It didn't matter that I knew she smoked cigarettes. Even in the absence of a medical history the sounds were unmistakable -- the faint, soft, shrill whistling sounds on inspiration, fused with the sound of two pieces of leather rubbing together. These sounds I've heard before and at each listening hope they'll be the last.
I tell her to breathe deeply, hoping they'll fade, for her sake and for those who love her. But I know they won't. And they don't.
In the same way an old song evokes a cherished forgotten memory the menacing sounds evoke memories of others who've already traveled the grim journey she's about to take. One being my father.
I relocate the stethoscope, away from the discordant sound, moving it now like some macabre treasure hunter, alert to aberrant sounds, the instrument working like a metal detector. But unlike a seeker in search of coins and jewelry, hope to find nothing. I wonder how such an attractive 59-year-old woman, looking 49, and once a finalist in her university's beauty pageant, has escaped the almost inexorable progress and appearance of the reptilian skin that many acquire from years of inhaling the nicotine and tar, even at the rate of one pack per day. I'm thinking maybe a favorable gene pool.
I return the instrument to the diseased site and ask her to pronounce the long vowel "E". She does, but I hear the letter "A" instead, confirming that a chest x-ray will almost certainly display the characteristic irregular white shadows and, most likely, mass in this area, the area of the right lower lung, a lung that if an autopsy were to be obtained today would be found by any pathologist to be as black as a starless night sky. But there will be no need for an autopsy. Her specialists in the coming months will confirm this diagnosis by biopsy, long before her statistically six months of life expectancy pass.
And when the biopsy results return she will come into the knowledge that she has worked her last year as a delegate for the Miss Universe Pageant.
I continue to listen realizing she has no knowledge her life has already changed. Changing from what she assumed would have been the simple prescribing of an anti-reflux medication for the complaint of "mild indigestion" to learning within the next two minutes that a CT chest scan, a fiberoptic bronchoscopy, and consultations with a lung and cancer specialist will be in order. Along with at least one hospitalization, probably followed at some point with the challenge of controlling her pain, and her shortness of breath to the point perhaps of needing a ventilator to delay the inevitable -- including a hospice enrollment.
I slowly fold the instrument into my coat pocket, sit down, sigh, and share with her my thoughts, what needs to be done diagnostically and what options there might be for treatment -- all made with a healthy dose of hope, along with a silent prayer.
* * * *
"The real sin against life is to abuse and destroy beauty, even one's own even more, one's own, for that has been put in our care and we are responsible for its well-being."
-- Katherine Ann Porter