to six weeks that the surgery requires. But the timing is also the timing — the cancer does not wait for the convenient month, the cancer does not consult the practice's schedule, the cancer is the thing that is there and that must be addressed and the addressing must happen when the addressing can happen, and the addressing can happen in October.

He drives home. He crosses the bridge. The bridge that he has crossed ten thousand times, the bridge over the Mississippi, the bridge that connects the high side to the low side, and Clem is driving from the high side to the low side, from Natchez to Vidalia, from the diagnosis to the parish, the crossing being the transition, the transition from the examined to the examiner, from the patient to the practitioner, from the man with cancer to the man with the practice.

The man with cancer. The words sit in his mind the way a diagnosis sits, heavily, taking up space, the space that was previously occupied by the ordinary, the ordinary being the assumption of health, the assumption that the body is functioning and will continue to function and the functioning is the baseline on which the practice is built, the baseline being: I am well, I can work, the working being the identity, the identity being the practice, the practice being the man.

The man with cancer is the same man. The diagnosis has not changed the man. The diagnosis has changed the knowledge, the knowledge being: There is a thing in the body, and the thing is a cancer, and the cancer is small and early and treatable, but the thing is there, and the being-there is the fact, and the fact is new.

He pulls into the driveway. The truck. The driveway. The house on Carter Street. The boots on the porch. The evening light. The ordinary that is the same ordinary it was this morning, the ordinary that the diagnosis has not changed, because the ordinary is the parish and the parish does not know about the diagnosis and the not-knowing is the ordinary's protection, the protection that Clem provides by not telling, by carrying the diagnosis the way he carries the confessions, internally, privately, in the space between the ribs.

But he will tell Renee. He must tell Renee. The not-telling of Renee would be a different kind of carrying, a carrying that is not the carrying of the confessions but the carrying of the deception, and the deception is not what the marriage is built on, the marriage being built on the other things — the hand on the hand, the evening on the porch, the rice and gravy, the thirty years of shared days — and the deception would damage the building.

Renee is in the kitchen. The smell of cooking. The ordinary evening. The evening that is the same evening that every evening has been for twenty-eight years, the evening that begins with the truck in the driveway and the boots on the porch and the man in the kitchen where the woman is cooking, the man and the woman in the kitchen together, the togetherness being the marriage.

He tells her. He tells her in the kitchen, standing by the counter, the counter where he eats his toast in the morning and where he stands now, in the evening, telling his wife that he has cancer.

He tells her the way he gives diagnoses. With clarity. Without drama. With the practical next steps outlined. He tells her: Prostate cancer. Early stage. Gleason six. Surgery in three weeks. Prognosis excellent. Recovery four to six weeks. He tells her the facts because the facts are the thing he knows how to tell, the facts being the language he speaks, the language of the diagnosis and the treatment and the prognosis, the language that is clear and direct and that does not soften.

Renee listens. She listens the way she listens to everything — with the full attention that is her nature, the attention that she gives to the patrons at the library and to the books on the shelves and to the children who come after school, the attention that is the gift, the gift of being fully heard.

She does not cry. She does not cry because the crying is for later, the crying is for the private moment that will come when the telling is done and the facts are absorbed and the absorbing produces the emotion that the facts contained but that the facts' clarity held at bay, the clarity being the wall between the information and the feeling, and the wall will come down, later, in the private moment, and the crying will be the wall coming down.

She takes his hand. She holds it. The holding that is the marriage's essential act. The holding of the hand that holds the parish, the hand that has been inside a thousand animals, the hand that carries the knowledge of twenty-eight years of touching the insides of living things, the hand that is now the hand of a man who has cancer, and the cancer is in his body the way the abscess was in the cow's hoof, the thing inside that must be opened and drained and removed, and the removing is the surgery, and the surgery is the treatment, and the treatment is the next step.

"When?" Renee said.

"October eighth," Clem said.

The date. The date that is the surgery, the date that is three weeks away, the date that is the day the thing will be addressed. The date sits in the kitchen the way all important dates sit, heavily, taking up space in the calendar that was previously occupied by the ordinary, the ordinary being: October eighth is a Tuesday, October eighth is a day when the practice would be busy, October eighth is a day that has now become the day.

"Who will cover the practice?" Renee said.

The question. The practical question. The question that Renee asks because Renee is practical, because the practical is the shared language, the language that the marriage speaks when the emotions are too large for the emotional language, the practical being the container, the container that holds the emotion by holding the plan, the plan being the thing that the emotion needs, the emotion needing the plan the way the water needs the levee, the plan containing the emotion's flood.

"Dr. Tran," Clem said. "From the Jonesville clinic. She'll cover the calls. I spoke with her this afternoon."

He has already arranged it. He has already made the plan. He has already done the practical thing, the thing that the diagnosis required, because the practical thing is the thing that Clem knows how to do, the doing being the response, the response to the diagnosis being the plan, the plan being the coverage and the surgery and the recovery and the return.

The return. The word that contains the hope, the hope that the surgery will be successful and the recovery will be complete and the return will happen, the return to the practice, the return to the truck, the return to the parish, the return to the work that is the identity.

He does not tell the parish. He does not tell Earl. He does not tell Marie-Claire. He does not tell Arceneaux. He does not tell the farmers and the ranchers and the animal-keepers whose animals he treats and whose confessions he hears. He does not tell them because the not-telling is the habit, the habit of the man who hears confessions, the habit that says: I receive, I do not send, I hold, I do not release, the holding being the practice and the practice being the identity and the identity being: I am the one who listens, not the one who speaks.

The not-telling is also the protection. The protection of the practice. The protection that says: If the parish knows, the parish will worry, and the worrying will change the relationship, will change the dynamic, will change the thing that happens at the chute and the shed and the barn, the thing that is the confession, the confession that happens because Clem is the strong one, the well one, the present one, and the being-strong and the being-well and the being-present are the conditions that allow the confession, and the diagnosis would change the conditions, would shift the weight, would make the confessors the comforters and the comforting is not what the practice is, the practice is the listening, and the listening requires the strength, and the strength requires the not-telling.

The not-telling is the veterinarian's habit. The man who hears confessions does not make them. The man who witnesses does not testify. The man who holds the hoof does not show the hand that shakes.

Clem's hand does not shake. His hand is steady. His hand is the hand that has been steady for twenty-eight years, the hand that has reached into the dark and found the thing and fixed the thing, the hand that is steady because the steadiness is the practice and the practice is the identity and the identity is the man.

The man has cancer. The cancer is small. The cancer is early. The cancer is treatable. The treatment is the surgery. The surgery is in three weeks. The prognosis is excellent.

The prognosis is excellent. The sentence is the sentence that Clem carries. He carries it the way he carries the confessions, in the body, in the space between the ribs, in the place where the heart beats and the lungs breathe and the blood carries the PSA that is 7.2 and the PSA is the number and the number is the diagnosis and the diagnosis is the fact and the fact is: The prognosis is excellent.

Evening. The porch. The chairs. Renee and Clem. The sweet tea. The fan. The September evening that is cooler than the July evening and that holds them the way all evenings hold them, in the space between the day and the night, the space where the day is set down and the night is picked up and the setting-down and the picking-up are the evening's transitions.

Renee holds his hand. The holding is firmer tonight. The firmness is the response, the response to the diagnosis, the response that says: I am holding you, I am holding you harder, the harder being the emphasis, the emphasis being: I am here, I will be here, I will hold you through the surgery and the recovery and the return, the holding being the plan.

The parish is quiet. The parish does not know. The parish is waking up tomorrow the same way it woke up today, without the knowledge, without the diagnosis, without the fact. The parish will call Clem tomorrow and Clem will answer and the answering will be the practice and the practice will continue for three more weeks, three more weeks of the truck and the box and the roads and the farms and the animals and the confessions, three more weeks of the practice that is the identity, the identity that the surgery will interrupt but not end.

The not-ending is the prognosis. The prognosis is excellent. The excellent is the hope. The hope is the levee. The levee holds.

Clem sits on the porch. Renee sits beside him. The September evening holds them. The diagnosis is carried. The plan is made. The surgery is scheduled. The practice continues.

The practice continues.