Chapter 64 Clinical
MIA
The spring clinical placement started on a Monday in February and I arrived at the oncology ward at Hamilton General at seven fifteen in the morning and stood in the main corridor for a moment before I went in, not from uncertainty but from the specific awareness that I was standing at a threshold I had been walking toward for two years and I wanted to feel that rather than rush through it.
I had been in this building many times before. The waiting rooms on the lower floors, the billing office where I had stood with insurance forms and a particular mixture of exhaustion and determination that had become one of the defining textures of the year Mom was diagnosed. The pharmacy on the ground level where I had collected prescriptions at hours that suggested neither the pharmacy nor I had been sleeping properly. The specific smell of the main lobby that I associated with the combination of anxiety and hope that tended to live in places where people came to find out things they were not sure they were ready to know.
I had never been on the ward itself.
The ward was different from everything below it in the way that the actual thing is always different from the anticipation of the actual thing. The waiting rooms were about the not yet. The ward was about the now, the daily reality of being ill and being cared for simultaneously, the specific and human texture of that relationship that no textbook had communicated properly and possibly could not, because it was something you had to be inside to understand.
Thomas was already at the nursing station when I arrived.
He looked up from his chart with the unhurried expression of a man who had been on this ward for twelve years and had learned to read the quality of a new person's arrival in approximately thirty seconds.
You did good work last spring, he said.
Thank you, I said.
Do not thank me, he said. Just keep doing it.
He handed me a chart and went back to his notes and I understood that this was the full extent of the welcome and that it was also everything I needed.
The second year placement was different from the first year in the ways I had prepared for and the ways I had not. I had prepared for increased responsibility and the specific weight of being the person a patient addressed directly rather than the person learning in the background. What I had not fully prepared for was how much of the essential work I already knew how to do. Not technically. The technical learning was ongoing every day and would continue to be ongoing for the rest of my career. But the human part, the part about being present in a room with someone who was ill in a way that made the room feel like somewhere a whole person existed rather than somewhere a diagnosis was receiving management, that part I had been practicing at bedsides and kitchen tables and in cancer center waiting rooms for three years without knowing it had a name or a place in a curriculum.
It had a name.
Thomas called it presence.
He identified it in me on a Wednesday in week three after a morning in room four that had been difficult in the specific and particular way that oncology mornings are difficult when results arrive that are not the results that were hoped for. He had handled the conversation with the careful dignity of someone who had made peace with the impossibility of making such things easy and had simply decided to make them as accompanied as possible instead.
Afterward he found me in the corridor.
You stay in the room, he said. When it gets hard, some students step back. Not physically. They go somewhere else while they are still standing there. You do not do that.
I thought about Danielle in the fall saying you watch the patient, not the procedure.
I have been doing it for a while, I said. Before I knew it was something you could learn on purpose.
Your mother, he said.
Three years, I said.
He nodded once.
It shows, he said. In the best way.
He walked back to his station and I stood in the corridor and thought about all the versions of the last three years that had been preparation for this specific moment without announcing themselves as preparation. The pill organizer on the kitchen counter. The counting of breaths through the wall. The waiting rooms and the billing offices and the afternoons in Dr. Patel's office learning to read the space between her words. All of it the education I had been receiving without knowing I was enrolled.
I called Caleb that evening and he listened to the whole thing without interrupting and when I finished he said: Thomas just gave you the word for something you already were. And I thought about that for a long time afterward, the idea that sometimes the most important things about you exist fully formed before anyone finds the language for them, and that finding the language is not the same as becoming the thing, it is just finally being able to see what was already there.
The contract review was Monday, which Caleb had told me about on Christmas evening, the good kind of developments, the call from December that had been sitting in both our chests since then.
Two days, I said on Thursday night.
Two days, he said. Porter thinks it is a three year extension. Full organization roster.
I sat with that.
Which means the same city, I said.
Two and a half hours from Hamilton, he said.
That is closer than you are now, I said.
Considerably, he said.
We sat with the number quietly.
Then I said: Mom's scan is Friday.
I know, he said. Walter told me.
He tells you everything, I said.
He tells me the things you forget to mention, he said. I have learned to treat it as a supplementary information system.
I almost laughed.
She is going to be okay, he said.
I know, I said.
I just wanted to say it out loud, he said.
I know that too, I said.
Friday came with the specific quality of days that carry things. Dr. Patel called my cell directly rather than the house line and I picked up in the corridor outside the nursing library and pressed my back against the wall and listened.
The scan is showing significant reduction, she said. More than we projected at this stage. I want to discuss next steps Thursday but Mia, this is genuinely good news. This is the result we were hoping for.
I stood in the corridor after I hung up and did not move for a long time.
Significant reduction. Beyond expectations.
I called Caleb and he picked up before the first ring finished and I said significant reduction, beyond expectations, and he said Mia, and I said I know, and we stayed on the phone in silence for a long time, just breathing in the same moment from different cities, and it was enough.