The Ambiguity

by David Ray

The doctor's signature as tiny as any Pearl had ever seen and the bold letterhead, THYROID PROJECT, read like an invitation. The hospital was inviting all patients who had been treated with radiation for acne, boils, tonsillitis, and other afflictions to return for free examinations.

Since her treatment for acne at Michael Reese Hospital when she was fifteen Pearl had over the years gone through some anxiety when she read about some link between radiation and cancer. She was an omnivorous reader of novels, and one year she had run across a reference in Sinclair Lewis's novel, Babbitt. A character named Dr. Kurt Yavitch, a histologist, was working on a "report on the destruction of epithelial cells under radium."

But she reminded herself that her treatments had not been by radium, and she put the matter to rest, only to be alarmed again when she came across a reference in another novel, Manhattan Transfer, by John Dos Passos. It seemed that even fictional characters knew back in the nineteen twenties, the era of flappers and weird dances, about radiation causing cancer.

Still, she reflected, doctors knew what they were doing, didn't they? They always said so.

"It's just some sort of research project," her husband Gerald said, "but I think you ought to go just so you won't worry about it any more."

"They don't offer to pay airfare or anything."

"What's to lose? They say they'll give you a free exam. When was the last time you had a physical?"

"The last time I needed one."

Pearl flew to Chicago from El Paso and took a taxi to the hospital, amazed at how the city had changed. On her earlier trips to the hospital, three decades back, she had ridden a streetcar along Cottage Grove Avenue.

Urban renewal with its bulldozers and wrecking balls wiped out the unpainted storefronts and shacks that looked as if they had been imported from the sharecropping fields of the South, and there were no more half-naked children playing on the sidewalks-the same children Pearl saw later in India and Africa. Pearl regretted she had not taken photographs through the open door of the streetcar as it clanged along, but she remembered how embarrassed she had felt even to witness such poverty. What right did she have to gape at such suffering?

She had once been early for an appointment and got off the streetcar a few blocks from the hospital and walked along the crowded sidewalk, sidestepping the children.

She paused before a storefront window draped with heavy green velvet curtains, perhaps salvaged from a theatre. A crystal ball and splayed Tarot cards advertised the services of a Gypsy woman who stood in the doorway and urged Pearl to come in for a fortune reading. Sitting at a small table across from the garishly dressed woman-saggy purple blouse and a scarf wrapped around her head, Pearl recalled-the fortune predicted nothing but good luck and happiness.

Almost overcome by the drift of incense and dust, Pearl extracted the agreed-upon five dollars from her purse, then let herself be talked into spending another dollar, as the fortune would not be reliable unless confirmed by the crystal ball. Torn between feeling silly and the near-hypnotic persuasions of the Gypsy, Pearl watched as the woman retrieved the crystal ball from the store window. But even the shadowy wisdom within the glass could find no bad luck in Pearl's future.

From time to time over the years Pearl had recalled the auspicious reading. Gerald had turned out to be a good choice of a husband, and her children had been born normal and had grown up with few problems, as if the Gypsy's reading had been validated for the entire family. And now, sitting in a crowded waiting room of the impressively remodeled hospital, Pearl again felt like the teenager who had come to the hospital every Tuesday for several weeks for the radiation treatments. Just as promised, the acne had disappeared, as if the tinkling of the x-ray machine had scattered scintillations of a magic wand.

Many of the people in the waiting room were dealing with the same questionnaire Pearl had been handed, filling the pages out on clipboards. She assumed they had all been summoned as she was. One by one they were led away by nurses.

When her name was called, Pearl allowed herself to be led along like an obedient child as she was passed along to a social worker who sat at a desk in a tiny windowless room with bare yellow walls. The woman's pink rhinestone-studded owl glasses and obvious blonde wig reminded Pearl of her sister-in-law Jennie, whose voice was annoying if it uttered more than half a sentence. Motioning Pearl to sit down in the only available chair, the woman hardly glanced at Pearl before she began jabbing a ballpoint pen on a pad of graph paper on her desk. With icy precision she explained that malignancies were like dots clustered inside a bell jar. Pearl leaned forward, wondering which dot might be hers.

"Each one represents a patient," the woman said, "and fortunately-as you can see-many fall outside the bell jar-on either side of it. Given the number of years since you had your treatment, you're likely to fall on the far side-with an excellent survival prognosis."

"Pardon me?" Pearl thought of the Gypsy's predictions. Had she not been granted lifelong immunity to harm?

"Well, look at it this way, we wouldn't be sitting here if you hadn't already many years?" She opened a file and ran her index finger across the first page inside. "Twenty-six years. That's very encouraging."

A green-coated attendant appeared and led Pearl by the elbow down the corridor, turning one corner, then another until an overhead sign, RADIOLOGY, inspired him to say, "Here we are." He departed with a prissy walk and a wave at the receptionist.

Pearl soon found herself lying on a table while a male technician stood at her side, sliding a slippery sonogram probe around her throat. He told her not to move when she tried to get a look at the glowing green monitor where a nurse sat pressing keys on a keyboard.

Pearl tried to gauge from the small talk whether what was turning up was ominous or just interesting. Now and then the technician would say with practiced neutrality, giving away nothing, "Fine, now would you turn just a bit farther over...that's a good girl."

A doctor in a business suit came in and without introducing himself began to add his muttering and hums to the mysteries as he stood beside the technician. Then he disappeared into the brighter light of the corridor as suddenly as he had arrived.

Pearl tried to trace his cologne, for Gerald now and then dabbed himself with it. English leather, she decided, but Gerald would never have been so goddamn rude, not even to a showroom customer who had test-driven a Rolls, then handed back the key with a wisecrack that he had just wanted a free ride.

Doctors shouldn't wear pin-stripes anyway, Pearl told herself, and they could at least say Hello. All the other staff members were dressed in white or in green scrubs, and wore standard identification tags. Pearl reflected that the doctor's lack of a nametag or hospital gown over his suit was a form of arrogance. Such a great man should be known at a glance.

Pearl was startled when the attendant bent over and wiped goo off her neck, his hand reaching somewhat lower than necessary. She sat up, taking the soggy tissue from his hand and buttoning her blouse.

"So what did you find out?" she asked, trying for a casual tone.

"The doctor will confer with you. We're not allowed to discuss findings." The technician led Pearl to the doorway, gave directions, then turned back and exchanged whispers with the technician. Pearl slowed, straining to hear. She thought of a movie called, Dead Woman Walking, then corrected herself.

The doctor of lofty status had his own little clinic, Pearl noted as she endured another reception room wait. At last the doctor ushered out a thin, trembling, red-faced man in tweeds, dropped a manila file in a plastic wall holder, and took another out. Pearl followed him into his office. The doctor spread the file on his desk and Pearl was impressed that the sonogram report was already a part of her official history.

"Where do I fall along the bell curve?" she asked.

"Bell curve?"

"The bell jar. That's what the social worker told me, something about a bell curve, where the survival rates get charted, I guess."

"Doesn't ring a bell," the doctor said, seemingly amused. He handed Pearl a paper cup and told her to drink. Then, with no warning, he began feeling her throat as she gulped. Pearl almost choked as his thumb and index finger pinched and probed. She coughed out some of the water.

"Palpating," he said. "Just once more, then we'll just do one more test."

He turned and wiped his hands with tissue. "We will inject a dye," he said, "which allows us to see how your thyroid is functioning, and if the nodules are hot or cold. It's really very simple, non-invasive. We should have skipped the sonogram. The scan is much more definitive."

"But isn't that more radiation?"

"It's an insignificant amount. The dye has a very short half-life."

"That's what they told me when they zapped my face with x-rays."

"The machines are much more efficient now. You'll get less exposure than what you got flying in from..."

"El Paso. I went through Dallas."

"Yes, Dallas. The radiation is minimal. The truth is, it wouldn't hurt a fly. It doesn't."


"Most experiments with radiation are done with flies, and they have to go through hundreds, literally hundreds, of generations before any negative outcomes prevail."

"I don't think I'm a fly."

"The point is, young lady, there's nothing to worry about. Those Hiroshima people are still alive, most of them, and there's evidence that low dosages-and yours were indeed low dosages-are beneficial. Nuclear workers-look at nuclear workers. They're healthier than your average people."

"The letter didn't make it sound like low dosages."

"All things are relative."


Pearl knew she should give up on attempts to get any honesty out of these people, and she couldn't believe either the pessimistic or the optimistic version. She knew the dosages quoted in the letter summarizing her history were massive, not trivial.

She couldn't go back and tell Gerald she had made the trip for nothing, that all she had found out was that she had some damn nodule that there was a fifty percent chance she should worry about and a fifty percent chance it wasn't worth worrying about. With another nurse, fatter, older, more doughy of face than the others but friendlier, Pearl went along for the scan without resisting, but still feeling like a prisoner. She knew anything she said in the way of protest was futile. Submission was the only option.

"When I saw that rabbit I should have known," Pearl said.

"Rabbit? What rabbit?" The nurse was startled.

"When they took me for the x-rays all those years ago, I looked through a window into a little room where a rabbit was strapped down and the poor little thing was being zapped and I asked why and the attendant said 'We're inducing cancer for an experiment.' Then we went into the same kind of room-exactly the same-and I was asked to lie down and there I was, just like the rabbit. I said 'Then why are you giving me x-rays if it's giving the rabbit cancer?' and the attendant said, 'Oh, this is a different kind. Yours is soft radiation."

"She was just helping you deal with your anxieties," the new nurse said. "The state of the art-medicine, that is-was very different thirty years ago."



"Something in me said to turn around and walk away," Pearl said. "I think I should have had enough sense to trust my intuition. Maybe I should do that now."

"Don't be silly. It's not the same situation at all. Like I say, the state of the art..."

"I should have just walked out," Pearl said. "They probably lied to the rabbit too."

"Then you'd still have your boils," the nurse said.


"Isn't that what you were treated for?"

"No, I had adolescent acne, that's all."

"At that time no one knew radiation causes cancer."

"I think you're wrong about that," Pearl said. "It was mentioned in novels way back in the twenties."

"You say it was fiction?" the nurse said. "I wouldn't believe everything I read if I were you."

In another room that reminded Pearl of Dr. Frankenstein's laboratory, she allowed herself to be strapped down and slid into a gigantic white machine as if she were a gigantic gingerbread cookie. Lying inside, she looked up as if at the faintly lit lid of a coffin. "Now just hold as still as you can," came a voice through an overhead speaker, as if coffins or baker's ovens were equipped with such devices to keep the dead in touch with the living, or baking cookies in touch with their cook creator.

A succession of strange noises began-tapping of little hammers, like toy ones, then the pounding of sledgehammers, followed by the stuttering of jackhammers, as if she had been buried beneath pavement where street work was in progress.

When the slab Pearl lay upon was pulled out, back into the brightly lit room, she was given a coupon with the good news that it would get her a free lunch in the cafeteria.

"I'd recommend a cup of tea," the nurse said. "It helps move the radioactive tracer out of your body."

"I thought there wasn't any radiation."

"Of course not, but you can't be too careful, can you?"

Pearl dressed and, as directed, returned to the main waiting room. She noticed that the black gentleman and the twins were gone, but the trembling man in tweeds was reading a magazine.

When she was summoned again, greeted with a handshake by the doctor, she tried to project a perky tone into her voice. "So do I have to get surgery or not?"

"Fortunately no, not in your case, at least at this time."

"So I can forget about it?"

"No, we'd like to check it every five years, maybe even a bit more often, to see what the growth rate is."

"How marvelous!" Pearl decided she was entitled to a bit of sarcasm.

"You don't have to do anything," the doctor ignored her rudeness. "We're grateful for your participation in our research and we hope you'll do the follow-ups. Stay in touch." He stood up, smiled, held out his hand, and had stopped smiling by the time he released her hand.

"So you stay in touch," she said.


"Nothing. It's just a damn commercial. You never heard it? So you got yourself some more data," she said. But the doctor only smiled anew for a moment as he held the door open for her.

"What's funny?" he said.

"Nothing," Pearl said. "I was just thinking."

"Don't think too much," the doctor said, his parting advice.

She thought it was good advice, but after that day Pearl felt herself set apart, as if she had joined other friends who had been victims. They loomed in her mind like gleaming portraits in a gallery, frozen in translucent shellac. She remembered Harold, who had flown to Switzerland and got himself strapped on blocks of ice, then sent to another clinic that treated him with heat, a cure called whole body hyperthermia or something like that. He had been put in a gigantic steam bath and almost roasted.

She recalled Gloria, who had gone to Mexico and taken laetrile injections, at great expense. If it's made of apricot pits why can't I just suck some, Gloria had joked.

Her classmate Bill Cavalo had died in his twenties, his girl friend Alma sliding him across the room on a pillow when he had to go the toilet, wincing from the pain. When Bill learned he was terminal, he had raced his motorcycle through busy streets, playing Russian roulette with his life. But as if the speeding motorcycle belonged to a stunt man in a movie, no cars shot out from side streets. It was as if Bill had been provided with immunity from accident, but not from the disease that brought him to his knees.

Resurrecting these friends, wandering a field between living and dead, Pearl felt unable to abandon their souls, though she had found it easy to bid goodbye, one by one, to their bodies. But shouldn't the living forget the dead, have little concern for them?

Wasn't that one of the unspoken rules that kept things running smoothly?

Maybe she didn't have cancer, Pearl thought, but people around her seemed to think she did. She noticed how they edged away from her and gave her suspicious looks. Maybe they had heard about her trip to Chicago. She realized that she had looked at friends like Gloria and Victoria and Bill just that way.

Not long after Pearl's return from Chicago, her friend Beth was diagnosed with breast cancer, but refused to take chemotherapy.

"I want to keep my own hair, you know what I mean?"

"I know what you mean," Pearl said.

"The doctor was mad at me. He says I'm being foolish, that tamoxifen or whatever they call the stuff would enhance my five year survival chance to sixty instead of forty percent."

"I think doctors are quacks," Pearl said.

"They're all quacks, aren't they?" Beth said.

"I think so," Pearl said with confidence. "That's the state of their art."

The two women broke into laughter, then couldn't stop and were wiping away tears. Pearl realized that she had never felt better, not since she had received the letter from the hospital. But she knew she would soon give in and beg her friend to take the chemo and obey all the quacks. She hoped she had left the only ones in her life behind in Chicago.

xx xx xx