A Second Opinion, Chapter Four: The Devil You Know
This is chapter 4 of a serialized novella appearing on Ars Gratia Libertatis every two weeks. Â Read from the beginning here.
Chapter Four: The Devil You Know
A light dusting of snow, freshly fallen, lay across the earth outside John Morales’ window. Like an accent it highlighted the objects it covered. Edges became sharper and more visible in the stark, white landscape, as if a lens had clicked into place to bring everything into focus.
Morales gave little thought to the reasons for his sudden change of heart. Not because he was a thoughtless person, or incapable of introspection. Rather, his decision had produced such a mental contradiction that he couldn’t approach it head on. He needed to give his subconscious some time to muddle on it obliquely. It seemed to him to have happened almost spontaneously. It did not follow from the previous decisions he had made in his life. It did not conform to the pattern.
Life presents us everyday with little opportunities to be good people.Â Â The judgment of whether or not one is a good man is not made at the hour of some momentous decision, but long before, in the sum of every little choice already made. The decision at that pivotal moment is merely a reflection of the thousands of times one chose to follow the dictates of conscience, or to ignore them, in small decisions each and every day. A consequence, not a cause. We are what we habitually do.
Yet up until that week all of John’s habits had been firmly in line with the status quo. It wasn’t that he hadn’t felt bothered by certain things he’d had to do, or that certain aspects of the system hadn’t aroused in him a vague feeling of uneasiness. Instead it was that he’d come to accept such aspects as the nature of life. It had never occurred to him that this nature was mutable.
He’d seen the Fremonts three times in the last month, sneaking them in after-hours and altering the names on his patient list to gain access to the tests and machines he needed. A brain scan had shown nothing untoward in Alyssa’s skull: no cancers, aneurisms or clots, no degeneration of the nerves or damaged tissue. After first hearing Lys’s description of her daughterâ€™s symptoms he had immediately suspected Lennox-Gastaut Syndrome, a neural-degenerative disease that caused numbness, spasms/seizures, and loss of vision. But none of the telltale signs of Lennox-Gastaut Syndrome showed up in his tests or scans. Each time the pair had visited his office he’d had a new hypothesis about Alyssa’s illness, and each time it had proven false.
4th time’s the charm he thought as he waited in his office, after hours, for the two to make yet another, illegal, visit. The first few times they had come he’d felt a nervous thrill in his stomach for so flagrantly and deliberately violating the law. He thought he should feel worse about it than he did. He’d never even gotten a speeding ticket before and here he was spending hundreds of thousands of dollars of government money on two people who, for all he knew, weren’t even government citizens. He should feel bad about it, but he didn’t. Even his apprehension at the possibility of getting caught evaporated after the first couple visits. The thrill in his stomach remained, however.
This despite the fact that each visit caused him more consternation than the last. And not just because he was having such difficulty pinning down the mystery ailment that afflicted Alyssa. He had ended each of the previous three sessions deeply shaken as a result of the verbal sparring his patient and her mother seemed to revel in. Their worldview was totally alien to him, their basic assumptions about the nature of life completely different. Yet he felt a curiosity, a compulsion to understand their unshakeable beliefs and simple, yet worrisome arguments.
Each visit they seemed to pick a different topic to batter him with, though all their conversations shared some common threads. He’d never heard such views expressed beforeâ€”at least not by educated people, and certainly not with such eloquence and force. Usually these views were pilloried on the evening news as belonging to a shrinking population of bitter crazies, clinging to some anachronistic view of the country. He looked forward to it each time.
The knock at the door came exactly at 7:30, as before, and John Morales smiled. Tonight he was testing a new hypothesis; that perhaps Alyssa had Moyamoya disease, a syndrome in which certain blood vessels in the brain were constricted. To test it he’d need access to an X-ray machine to do an angiogram so he’d made sure to palm an extra copy of the lab key earlier in the day when he’d done his rounds. No one had noticed it go missing.
He opened the door and smiled again, inviting the energetic young girl and her mother inside. Alyssa was like few children he’d encountered. From the pair’s first visit when she’d so impertinently interrupted the adults’ conversation to challenge Morales, to their most recent visit when she’d eagerly pestered him about the use of every piece of machinery and doodad in the MRI/Medical Imaging room, he’d been struck by the girl’s relentless intelligence and absolute fearlessness. Hers was not the mien of a sick child being brought to the hospital.
Her mother was also a mystery. Though Morales had stopped asking her where she came from and why the pair had no official record he had not stopped trying to learn other things about her. He tried, subtly, to learn her occupation, where she’d been born, and how she’d come to have such radical ideas. So far he’d uncovered answers to none of these questions.
Alyssa swung her legs playfully from atop the examination table while Morales began prepping tests.
â€œWhat’s the purpose of life, John?â€ Lysandra broke the silence.
Morales smiled as he filled a needle, â€œWell that’s the million dollar question, isn’t it?â€
â€œI’m being serious. If you continue to live on earth you must have a reason for it.â€ She paused, â€œWhat’s the purpose of your life John?â€
He lowered his his arms for a moment and looked up at her, â€œI hadn’t really given it much thought.â€
Now it was her turn to smile, â€œNot many people do.â€
â€œUh, I guess the purpose of my life is to help people then; leave the world a better place.â€
Lysandra broke eye contact, â€œDo you like neurosurgery John?â€
â€œI…â€ he faltered.
â€œI can’t imagine anyone devoting so much time and effort, and being as good as you are at something like this without having a burning passion for the work they were pursuing.â€
â€œNo, yes I…do. Surgery is my life.â€
Her eyes watched him closely, â€œYou do, or you did?â€
Morales didn’t respond.
â€œJohn, the first law of medicine is ‘do no harm,’ but how can it be anything but harm prescribing people suboptimal procedures and tests because some bureaucrat won’t sign off on the higher cost ones? All the while giving the best treatment to the politicians and their sycophants who control your purse strings?â€
â€œLyse,â€ he broke in, â€œwe’ve been over this; I know there are problems with the current system. If I could treat every hard-working and good-hearted individual, based solely on the merits of their illness, rather than their political connections I would, but I can’t. And I don’t see how that can be changed.â€
â€œIf you could practice in a system that let you treat people based on the merits of their illness, rather than their political pull, that would be better?
â€œYes, but that system doesn’t exist.â€
â€œWhat if it did?â€ The question as she uttered it had a peculiar quality: a slight pause before the last word, her tongue resting on the â€œtâ€ sound just a little too long.
Morales hardly noticed the odd inflection but still his eyes narrowed slightly, â€œI’d have heard of it, doctors would be flocking there in droves.â€
â€œWould you? If it meant leaving your current practice and starting over?â€
â€œWell I guess that would depend on a lot of different factors, wouldn’t it?â€ Lysandra crossed her arms, waiting for an answer and Morales laughed. â€œSure, yes. As long as I didn’t have to make some deal with the devil to get there.â€
Her next words stuck with him long after the pleasant chit-chat of the rest of the night, past the administering of tests on Alyssa and his careful efforts to clean up the lab room and make it appear undisturbed for tomorrow. They stayed with him after he tiredly stumbled into bed next to an already slumbering Shelly Reyes and as he drifted towards sleep: â€œNo devil, just me.â€