PASSING THE TOUCH | Nathan Rockey
I held the anatomy textbook that belonged to a man I never met. It was from the 1950s, spiral bound with a faux-wood cover. I flipped through the pages, whose margins were decorated with tiny cursive notes and little doodles of faces with chiseled cheekbones. I carried the book with me during many moves: eight different apartments over the past eight years. Only after residency did I spend time examining its pages. I thought about the man who underlined multiple words in each sentence as though a dash of his No. 2 pencil would cement the anatomical detail in his brain. The student who would go on to love primary care and to love his patients. He had said that the laying on of hands was inextricable from primary care for both diagnosing and communicating compassion.
He was my grandpa, my mom’s dad. I learned that he often whistled in-between seeing patients in his family medicine clinic. “There is no place he’d rather be,” I was told. He died when my mom was a few months pregnant with me. She and her two siblings had visited their dad as he lay dying in Oregon. He was weak and his voice raspy. A hand-held microphone amplified his speech. His jaw line looked just like the pictures he drew throughout the textbook. Gaunt, with no fat on his face.
When I first started medical school, my mom and her sister, Laine, visited me in Rochester, Minnesota. It was a sunny August day. The sort of day that makes you forget the cold that is just around the corner. I was proud to be a Mayo medical student, though reluctant to admit this pride. Any facade of humility was broken down when Laine hugged me and bubbled over squealing, “Look at our doctor! In a suit!” Laine bent down to her luggage and presented me with a large spiral bound textbook, “A Guide to the Regional Dissection of the Human Body.”
“Thank you so much,” I said looking up to her. We hugged, and the three of us admired the book. I flipped through the pages again.
“Look at this face!” I said, flipping to one of the black stenciled portraits.
“He was good at drawing. He just loved details,” Laine said.
“Thank you,” I said again. It was all I could say, I had forgotten my grandpa had been a family medicine doctor. During college I had told friends I was going to be the first doctor in my family. I wasn’t trying to lie, I just hadn’t remembered. Laine’s gift was a loving corrective to my negligence.
My grandpa loved life and had faith that his disease could be cured up until the end. In a newsletter from that time he had asked his friends to “find a little rock or stone that will remind you of me. Then, once, a day, hold it tightly in your hand and say, Glenn, be well.”
What did he think was possible in the end? My mom had said the only time he cried was when he realized he would never get to meet me. My heart sunk. This man who had been dead for thirty years had thought about me – future me – as his body wasted away. How had I failed to think of him?
Thirty years after his death, his oldest daughter, my aunt Laine, was dying of metastatic cholangiocarcinoma. She called me to review biopsy results in the spring. She had just been discharged from the hospital after needing a stent in her common bile duct. We had expected there to be a gallstone, but none was found. Her bile duct was blocked by a mystery. An elusive invader. A biopsy of the duct and subsequent diagnostic laparoscopy showed cancer that had spread beyond the biliary system into the liver and throughout her abdomen.
I stepped outside of a bar in Denver when she texted me the pathology report. She wanted to review it together. I read it aloud and paused after each sentence.
“What is adenocarcinoma, Nate?”
“It’s a type of cancer, Laine.”
“Oh shoot.”
“Damn. It means they found cancer cells in the abdomen.” I stopped reading, I looked back inside. My friends were sitting at the high stools, laughing. It is rare to feel like you are exactly where you need to be, doing exactly what you need to be doing.
“So, no surgery, right?”
She was right. We said goodbye and I looked up at the sky. I decided I would be there when the chemotherapy started. I wouldn’t move to New York until that summer but needed to be with Laine when she received her first treatment.
In the winter of the following year, Laine rode the train down to the Lower East Side and visited my clinic. Her style was persistently wasted on me. It had taken me thirty years and moving to New York City to fully become aware of this. Her earrings were matte-white dangling circles that matched her sweater, which had jagged lines of brown and black. I certainly didn’t notice her headband that day — but in a picture I now see that it has the same three colors as her shirt. I loved her for this coordination and felt some shame that her nephews had the cumulative fashion sense of a toad.
I met her at the East Broadway stop and we walked to my clinic just a few blocks away.
“Wow, Nate, this is incredible!”
“This is where I work!”
“Doctor Rockey, reporting for duty!” She smiled at this thought, not waiting for a response, and continued to look around.
We took a break on a bench in a quiet hallway overlooking the main entrance. Her excitement was real, but the energy was not sustainable. It was a temporary disguise that hid her multiplying cancer cells. After she allowed herself a moment to relax and take several deep breaths, her eyes burst open, the energy tank refilled. She pulled out a thin white cardboard gift box, tied up in a pale-green fabric bow. She handed it to me. I unwrapped the box and said the customary phrase, “You didn’t have to get me anything, Laine.”
I removed the wrapping paper and pulled out a glass dome, about the size of half a baseball. It was a paperweight with seashells and mini seahorses magnified in the glass. the flat surface covered by a fading green fabric. Most of the seashells were white, with a few bright green, pink and yellow ones.
“I made that for my dad when I was in grade school. He had it on his office desk until he died,” she said.
I moved it around in my hands. It was heavy, as its job required.
“He would be so happy to know his grandson is a doctor,” she said.
Two weeks after Laine’s visit to my clinic, her oncologist decided the chemotherapy was no longer working, and it was time to look into clinical trials. Her pain in her abdomen was increasing, which a CT scan the following day told us was, indeed, due to increasing metastatic lesions throughout her body. The stent that had opened the bile duct was now closed from tumor regrowth.
I thought about what Laine was sacrificing to get this chemotherapy. She sewed pillows and skirts for a living and had to stop because of progressive chemotherapy-induced peripheral neuropathy. Medicine, in its fervor to slow down her cancer, had taken her ability to feel with her hands. I was at the visit when she first spoke about this loss, and she did so reluctantly and only when asked directly. Her desire to live and to keep knocking down the cancer cells outweighed any mourning for the loss of her fingertip sensation. She had been creating fewer skirts and pillows because she was so tired, but now she had to stop because she couldn’t feel her work anymore. Her sewing machine sat unused on the table in her room, a quiet bystander to her loss.
“Can I examine them?” I said.
“My hands?” She held them out to me. “Sure!”
I held Laine’s hands one at a time in both of mine. Hers were bony and pale, but also warm and full of life. There was no outward evidence of the damage to the nerves traveling just underneath the skin. My eyes blurred with a thin film of tears. Were these the tears of a doctor empathizing with his patient or of a nephew watching his aunt die? I pressed on her fingertips and asked how it felt. She said that, well, it really didn’t.
I wanted to tell Laine how much I admired her ability to create with her hands. How my hands so often trembled and shook when I needed to use them. The first time placing an IV in medical school or an arterial line in the intensive care unit during residency. How scared I was to make the wrong move, of my hands causing harm. I hoped she could feel my pride in her making it in this world. Her forging ahead as an entrepreneur and craftsperson. I thought about her starting in the city decades ago, forming a business and using her hands to create art. I think about the customer who will wear one of her handmade skirts on a walk through Central Park. A skirt made by hands with fading neurons.
Why was it so important that she passed along items that belonged to her dad? I held the glass dome and could imagine her pride when she would go to his office after school and see it on the desk. She always would say, “I was left-handed, reaching six-feet tall, and dyslexic. Hellloooo. School was hard.” But after middle school she would visit her dad at work, a sanctuary he created between him and his patients. And there was that glass paperweight. Laine said it was the one thing she asked her stepmom for when her dad died. And she wanted it to be on my desk, with the textbook in the drawer underneath. For me to feel the weight and flip through the pages. To use my hands to remember what came before. To feel and to remember the power of physical touch.
Just as my grandpa had asked for people to hold a stone and to think of him. I held the glass dome, and I thought of my aunt.
Laine, be well.
Nathan Rockey is a primary care physician in Colorado. He likes to read and write about medicine and is working on a nonfiction piece about his medical training. His favorite piece of writing is an unpublished poem his dad wrote called “The Last Fact.”