No Smoking

04/11/10

My preceptor turned her dark red Altima off the blacktop onto a rock road, or what should have been one if the torrential rains of spring had not washed much of the gravel into deep trenches carved out by the runoff from the rain.  The car was dusted yellow with pine pollen, and we could feel its grit in our eyes and noses, even with the air conditioner trying to filter the air.  

Then she turned left onto a dirt road, rutted and potted by the rain, large roots exposed and, along with the pots, making for a bumpy and swaying drive up to the back of the trailer.  The dirt yard was littered with old toys, a rusty tricycle, paper fast food wrappers and the skeletons of two old cars sitting on the dirt, wheels long gone.  

Two operational vehicles - both red muscle cars -  were parked beside one another, their pointed hoods aimed at the back stoop, which was supported by an arrangement of boards and concrete blocks which also served as steps.  There were three open packs of unfiltered Pall Malls on the rail. 

Our patient stood alone on the stoop, shirtless, shoeless, wearing only an old stained pair of beige Bermuda shorts, his is steel gray hair in disarray.   He waved, and we tooted the horn while we tried to find a place to park without blocking in the other cars or running over a nail or broken beer bottle.

Mr. X has no voice box.  His larynx was removed several years ago in an effort to cure the cancer growing there.  He breathes through a hole in his neck.  Now, on the right side of his neck, there is a gaping wound, tunneling inward, and next to it is a tumor the size of a small roma tomato and the color of a ripe plum.  It looks as though it might rupture at any minute, but it has looked that way for a while.  I think it is bigger today.  We advised his daughter - the one who came from Texas to help him die -  to keep dark towels at hand for when he bleeds out.  

He opened the screened door for us, and we walked into his dark living room where the out-of-focus TV blared from an entertainment unit pushed against the opposite wall. He took his usual seat in an old loden recliner in the corner and pumped the handle on the side to kick his feet out, then waited for us to start taking vital signs and asking questions about pain.

His daughter from Texas came into the room and helped interpret for us.  The way he moves his lips makes it hard to read them.  She is in charge of his drugs, which she keeps under lock and key.

The others, two sons and another daughter with a small girl in tow, walked past us out onto the stoop, scooped up the Pall Malls, each lit one and got into one of the red cars, tobacco smoke swirling around the child's head.  They said they were going to Wal Mart.