Pain

PAIN/ William Herman I'M STARTING her story here because of her attachment to looking into things, her penchant for gazing into closed-off spaces. The MRI sections of her pelvis—a panel of pictures with diverse views—were hung on the light box in my office, and we were looking at them together, my patient and I. I'm an internist. I've seen MRI pictures and can follow the basic anatomy well enough, but I'm not the guy to dig out the subtle pathology. Still, this patient insisted that I take a look too. She could point something out. The radiologist had said these pictures were clean but she was hooked on my seeing them. She'd put up a terrific battle in Dr. Chaney's office to come away with the pictures he preferred not to send over to me. She prevailed. She'd seen in them what was, to her, cataclysmic evidence of anomaly in her lower back—despite Chaney's perfectly professional assurances that nothing he saw could be causing her distress. And here we were. Pictures and her pain. She pointed to the transverse processes. She declared there to be a fractional asymmetry in these. She trusted her eye. (I didn't see it.) Then there was the "disjointed rhythm of the gray-scale contrasts!" between soft tissue and bone. This shaft of art criticism should have automated my brain to the pleasure of cozy derision. Instead, I was touched by her devotion to the molten vision in her head. It had lightness and poise. Yet it was defiant, too. (I noticed an opal freckle glowing on a nostril.) For the sake of what she was sure she saw, she was willing to seem like a nut, to risk exposure—though I doubt she put it to herself in those terms. No professional statistics, no medical typologies or experience had prepared me for this particular character. All her edges were flush with? . . . some glow of her interior. Yet she was also a student of emergencies, a connoisseur, an aficionada, an expert and a fan. She waited for things to fall on her head the way you wait to hear about the birth of the new baby, holding your breath, boy? girl? She longed for alarms and excursions, sudden asthma attacks, news of incredibly complicated infidelities, unspeakable atrocities, a man deserting his wife and kids, or better, the wife taking it on the lam 20 · The Missouri Review after strangling the husband. There may have been others like her. Living along a fault line. But none of this was apparent when she first slipped sideways into my life. She stepped into my office, folded herself into a chair at my desk and looked straight at me, her eyes very wide, shiny black olives against the translucent whiteness of her skin. She was four feet away from me but when she spoke it was as if the distance were miles, and her words echoes, working away from some rocky depth of sadness. While I looked at the information sheet Eileen had sent in, I sneaked glances at her. Rings under the eyes. A crooked mouth. Nose a little bulbous. Bobby pins holding her hair in place. Decidedly not beautiful . Yet acutely alert. Someone to look at in return. Something—not just the usual—beneath her clothes that aroused my interest. Forty-three years old. Divorced. No children. In excellent health. One symptom. "You have a pain in the lower back, Ms. Mallory?" "Yes, doctor." "Everything else okay?" "Yes." "Can you remember doing anything to cause this—anything athletic?"—she's shaking her head repeatedly—"Any sudden movement . . . did you lift anything?" "None of the above." "You seem to be walking without difficulty." "It's not exactly excruciating this morning." "What's your occupation, Ms. Mallory?" "My profession ... I paint. I make paintings. And horticulture. I grow things." "No strenuous exertion, then? When you paint? Grow things? Lift pots? No?" She shook her head. On the edge of dismissing me as an idiot. "Bueno—glad to hear it. You have a gynecologist you see regularly ?" "Yes. I have my regular mammograms. Pap smears. You think that...