Part 2 — What Dr. Abrams Had Been Watching
Dr. Abrams told me the story from the beginning.
Not from the beginning I knew. From the beginning the results described.
Eighteen months earlier, during a routine blood panel, Dr. Abrams noticed an anomaly. The anomaly was not in the expected direction. The expected direction was the direction the prognosis had been tracking, the declining direction, the numbers-getting-worse direction, the particular, progressive, disease-advancing trajectory that the term!nal prognosis described and that every previous panel had confirmed.
The anomaly was in the opposite direction.
One marker, a specific inflammatory indicator that had been elevated since the diagnosis and whose elevation was the evidence the disease used to announce its presence in every panel, was lower. Not significantly. Slightly. The particular, barely-detectable, within-the-margin-of-error, could-be-a-lab-variation reduction that a physician notices and files and does not act on because the filing is the appropriate response to a single data point whose single-ness does not support the conclusion the data point’s direction would imply if the direction were sustained.
Dr. Abrams filed it. He did not tell me. The not-telling was the standard medical practice for a single anomalous result because the telling would introduce hope and the hope, if the anomaly was a lab variation rather than a trend, would produce the particular, devastating, hope-then-disappointment cycle that physicians are trained to prevent by withholding the preliminary data until the preliminary becomes the confirmed.
The next panel, three months later, showed the same marker lower again.
Not within the margin of error. Below the margin. The reduction was measurable. Repeatable. The second data point that transforms a single anomaly into a potential trend and that the potential activates the physician’s attention in the way a second footprint activates a tracker’s attention because the second footprint confirms the first was not random.
Dr. Abrams ordered additional tests. Quietly. Without telling me. The quietly was the caution. The caution was the professional judgment of a physician who has been treating a term!nal patient for over two years and whose treatment has been organized around the management of the decline and whose decline is now producing data that contradicts the decline and the contradiction requires the caution because the contradiction, if announced prematurely, would restructure the patient’s understanding of his own life and the restructuring, if the contradiction proves temporary, would produce a collapse more devastating than the original diagnosis.
Dr. Abrams was afraid of the collapse. The afraid was the reason for the delay. The delay was the eighteen months between the first anomaly and the appointment I was sitting in now.
Over those eighteen months, Dr. Abrams monitored. Panel after panel. Test after test. Each one showing the same pattern. The inflammatory marker declining. The disease markers stabilizing. The particular, sustained, repeated, panel-after-panel, test-after-test evidence that the body whose prognosis said weeks was performing a response the prognosis had not predicted.
The response was immunological. Dr. Abrams explained the mechanism with the particular, clinical, careful, this-is-what-we-believe-is-happening language of a physician who is describing a medical event that the physician’s training classified as extremely rare and whose extremely rare was the reason the physician delayed the telling because the extremely rare is the category that produces false hope when announced prematurely and that produces genuine hope only when confirmed through the sustained observation the eighteen months provided.
My immune system was responding to the disease. Not through the medication. Through a process the medication may have initiated but that the immune system was now performing independently, the particular, self-directed, biologically autonomous, the-body-is-fighting-without-being-told-to response that medical literature describes as a spontaneous immunological event and that the describing does not fully explain because the describing is the naming and the naming is not the understanding and the understanding is the thing medicine does not fully possess for events whose rarity places them outside the scope of the controlled studies the understanding requires.
Dr. Abrams told me the disease was not advancing.
I heard the sentence. I did not process it. The not-processing was the particular, too-large, information-exceeds-capacity, the-mind-cannot-hold-this-yet delay that a brain performs when the brain has been organized around one reality for two and a half years and the reality has just been contradicted by a sentence and the contradiction requires the reorganization of everything the brain has been maintaining.
Dr. Abrams told me again. Slowly. With the particular, repeated, let-me-say-this-a-second-time, the-first-time-did-not-land delivery of a physician who understands that the patient’s capacity to receive the information is overwhelmed by the information’s content and the content requires the repetition the capacity demands.
He told me the disease was not advancing. He told me the markers had been declining for eighteen months. He told me the decline was sustained. He told me the decline was consistent with a trajectory that the term!nal classification did not describe.
He told me the term!nal classification was being revised.
Revised. The word that contains the unmaking of the previous word. The word that takes term!nal and removes the term!nal and replaces the term!nal with a different word and the different word is the word the nightstand’s medication bottles had been standing between me and the reaching of and the reaching was now occurring because the bottles’ managing had participated in the initiating that the immune system was now continuing.
The revision was not a cure. Dr. Abrams told me this directly. The revision was not the particular, complete, disease-eliminated, body-restored, you-are-healthy declaration that the word cure implies. The revision was a reclassification. From term!nal to chronic. From the timeline measured in weeks to the timeline measured in years. From the prognosis that said the ending was approaching to the prognosis that said the ending was receding and the receding was the trend the eighteen months confirmed.
Chronic. The word that replaces term!nal. The word that says the disease remains but the remaining is managed and the managed is the condition rather than the conclusion and the condition is the living-with rather than the dy!ng-from and the living-with is the word the nightstand had been hoping the bottles would produce and the hoping was now confirmed by eighteen months of panels the doctor had been afraid to share.
I asked Dr. Abrams why he was afraid.
He told me the afraid was professional. The afraid was the physician’s fear of the false hope, the particular, devastating, more-harmful-than-the-disease, promise-that-is-withdrawn hope that a physician produces when the physician announces a positive trend prematurely and the trend reverses and the reversing destroys the patient because the destroying is performed not by the disease but by the hope the disease’s temporary retreat produced.
He told me he waited until the evidence was overwhelming. He told me overwhelming required eighteen months. He told me the eighteen months were the price of the certainty the overwhelming produced and the certainty was the thing he was now delivering and the delivering was the thing the tears were about.
The tears were not grief. The tears were the particular, relief-based, I-have-been-carrying-this-for-eighteen-months, the-carrying-is-ending, the-patient-is-going-to-live tears that a physician produces when the physician has been watching a man count his remaining weeks while the physician’s panels showed the weeks expanding into months and the months expanding into years and the expanding was the secret the physician carried because the carrying was the caution and the caution was the medicine.
Dr. Abrams cried. I cried. Two men in a medical office. Crying. The particular, shared, same-room, same-information, same-tears crying of two people who have been connected by a diagnosis for two and a half years and whose connection has just been restructured by the revision the connection now contains.
I asked Dr. Abrams how long.
He told me the prognosis was no longer measurable in the way the previous prognosis was measurable. The previous prognosis was weeks. The revised prognosis was indefinite. Indefinite meaning the disease was present but managed and the managing was being performed by both the medication and the immune response and the both was the condition the panels confirmed and the confirming was the eighteen months and the eighteen months said the trend was sustained and the sustained said the indefinite was the timeline the trending supported.
Indefinite. The word that replaces weeks. The word that says the ending is not visible from here. The word that says the nightstand’s bottles will continue and the continuing is the management and the management is the living and the living is the not-wasting that Carrie’s sentence organized our lives around.
We were not wasting a single day.
The days were now indefinite.
