Perspectives in Biology and Medicine

HIS MASTERS' VOICE LA WRENCE A. KOHN* When he woke, the room was light enough that in the big mirror over her dresser he could see his eyeballs were yellow; there was no doubt about it. Well, he thought, you were right last evening. How frequently, though, you've told students that one needs daylight to spot slight jaundice . There was a thud against the front door, and he padded out to start coffee and pick the rolled-up paper from a drizzle. "Showers, probably clearing by afternoon; high temperature of65 degrees." It was Thursday, and in spite ofhis dull aches he had planned to fish in the afternoon. Not now, he thought; not any more. The water boiled and he poured it through, piled cup and saucer on a tray and retreated to bed. One of the handicaps of being a doctor, he had often remarked, was that you tended to put the worst interpretation on your own symptoms. Every chest pain suggested a coronary; every arm gone to sleep a beginning stroke. But here it was, and better to have an answer than the uncertainty of formless discomforts. It wasn't, after all, that he was still depressed about losing Helen. Not thatJim had come straight out with it, but it had been in his mind. "Your autonomic continues to rebel long after your cortex has accepted." Yes, it might have been that way, but it hadn't been. He was awake now, after the second cup, and the outlines of the problem began to sharpen. These were often his best moments; many times obscure signs and symptoms in his patients had fallen into place with the morning coffee and the paper. Jaundice could be benign: hepatitis ofsome kind or even a gallstone, but forty years ofteaching and practice told him otherwise. No fever, no real pain;just weeks of discomfort, days ofslight nausea, and now the yellow proofofit. This was cancer in the liver. Well, sooner or later we all have to look straight at it: The reward is death, and not of sin alone. * Dr. Kohn's present address: 457 Park Avenue, Rochester, New York 14607. 640 Lawrence A. Kohn · His Masters' Voice Perspectives in Biology and Medicine · Summer 1967 Not that it mattered so much. Helen had died almost two years ago, but the aching hole was as wide, as deep as at the first sharp cutting. Bill and Bonnie had done their best, and so had his friends, but it hadn't filled in. He had taken young Bill, the oldest grandson, to the Laurentides and watched him take his first trout, but every familiar lake, every portage, every lonely night drying the lines had turned the knife. Medicine was a fine mistress and fishing nearly her equal, but when you are seventy you need a wife. Evening after evening he had plowed through journals, trying to finish a paper begun many years earlier, unable to play a record because it would be one they had chosen and loved together. Who wanted any more ofthat? Not that annihilation in itselfwas so attractive. This might be the last time he would savor coffee and the paper in bed, as Helen for so many years had spoiled him to do. He'd never get to show young Bill how to use a dry fly, nor take him to the Margaree. The big trout in the bend pool who had broken him promptly a week back would come to someone else's net. The little paper on blood pressure would remain unpublished. But it wasn't death that mattered; it was what would precede it, the misery one had to endure while careful and concentrated medical study was applied. He'd seen plenty ofgood men on the rack; he'd even taken a pull at the wheel when he thought it essential. X-rays and tubes and needless and carefully evasive answers; the indignities that come with surgery and the crippling that may follow it, and, finally, a crescendo ofunspoken and unanswerable despair; he know it too well. He'd seen them through it, the old and the younger ones. He'd tried to ease it for...