need to get you through this without another operation. I’d rather see you use some cream for the hemorrhoids.”
“I used the cream.”
“Well, maybe we can try another one. I’m more concerned with the balls. How are you doing with the balls?”
Cogan was talking about the small device, an incentive spirometer, lying on the bed next to her. Made out of clear plastic, it housed three small balls that would, when you inhaled with proper gusto into the device’s mouthpiece, rise in their respective compartments.
“Show me what you can do,” he said.
Mrs. Richter picked up the device, put it to her mouth, and drew a breath with as much force as she could muster. One ball rose halfway up in its compartment, but the other two didn’t rise at all.
“OK,” he said. “That’s better than yesterday.”
He told her she had to breathe into the device for fifteen minutes every hour. They needed to get her lung capacity up and make sure she didn’t get an infection.
“I’ll be back this afternoon and I want to see those balls dancing.”
“It’s hard.”
“I know it’s hard. But it’ll feel good when you get them all going. I promise.”
His next patient was younger, a woman in her fifties named Greer, who was very aware of her body and constantly monitoring it.
“This seems more like the episodes I was having when you brought Dr. Fein to see me,” she said, describing some pain she was having in her breasts. “With the exception of last night and the night before, my fever was 101 and my breasts felt really heavy and tender. I thought I was getting an infection.”
She was wearing her own sleeping gown, a thin pajama top that was almost halfway open. She probably left it unbuttoned so she could more easily monitor herself, but unlike a patient he saw yesterday, a forty-two-year-old woman who’d been in a car accident five weeks earlier and hit the steering wheel with her chest, Greer was quite comfortable exposing herself and having doctors and nurses examine her.
Yesterday’s patient had bruised her sternum and heart, a myocardial contusion. She had large, pendulous breasts that she clearly felt uncomfortable revealing. From the get-go, he’d noticed she was very uncomfortable with his examinations, which automatically put him on alert. He was always careful not to give any wrong impressions when he was examining his female patients, but with certain women he could sense that he really needed to take extra precaution.
When he examined women, he always had a female nurse or resident present at the examination. It was to protect him as well as the patient, because if anything went down—if the patient had a complaint—there was another woman there to act as a witness. In the three years Cogan had been at Parkview, two doctors had lost their jobs for allegedly doing inappropriate exams.
“I know you took some pain meds yesterday,” he said to Greer without examining her. “Did you take anything today?”
“I took one pill last night. But other than my breasts, I feel fine. I got all three balls dancing.”
“Really? Lemme see that.”
She picked up the device and inhaled deeply.
“Wow,” he said. “There’s a woman down the hall who can barely get half of the first one.”
“Well, when you first gave it to me, I thought you must be crazy.”
“Very good. I’ll be back.”
His last patient was in the worst shape of the three and the youngest at thirty-six. She was El Salvadorian and had three children, and Cogan felt bad for her because she was going to “box.” That was slang that meant she was going to die, and although he hadn’t liked the phrase when he’d first heard it, over the years he’d found that it had become an integral part of his vocabulary, so much so that he rarely used the d-word anymore.
The woman had breast and lung cancer. They hadn’t caught either very early, and now they were carving her up in an attempt to save her. She’d had both breasts and an entire lung removed. She was now weighed only eighty-five pounds. If she were fifteen years older, Cogan wouldn’t have operated on her, but she was thirty-six and she had three kids and he wanted to try everything he could, even though he’d had to argue with administrators to get the OK. But now things had taken a turn for the worse. She had a lump on her shoulder that he was worried was a metastasis. He’d done the lung operation three weeks