Choke

Chapter 16

THE NEXT PATIENT IS A FEMALE, about twenty-nine years old, with a mole high on the inside of her thigh that doesn't look right. It's hard to tell in this light, but it looks too big, asymmetrical, with shades of blue and brown. The edges are irregular. The skin around it abraded.

I ask her if she's been scratching it.

And is there any history of skin cancer in her family?

Sitting next to me with his yellow legal pad on the table in front of him, Denny's holding one end of a cork over his cigarette

lighter, turning the cork until the end is burned black, and Denny says, "Dude, for serious." He says, "You've got some weird hostility tonight. Did you act out?"

He says, "You always hate the whole world after you get laid."

The patient falls to her knees, her knees spread wide apart. She leans back and starts to pump herself at us in slow motion. Just by contracting her butt muscles, she tosses her shoulders, her breasts, her mons pubis. Her entire body lunges at us in waves.

The way to remember the symptoms of melanoma is the letters ABCD.

Asymmetrical shape.

Border irregularity.

Color variation.

Diameter larger than about six millimeters.

She's shaved. Tanned and oiled so smooth and perfect, she looks less like a woman than just another place to swipe your credit card. Pumping herself in our faces, the murky blend of red and black light makes her look better than she really is. The red lights erase scars and bruises, zits, some kinds of tattoos, plus stretch and track marks. The black lights make her eyes and teeth glow bright white.

It's funny how the beauty of art has so much more to do with the frame than with the artwork itself.

The light trick makes even Denny look healthy, his chickeny wing arms coming out of a white T-shirt. His legal pad glows yellow. He curls his bottom lip inside, biting it as he looks from the patient to his work, and back to the patient.

Pumping herself in our faces, yelling against the music, she says, "What?"

She looks like a natural blonde, a high risk factor, so I ask, has she had any recent unexplained weight loss?

Not looking at me, Denny says, "Dude, do you know how much a real model would cost me?"

Back at him, I say, "Dude, don't forget to sketch her ingrown hairs."

To the patient, I ask, has she noticed any changes in her cycle or in her bowel movements?

Kneeling in front of us, spreading her black-polished fingernails open on either side of herself and leaning back, looking down the arched length of her torso at us, she says, "What?"

Skin cancer, I yell, is the most common cancer in women between the ages of twenty-nine and thirty-four.

I yell, "I'll need to feel your lymph nodes."

And Denny says, "Dude, you want to know what your mom told me or not?"

I yell, "Just let me palpate your spleen."

And sketching fast with the burned cork, he says, "Do I sense a shame cycle?"

The blonde hooks her elbows behind her knees and rolls back onto her spine, twisting a nipple between the thumb and forefinger of each hand. Stretching her mouth wide open, she curls her tongue at us, then says, "Daiquiri." She says. "My name's Cherry Daiquiri. You can't touch me," she says, "but where's this mole you're talking about?"

The way to remember every step to a physical examination is CHAMP FASTS. It's what they call a mnemonic in medical school. The letters stand for:

Chief Complaint.

History of Illness.

Allergies.

Medications.

Past Medical History.

Family History.

Alcohol.

Street Drugs.

Tobacco.

Social History.

The only way to get through medical school is mnemonics.

The girl before this one, another blonde but with the kind of hard old-fashioned boob job you could chin yourself on, this last patient smoked a cigarette as part of her act, so I asked if she had any persistent back or abdominal pain. Had she experienced any loss of appetite, any general malaise? If this was how she made her living, I said, she'd better make sure and get regular smears.

"If you smoke more than a pack a day," I said. "This way, I mean."

A conization wouldn't be a bad idea, I told her, or at the very least a D and C.

She gets down on her hands and knees, rotating her open butt, her puckered pink trapdoor in slow motion, and looks back over her shoulder at us and says, "What's this 'conization' scene?"

She says, "Is that something new you're into?" and exhales smoke in my face.

Sort of exhales.

It's when you razor out a cone-shaped sample of the cervix, I tell her.

And she goes pale, pale even under her makeup, even under the wash of red and black light, and pulls her legs back together. She puts out her cigarette in my beer and says, "You have one sick issue with women," and goes off to the next guy down along the stage.

After her I yell, "Every woman is just a different kind of problem."

Still holding his cork, Denny picks up my beer and says, "Dude, waste not..." then pours everything except the drowned butt into his own glass. He says, "Your mom talks a lot about some Dr. Marshall. She says he's promised to make her young again," Denny says, "but only if you cooperate."

And I say, "She. It's Dr. Paige Marshall. She's a woman."

Another patient presents herself, a curly-haired brunette, about twenty-five years old, exhibiting a possible folic acid deficiency, her tongue red and glazed-looking, her abdomen slightly distended, her eyes glassy. I ask, can I listen to her heart. For pal- pitations. For rapid heartbeat. Has she had any nausea or diarrhea?

"Dude?" Denny says.

The questions to ask about pain are COLDERRA: Characteristics, Onset, Location, Duration, Exacerbation, Relief, Radiation, and Associated Symptoms.

Denny says, "Dude?"

The bacteria called Staphylo coccus aureus will give you STAPHEO: Skin Infections, Toxic Shock Syndrome, Abscesses, Pneumonia, Hemolysis, Endocarditis, and Osteomyelitis.

"Dude?" Denny says.

The diseases a mother can pass to her baby are TORCH: Toxo-plasmosis, Other (meaning syphilis and HIV), Rubella, Cytomegalovirus, and Herpes. It helps if you can picture a mother passing the torch to her baby.

Like mother, like son.

Denny snaps his fingers in my face. "What's up with you? How come you're being like this?"

Because it's the truth. This is the world we live in. I've been there, taken the MCAT. The Medical College Admission Test. I went to the USC School of Medicine long enough to know that a mole is never just a mole. That a simple headache means brain tumors, means double vision, numbness, vomiting followed by seizures, drowsiness, death.

A little muscle twitch means rabies, means muscle cramps, thirst, confusion, and drooling, followed by seizures, coma, death. Acne means ovarian cysts. Feeling a little tired means tuberculosis. Bloodshot eyes mean meningitis. Drowsiness is the first sign of typhoid. Those floaters you see cross your eyes on sunny days, they mean your retina is detaching. You're going blind.

"See how her fingernails look," I tell Denny, "that's a sure sign of lung cancer."

If you're confused, that means renal shutdown, severe kidney failure.

You learn all this during Physical Examination, your second year in medical school. You learn all this, and there's no going back.

Ignorance was bliss.

A bruise means cirrhosis of the liver. A belch means colorectal cancer or esophageal cancer or at the very least a peptic ulcer.

Every little breeze seems to whisper squamous carcinoma.

Birds in the trees seem to twitter histoplasmosis.

Everybody you see naked, you see as a patient. A dancer could have clear lovely eyes and hard brown nipples, but if her breath is bad she has leukemia. A dancer might have thick, long, clean-looking hair, but if she scratches her scalp, she has Hodgkin's lymphoma.

Page by page, Denny fills up his pad with figure studies, beautiful women smiling, thin women blowing him kisses, women with their faces tilted down, but their eyes looking up at him through falls of hair.

"Losing your sense of taste," I tell Denny, "means oral cancers."

And without looking at me, looking back and forth between his sketch and the new dancer, Denny says, "Then, dude, you got that cancer a long time ago."

Even if my mom died, I'm not sure if I'd want to go back and get readmitted before my credits start to expire. As it is, I already know way more than I'm comfortable with.

After you find out all the things that can go wrong, your life becomes less about living and more about waiting. For cancer. For dementia. Every look in a mirror, you scan for the red rash that means shingles. See also: Ringworm.

See also: Scabies

See also: Lyme disease, meningitis, rheumatic fever, syphilis.

The next patient who presents herself is another blonde, thin, maybe a little too thin. A spinal tumor probably. If she has a headache, a low fever, a sore throat, she has polio.

"Go like this," Denny yells up to her, and he covers his eyeglasses with his open hands.

The patient does this.

"Beautiful," Denny says, sketching a study fast. "How about if you open your mouth a little."

And she does.

"Dude," he says. "Workshop models are never this hot."

All I can see is she's not a very good dancer and, for sure, this lack of coordination means amyotrophic lateral sclerosis.

See also: Lou Gehrig's disease.

See also: Total paralysis. See also: Difficulty breathing. See also: Cramps, tiredness, crying.

See also: Death.

With the edge of his hand, Denny smears the cork lines to add shadow and depth. It's the woman onstage with her hands over her eyes, her mouth slightly open, and Denny picks at it fast, his eyes going back to the woman for details, her belly button, the curve of her hipbones. My only gripe is the way Denny draws women is not the way they look for real. In Denny's version, the cheesy thighs on some woman will look rock-solid. The bagged-out eyes on some other woman will become clear and toned underneath.

"You got any cash left over, dude?" Denny says. "I don't want her to move on just yet."

But I'm broke, and the girl moves on to the next guy down along the stage.

"Let's see, Picasso," I tell him.

And Denny scratches under his eye and leaves a big smudge of soot. Then he tips the legal pad enough for me to see a naked woman with her hands over her eyes, sleek and tensing every muscle tight, none of her looks trashed by gravity or ultraviolet light or poor nutrition. She's smooth but soft. Flexed but relaxed. She's a total physical impossibility.

"Dude," I say, "you made her look too young."

The next patient is Cherry Daiquiri again, coming back around, not smiling this time, sucking hard on the inside of one cheek and asking me, "This mole I have? You sure it's cancer? I mean, I don't know, but how scared should I be ... ?"

Without looking at her, I hold up one finger. This is international sign language for Please wait. The doctor will see you shortly.

"No way are her ankles that thin," I tell Denny. "And her ass is way bigger than you have there."

I lean over to see what Denny's doing, then look down the stage to the last patient.

"You need to make her knees lumpier," I say.

The downstage dancer gives me a filthy look.

Denny just keeps sketching. He makes her eyes huge. He fixes her split ends. He gets everything all wrong.

"Dude," I say. "You know, you're not a very good artist."

I say, "For serious, dude, I don't see that at all."

Denny says, "Before you go trash the whole world, you need to be calling your sponsor, bad." He says, "And in case you still give a shit, your mom said you need to read what's in her dictionary."

To Cherry crouching there in front of us, I say, "If you're really serious about saving your life, I'm going to have to talk to you someplace private."

"No, not dictionary," Denny says, "it's diary. In case you ever wonder where you really come from, it's all in her diary."

And Cherry dangles one leg over the edge and starts climbing down off the stage.

I ask him, what's in my mom's diary?

And drawing his little pictures, seeing the impossible, Denny says, "Yeah, diary. Not dictionary, dude. The stuff about your real dad is in her diary."