The Best Doctor

by Karen Sagstetter


Galveston 2000


Dr. Parek? Oh, hello Dr. Parek. You know we need to run to the store for milk and after that we need gas, but I wondered if it would be all right for me to call you back around noon because we're a little worried about our mother. This is Beverly, her daughter. Or you could call us. Thanks.

So, message one concerned Mrs. Wilkens, on whom Jay had operated that very morning. He readied his pen for message two.

Hello? Hello? This is Beverly Wilkens again. Wanted to let you know that I can't call you at noon, like I wanted to, because the electrician is coming, but let me leave you my number. Can you call me back this afternoon? You just say when and I'll be right by the phone.

Jay had to search his patient database, because she didn't leave the number on the machine. He punched it in. But his temples were pulsing and without intending to, he hung up after three rings. Her calls were from earlier, when he was in surgery, so he presumed the problem had resolved itself. He cycled through the queue of messages.

Hey Edward, can you get the baby to stop crying? I'm going to tell the doctor. We want our mother to reach her one hundredth birthday. Hello? Dr. Parek? It's 3:00. I'm going to call the hospital. This is Beverly Wilkens. Mama isn't feeling very good. Dizzy.

He recalled this woman from a pre-op interview. She was chatty and not well informed about her mother's condition. There were five other brothers and sisters—a middle-class black family with good insurance.

Dr. Parek? Hi, it's Connie Ardennes. I'm having a terrible spasm in my back this morning. It's my birthday, too. Can you send me some pills?

This office, Jay thought, needs an aquarium. Little red and yellow fish. Whirls of seaweed. He patted down his thick black hair and straightened his glasses, gulped Evian. He liked the flesh and intensity of surgery, the nurses, monitors, and instruments, and took inherent pleasure in meticulous execution of a task. All this led to amazed gratitude, something he took for granted, from patients who would wake up with restored digestion or a clear throat. The operating room was the closest thing to a home he'd encountered in America: a den where you lock arms with good men and women and work along, riveted on each other's every gesture. But the daily riff of sick people was not his best arena; the phone calls, consultations, and small talk with patients wearied him. Often he'd let his machine take a message on purpose so he could avoid yakking with someone.

Connie was a young mother and a chemistry graduate student, and he hated for her to be in pain on her birthday. He rang back, got her recorder.

Mrs. Ardennes, this is Dr. Parek. I suppose this pain is similar to the spasms you've had before? Along the shoulder blade? I'm going to call in a prescription; it should relax you and reduce the pain. Call me back if you need anything else.

He tried the Wilkens family again; after twelve rings an answering machine clicked on: We're so sorry to miss your call. Please leave a message and have a wonderful day.

To which Jay replied: I understand your mother is not quite well. I hope she's feeling better. Please call me if you have more problems. Good luck.

He picked up his briefcase and empty lunch box, headed to a dentist's appointment, after which he'd go home, a one-bedroom condo four blocks away, where he'd lived alone since he began his residency. He hadn't had a single live conversation all afternoon and felt a hint of despondency. He flashed to the beauty of the backwaters and his home in Kerala, where paths wound through serene palm groves among friendly houses. He knew every man and woman, boy and girl, in the village; as a child he drank tea in their kitchens, did homework on their porches, fished from their docks.

But as he grew older, he'd been driven mad for a chance to be alone once in a while. Every dinner at home included more neighbors and cousins than he could count; his mother would tend people with extra dal, rice, and chapatis, and there were always mangoes and good tea. He couldn't sit down with a book without being interrupted a dozen times by five-year olds, fifteen-year olds, seventy-year olds. And now here he was in Galveston, close to the ocean, relieved in a way of the crowds in India, but in another way, unsettled by a viral silence that beset him after a day of e-mail, voicemail, and memos. The desire for solitude competed constantly with his loneliness; he was surrounded by perfectly nice people, friendly people. Yet, he was aware that he came across as too clinical, even impatient. Well, he was just all screwed up, rudderless on the hot gulf coast of America.

* * *

"Wow,” Janet exclaimed, her two thumbs positioned on his lower front gum. "Great graft!"

"Mmmmm," responded Jay.

"Sonia! Can you come in here for a second? Look here! See how fine the scar line is. That surface is perfectly flat."

"Where?" She pinched his lower lip with her index finger and thumb, so that now three hands were tugging at Jay's mouth. "Oh, yeah. Great!" Sonia looked genuinely pleased as though she'd just solved the crossword and won a mug.

"Dr. Young did it. Four years ago. He'd have lost that tooth otherwise. Any trouble with the flap, Jay?"

To the best of his ability, Jay shook his head no. Sonia let his lip loose and turned to x-rays. Janet rambled on.

"You know, Sonia, Jay here took a trip to New Orleans this spring. Have you ever been?"

"Not yet. It's on my list. I heard about New Orleans back in Macedonia. Famous place." Sonia spoke in heavily accented English.

Jay's mouth remained winched open by Janet's formidable hands, and she continued to stab his soft tissues with sharp instruments. Several minutes went by, punctuated by wincing from Jay, as the two women conversed about Mardi Gras.

Suddenly Janet retracted her hands and swiveled backwards to study a folder. "You have a crown, don't you? Dr. Young's?"

Finally able to speak, Jay answered: "Yes. From two years ago."

Without explanation, Janet left the room for about five minutes. She then resumed probing and scraping at Jay's teeth and gums, amid talk of family car trips and praise for the American highway system.

"What are you doing tomorrow?" she asked warmly. Tomorrow was the Fourth of July, and Jay planned to take a picnic to the beach and enjoy fireworks. In fact, he wanted to get blasted. But with his mouth immobilized, he could not explain this. Sonia beckoned to Diego, a hygienist in training. Now everyone grabbed Jay's lips to again admire the dentist's craftsmanship. Jay had been prostrate in the chair for forty-five minutes, and the hygiene seemed only now to be commencing. He wasn't in a hurry, really, but he felt mildly annoyed. How much did these people accomplish in a day? Was Janet doing a professional job or was she distracted and slow? When she finally finished polishing his enamels, still perky, still ruminating aloud about Independence Day, he paid with a credit card and escaped to his condo.

* * *

Gulf of Mexico had in Jay's loneliness sounded almost as seductive as Malabar Coast, and though Galveston island didn't have cashew trees or rice paddies, it possessed a medical school, and its wide beaches, burly heat, abundant oleanders, and rowdy tourists gave Jay a certain rough succor. He sometimes missed dwelling among Hindus, and so, though he wasn't a believer, he made a point on holidays to fashion offerings to a small Ganesha: marigolds, caladiums, pine cones, candles; whatever was handy here in Texas. On American Independence Day, at ease in his breakfast nook, he smiled and prepared a shrine with strawberries, white oleander petals, and blueberries. And jasmine incense.

On this first Fourth of the third millennium of the common era, Jay hit the beach, with his state-of-the-art Gortex backpack, filled with peanut butter, samosas, coriander chutney, bhel puri, and Kingfisher beer. He settled his yellow chair low to the ground and close to the water, so that waves swept under his bottom, bathing his feet and spraying his contented legs. Good humored masses of people were streaming north, south, east, and west—girls in red, white, and blue bikinis hovered and swished past, like patriotic butterflies. People spread mats over the sand and set up wind breaks and umbrellas amid a convergence of plastic plates, coolers, volley balls, soaring kites, and icy beer. Squealing children dashed in and out of the surf. Every brand of picnic sprouted forth: fat-free veggie chips, kiwi fruit, and spring water served on recycled paper; jalapeno poppers, fish sticks, and burritos on Styrofoam. A couple slathered each other's backs with suntan lotion, then giggling, lay down on their blanket propped up on elbows. They passed an egg roll back and forth; he bit off his end and conveyed it by mouth to his girlfriend; she bit her end, passed it back. They split the last morsel and kissed. Jay caught himself staring, even smiling, rather too obviously; the pang of envy surprised him.

Around eight p.m. there came awesome, drenching rain. Ten minute downpours followed by slight clearing and wet wind, quickly interrupted by another ten minutes of pounding thunder and more thrilling rain. Within minutes the beach had metamorphosed into a carnival of blue tarps and gay umbrellas--everybody soaked and huddling under makeshift shelters and still in good humor. Jay decided to pick up and struggle through the crowd toward the huge performance stage, which had been erected near a beautiful pier that stretched like a wing out over the sea. Latin superstar Ricky Martin was prancing and singing under a giant canopy, to the utter delight of the crowd. Britney Spears, idol of millions of eleven year olds, was holding up her own umbrella—wow! The Texas A & M marching band elected not to march through the storm, but pounded out Sousa tunes from their metal folding chairs beneath the canopy. The rain was a nuisance, but the adversity energized and entertained an already jovial crowd and spirits stayed high. For a couple of hours roaring showers and crazy wind were interrupted by brief quiet breezes, during which respite gangs of people would scurry from shelter to shelter.

Under an overhang by the stage, Jay found himself mashed, beer in hand, up against two old ladies in wheelchairs. Each had short, white, curly hair and big glasses; each wore a tee shirt and khaki slacks, Nike walking shoes, and thick socks. Both were covered head to toe in what appeared to be a year's supply of plastic. Old lady number one sported an umbrella-shaped cap—it perched on top of her head and spread its red, white, and blue crown widely enough to keep rain off her hair. Old lady number two wore a clear plastic shower cap, just the thing for wet weather. Her American flag earrings dangled below the elastic edge of the cap. A poncho tumbled over her shoulders and bunched into her lap; more sheets of plastic were wrapped around and around her legs. She resembled a whole sheep, ready for the freezer, and also prepared if necessary, to rev up her wheelchair and storm into the eye of a hurricane. Dr. Jay, sometimes bored by old people in his practice, was amused.

Suddenly lady number one sneezed passionately and seemed unable to stop. Dr. Jay Parek, barely protected from the elements in shorts and sandals, felt mildly alarmed. He adjusted his pack.

"Good madam, are you all right?"

The sneezer paused. "Oh, yes. This happens in weather."

"Well, you certainly look protected against the rain."

The two old ladies laughed. "Peggy, there, my daughter, wrapped us.”

"Are you sisters?"

"Friends! I'm Evelyn and she's Betty. We worked together for thirty years."

"Phone company," added Betty.

"We've been retired for twenty," Evelyn said.

"Came for the fireworks," confirmed Betty.

They dissolved into a long, infectious bout of laughter.

"What?"

"I don't know, " Betty answered, dabbing her eyes.

"We get like this some times," Evelyn gasped, trying to find her breath. "Get each other started. On a jag. Can't stop."

By now daughter Peggy and the inquiring doctor were also grinning.

"Where are you from? said Betty.

"I come from India."

"I look awfully pale next to you. I should get out more."

"In my country we have seasons of rain like this every year."

"Oh those terrible cyclones."

"Occasionally. But the regular monsoon rains can be very heavy."

"Monsoons. Palm trees bent double. Software deliveries delayed. I've heard!" More laughter.

"Good luck with the fireworks."

"Do you think they'll cancel them?" asked Betty.

"Oh no. They can shoot them no matter what the weather."

"Hope so," said Evelyn.

"Hope so," said Betty. "We drove two hundred miles just to see 'em."

In that minute, the sky exploded: yellow pinwheels, green starbursts, and red and white girandoles shot up through the drizzle and bloomed above the cloud bank. The crowd sang out its approval and Jay and Peggy and the old ladies applauded, their spirits borne aloft by the rough exalted voice of Ray Charles oh beautiful for spacious skies, for amber waves of grain, for purple mountain majesties from sea to shining sea.

* * *

Hello Jay, it's Robert. Evidently Beverly Wilkens couldn't get you on the phone. Jay, there's a problem regarding this family. Please call me right away, ok? If I don't hear from you in a half hour, I'll stop by your office.

Jay checked his watch. It was ten o'clock, and the message was a half-hour old. Sure enough, an impatient knock rattled the door.

"Jay, how are you?"

"I'm well. You?"

"Okay, I guess. Listen, you performed an exploratory day before yesterday on Mrs. Wilkens, the elderly African-American woman with stomach cancer?"

"Yes. To check the intestine." Jay felt his diaphragm tighten. He tended his cuffs, arranged his clipboard so it was perpendicular to the edge of the desk.

"Apparently Mrs. Wilkens seemed fine until she got home. Collapsed on the way from the car to the house, and her daughter managed to get her to bed. She was conscious by then and said she was dizzy and wanted to rest. So they let her sleep. Said they left you a message, but didn't hear back. About four o'clock they called 911 because she was incoherent."

"I did call back. I left a message."

Dr. Robert Bentley had been leaning against the door jamb with his arms crossed. Now he took a chair, proceeding in a softer tone. Dr. Bentley had clear blue eyes and white hair, had been chief of gastroenterology for twenty-five years. Dr. Parek had graduated in the top ten percent of his med school class, but had been practicing for only five years. Dr. Bentley had performed two surgeries on the old woman; for the exploratory procedure, which involved a small incision in the stomach wall, the family had requested Dr. Bentley—We want the best doctor—but he was unavailable.

I'm sure you're very good but we had gotten used to Dr. Bentley and I guess if he says you can do the procedure it will be fine but we wanted to meet you first.

"So the stomach wall was compromised?" Jay took pride in mastery of the latest techniques, but now his breath was short. The details were hailing down on him like pellets of ice.

On the way into the operating room, the nurse and anesthesiologist in their scrubs had fitted the ninety-nine-year-old Patti Ann Wilkens with a plastic cap and I.V. and joked with her. "How do you like your chapeau?" Mrs. Wilkens was stable, alert, and chuckling. "But of course! I look good in hats. Can I hold somebody's hand, though? I'm so damned old."

"Exactly. The medics brought her into emergency. There was an outcry from the family that they don't know how they got you in the first place and to please call Dr. Bentley. I went in and cauterized the incision. The old woman had to be awake for a good part of it. It was hard going; she's so elderly and already very sick. She was woozy but pulled my head down to her and whispered that it meant something to the family for her to hang on. "

"So I didn't close the wound?"

"Right."

"I've never made that mistake before. Are you sure the disorientation was caused by the procedure?"

Mrs. Patti Ann was the first black woman in Galveston to cast a vote.

"Absolutely. Anyway, I did what I could and told the family their mother was in danger, but after rest, she might rebound. Two of the sisters were crying. I think she has a slight chance to pull through but she lost a lot of blood. Of course, she also has incurable stomach cancer that'll get her in a few months. You were off yesterday for the Fourth, and I was glad to watch her. But she's not doing well."

"I'll go see her later this morning. If they knew what her insides look like, they wouldn't be so anxious to keep her going."

"The family is insisting that you stay off the case."

"I see. They refuse to acknowledge that these procedures have risks."

The ancient, amazing Mrs. Wilkens had a web site, selling caladiums on-line.

"They say you didn't explain, and there was no form to sign. But also that you always seemed impatient and distracted, like you were thinking of anything but their mother."

Our mother raised us kids on her own through the Depression and war, and two went to college in the 1950s. Guess which one of us knows Chinese. South Texas black kids.

"Since she had an endoscopy recently, I didn't think it was necessary to go over it all again."

"But you need to remind people. They're not going to remember that stuff four months later. I told them you were conscientious and had quite a few patients, so you might seem hurried. But you know how important it is in this hospital to treat people with respect. Like you have all the time in the world; we give them potted plants to take home. We recommend a fertilizer. "

Ms. Beverly Wilkens, her three brothers and two sisters, assorted spouses, and several small children had marched into Jay's office, talking nonstop. Almost completely silver gray, the hair of one sister was fixed in cornrows and little braids and red and yellow bows. Silly, at her age. She was managing twins, about five years old. "Doctor, this is April and this is May. Born at midnight on April 30. They did my hair; I decided to leave the bows in; it tickles the kids."

"My accent bothers people some times."

"This has nothing to do with your accent. It has to do with their mother dying." Dr. Bentley left abruptly, not bothering to pull the door closed behind him. Jay had always admired Dr. Bentley's honesty and was stung now by his attitude. An amorphous loneliness overcame him, like a muddy wave. It was true—he tended to just see a patient's ailment, snipped away from its effect on loved ones.

Our mother Patti Ann Wilkens is 99 years old. She was a miracle, born on Sunday, September 9, 1900, the day after the great hurricane in Galveston.

* * *

He walked home, flicked on his air conditioning, made a cup of tea. He had no wife or children; and he had chosen to live a world away from his family. He clung to the admiration of his colleagues; it connected him to them, to something; now he found himself rummaging for a phone number.

It was seven in the morning in Kerala. His father answered.

"Oh hello, Jay! I am just out of bed. How are you? It's not my birthday, is it?"

"No, no, I just wanted to see how you are. "

"We're fine. Your mother's gone for a walk; you know she loves early morning. Your sister and the kids are staying here for a month. It's warm, but in paradise the heat doesn't bother you. I know it bothered you, sometimes."

"It's plenty hot here."

"I know, I know. I'm rubbing it in. What are you reading lately?"

"Oh, medical journals. Sometimes a mystery story. What about you?"

"I'm deep into the newspaper. That's about it for me these days."

"What about your fishing? You still like it, don't you?"

"Yes, I do. I go on Tuesdays and Thursdays."

"Tell everybody hello for me, will you?"

"I will do it. Take care of yourself, son."

Next morning, at seven-thirty a.m. Jay checked his sort-of shrine. He lit a candle and a stick of cranberry incense and dusted off his Shivas, as though his race memory was telling him to summon the help of the gods. The thought of his father, calling him "son," warmed him.

When he reached the hospital, the nurse greeted him. "Why hello Dr. Parek. How are you today?"

"Tired. How are you?"

"I have to tell you that Mrs.Wilkens died an hour ago. The family's in the room with her."

The unkind thoughts he'd had about the Wilkens family suffused his mind and body, and his skin went hot and soft in shame. One afternoon, after a bunch of them had vacated his office, he'd pictured brown pelicans, beaks in constant motion with ungainly wingspans, bumping into his bottled water, kicking his sticks of incense, threatening his striped yellow-tails from Baja, and he didn't even have an aquarium. They had not, of course, touched a thing. Did they remind him of mobs at his mother's house? He thought of his grandmother who died at the age of fifty-five, so young, and her funeral pyre. The fire had frightened him and the sight of the ashes ascending made him sick. He felt his cheeks again damp, as when he had cried for her, the one person who always whispered to him as if he were the only boy on earth. It didn't matter to her children how lucky Mrs. Wilkens had already been, to live so long, or how merciful a quick death might seem to some doctor.

He peered through the high window in the patient's door. The room was dim, crowded. Tall candles and vases of roses and calla lilies were arranged on the side table. Mrs. Wilkens stretched the length of the bed with her arms folded over her chest. Her head was propped on a pillow, hair nicely combed, the picture of serenity and grace. But the rest of the sad room was grayed out, homeless.

Beverly's head lay in her dead mother's lap. April and May were silent; each held one of Patti Ann's hands. Edward held her feet, rubbing them. A son and daughter, Ben and Serena, were sitting on the side of the bed, sobbing. Her daughter Charlotte had covered her own face with a handkerchief; a son 's arm encircled her. Patti Ann Wilkens, her stomach riddled with nodules of cancer, had stopped breathing. Her hair was thin; her flesh spotted and pocked and wrinkled. She'd told the nurse that when she looked in the mirror she saw someone else, an alien, not the healthy eighteen-year-old who lived inside.

Jay remembered sideswiping a car in Madras. He scratched the passenger door and had knocked off the side mirror. He'd left a note and phone number: "So sorry. I swerved and nicked your car. Please call me and I will make amends." He wished he could do that now: "So sorry, I cut into your mother and she died. I am very very sorry."

He knocked, opened the door slightly, not going into the room.

"I am so sorry for your loss. Mrs. Wilkens was a fine person, a friendly woman, and I know how hard this must be."

The family fell completely quiet, astonished to see him. No one spoke or moved.

"Do you know?" said Beverly, at last. "Really?"

"I may have made a mistake during the procedure. I'm sorry. I'm sorry. " His eyes filled.

"Well, can you fix it? " That was little April.

Edward came over to him. "You seem upset and we appreciate your words."

"We're not going to sue you, doctor. She's been spared a lot of suffering. It's just that we all wanted her to get to be 100. And we didn't want to let her go," said Charlotte.

"If I can do anything to help, please let me. I'm so sorry." Jay backed out of the room, pulled the door. He went to the staff cafeteria for a cup of tea but in a few minutes was hurrying back to that corridor.

The blind on the Wilkens' high window was not quite closed, so that he might look in without the family noticing. He forgot about the nurses and visitors traversing the hall, who would wonder why a doctor was outside a sick chamber, staring in.

Yes, he could see inside, a sliver of the room. Charlotte was lighting candles; hints of flame flickered off the dark blue stone on her ring. Brothers and sisters and grandchildren were holding hands, in twos and threes, and the little girls were whimpering. Patti Ann Wilkens, almost one hundred years old, washed in pure love.

He had no place to go, except an office that had no bright fish. An apartment and its wilted shrines. He could not leave her window yet. He wanted to stay a while longer, he wanted to find tears.