THE DAUGHTER AND THE DOCTOR | Natalie Malluru
It began in red. A few drops at first, blooming in the water like ink dropped from a careful hand. My father told no one. He had spent his life inside a body that had asked nothing of him, and the body, he believed, would not begin asking now. The drops returned the next day, and the day after that, and finally, he went to his doctor.
The urine test was clean. No infection. No reason. He called me that evening, his voice careful, the way he always made his voice careful when he did not want me to worry. I was a few months into residency. I had already started learning to listen for what people did not say.
"It's probably nothing," he said.
I built the differential as he spoke. Stones. Glomerulonephritis. Mass. The word mass settled in my chest like a swallowed coin. I told him, in the voice I had been taught to use with patients, that we would not know anything until the cystoscopy. I did not tell him what I was thinking. I did not tell him that the daughter and the doctor in me had begun, already, to argue.
We waited weeks. The cystoscopy found a bump, the urologist said. Small. Nothing dramatic. We waited again.
The afternoon the pathology was due back, my mother texted that she would call after she had spoken to the urologist. I drove home from the hospital that evening with my phone face up on the passenger seat. I had counseled patients through this exact wait. Each minute the phone did not ring became a small pressure against my sternum. When my mother finally called and asked me to sit down, I was already sitting.
High-grade papillary urothelial carcinoma.
What followed was not one feeling but a layering of them, each one operating on a different timeline. There was the daughter, who could not speak. There was the doctor, who was already running through staging, cystectomy versus intravesical therapy, prognosis, and the questions she would need to ask the urologist. And there was a third self I had not met before, a kind of translator standing between the two, whose job was to take what the doctor knew and hand it gently to the family in a form they could hold. My mother needed to know what came next. My younger brother needed to know whether he would be alright. My father, when I called him an hour later, needed to hear my voice sound the way it had always sounded. I gave each of them a different version of the same news. I did not give myself any version at all. I was the last person in the room I attended to.
I have thought, since, about how strange that triage was. In medicine, we are taught to compartmentalize. What I learned that evening is that compartments leak. The doctor I was for my family was the same doctor who would walk onto wards the next morning. The grief I was not letting myself feel did not disappear; it waited.
A week later on wards, we had been waiting on a pathology result for one of our patients, a man on the fourth floor with a bladder mass. His report came back on a Tuesday. I read it twice. I read it three times. The same words. The same diagnosis. High-grade papillary urothelial carcinoma. As if the universe had decided I should learn this lesson twice.
I walked the long hallway to his room, the translator iPad, orange, awkward in its plastic cradle, rolling alongside. I knocked. He looked up from his bed the way patients look at their doctors, hopeful, the way you look at someone you believe might be carrying good news.
I sat down. I pulled the translator close. I took a breath that did not steady me.
I had been taught how to do this. There are protocols. There are scripts. And yet when I opened my mouth to speak, the only face I could see was my father's, and the only voice I could hear was the one in my own chest, telling me to be slow, to be careful, to remember that this man would carry these words for the rest of his life.
I told him what we had found.
The words traveled through the orange screen and back again, and when they reached him, his face did not move. His eyes lifted to the ceiling. He held them there. I held his hand. He did not squeeze back.
In that moment, I thought of my father. I thought of the surgeries that were coming for him, the appointments, the slow cracking and restructuring of our family around a new and uninvited center. I thought of how I had not been able to sit with him like this. How the news had reached me through a phone, in a quiet room, and how I had gone to work the next morning. I had imagined, before this, that delivering bad news would be a thing I gave away, a weight I set down on the bedside tray and walked away from. I learned that afternoon that this is not how it works. What I had not expected was that the doctor and the daughter would not take turns. They sat in the same chair. The doctor watched the patient's face for the small involuntary movements, the swallow, the place where the gaze fixed itself on the ceiling tile. The daughter watched the same face and saw her father, a week earlier, hearing the same diagnosis through the same kind of quiet. I could not separate them.
We sat for a long time without speaking, my patient and I. The translator, mute, listening.
Months later, I still carry that afternoon with me. I have noticed small changes in how I practice. I sit down more often, even when I am pressed for time, because I learned in that room that standing makes the doctor a vertical thing, a column of authority, and that bad news is easier to hear from someone whose body has admitted it has nowhere else to be. I leave longer silences. I have stopped reaching for the next sentence to fill them. I have stopped using the word soon. When I tell a patient that we are waiting on results, I tell them how many days it will take, and if I do not know, I say I do not know.
I do not think these changes make me a better doctor in any way that could be measured. They are smaller than that. They are the residue of a particular afternoon and of the months that followed it, in which my father became a patient, and I slowly became a different kind of physician than the one I was being trained to be.
Natalie Malluru is a first-year internal medicine resident at Dell Medical School at the University of Texas at Austin. She writes about the unique challenges of being a medical trainee, as well as how literature and poetry have shaped her perspective on her patients and herself. Malluru's work has appeared in Pulse and the Travis County Medical Society newsletter.