By Geologic Standards

Paul had to agree that Death Valley was not a likely choice for a getaway.  His clinic staff were surprised that he planned to spend the weekend there, but he could live with their teasing for now. Years before, he and his wife, Marsha, had done some hiking there with a Smithsonian tour group and found it oddly peaceful and haunting. They’d always intended to go back. Not in mid-summer of course but now in late winter when temperatures would be comfortably warm. And after the recent heavy rains, the desert flowers might even be in bloom.

More pressing were the practical problems of extricating himself from the office in time for the flight. Twenty years into his practice, he knew very well that any plan to leave town virtually ensured last minute crises of all sorts. A favorite patient would decompensate. Something in the mail would require urgent action. A work-in patient with a supposedly simple problem would need lavish amounts of time. It never failed.

So today had come as no surprise to him. He managed the usual crush of prescription refills and phone calls. But there was that one patient booked for a routine appointment who was anything but routine. Lois was herself a physician with whom he occasionally had professional contact, but she was not a close friend. When he’d asked about any new concerns since the last exam, she mentioned nothing out of the ordinary. He helped her up onto the examining table. His nurse was checking supplies in the corner of the room. Paul began to examine her. Vital signs, heart, lungs, were all unremarkable. But in her left breast he found unmistakable coarsening of her skin and a hard irregular mass. As he re-examined it, establishing its margins as best he could, he watched her face. She stared at the ceiling, not reacting in any way. He progressed to palpating her axilla and neck and then the right breast, all of which were fine. He glanced at her face every few seconds as he moved through the exam, but her expression was utterly neutral.

“Lois,” he said, “tell me about this.”

“About what?”

“Well, this mass in your left breast. Surely you’ve noticed it. Haven’t you been worried?”

“Not really.”

“Why didn’t you mention it to me?”

“Well, I was waiting to see if you would say anything about it.”

“Lois, you must have some idea what this could be.”

“Maybe a cyst, I suppose.”

Paul had seen people act like this, people who were naïve and uneducated, but he did not expect this reaction from another physician. The scene reminded him of times when a bird or a mouse had become trapped in his house. Such a tiny and familiar creature would suddenly seem so alien and unpredictable. Lois, normally a reasonable person, suddenly seemed alien too. He saw no rational way that she could believe this mass was a cyst. Maybe at first, but not now. She must have been letting it grow for some time without doing anything.

He asked Lois whether her husband Tom was aware of this.

“No, I haven’t mentioned it to him.”

“Hasn’t he noticed it?”

“No,” she said, revealing nothing further.

He looked over at his nurse, who shrugged her shoulders ever so slightly.

Paul finished his exam and then moved aside to begin his note. His nurse helped Lois with her clothes. He listened, eavesdropping really, hoping their small talk might reveal something more. It did not. He rolled his chair closer to her again. Being as gentle as he could, he deliberately avoided cornering her in any way. He told her the mass could be a cyst as she said, but just in case, they should make some pictures. Not now, she said. She was about to leave on a trip. He pressed a bit, saying that they might want to get moving on this. She would think about it and get back to him. He asked that she bring her husband next time. He offered to call her husband, and then immediately knew that was a misstep. But he was uncomfortable that her husband had no part in this. He made sure to write a thorough note to document everything. He scheduled a follow-up, hoping she might be thinking more clearly a week from now. It was the best he could do. Though distracted by this all the rest of the day, he was able to keep on schedule and made it out of the office in time to meet Marsha.

Once they were checked in at the airport, they sat quietly without much conversation. This had become their custom. Since conversation was difficult at best and never private there anyhow, they welcomed the clamor of the airport as a means to distance themselves from their routines. Even once seated on the plane they were quiet. Free of the need to maintain that respectful distance one does with a stranger, they leaned against each other inconspicuously but with intent and pleasure. They held off on drinks. That would come later at the hotel once they were settled in. Paul was grateful for these routines which suited him especially well on this trip, when scenes from the office were lodged so stubbornly in his head.

Once they’d arrived there, Death Valley did not disappoint. Just as they remembered, the valley spreading out for miles made everything else seem trivial by comparison. Their wine and dinner pleased them. Being back at Forest Creek Inn, they found memories of their previous tour more vivid than they’d expected. They reminisced about that, but they were glad there was no group this time. Just themselves. Paul wanted to do some hiking but nothing too ambitious. Hiking without a guide was risky even in cool weather. It still was Death Valley after all. Marsha wanted to see Golden Canyon again, but never having used the pool last time, she wanted to indulge herself there. Paul would still have time to himself. A good thing, he felt.

They stood out on the patio for a while after dinner. There seemed to be even more stars than last time. Then they headed to their room and to bed. Too tired for sex, they simply curled up together. Paul’s hand rested on Marsha’s breast as she fell asleep. He found it difficult to sleep and was annoyed that thoughts about Lois intruded again. Especially that her husband didn’t know about that mass. He knew that some married couples didn’t have sex very often. He could imagine that some men thought of a woman’s breasts only as means to an end. As for himself, he probably had been cursory and inattentive in foreplay at times.  But would he fail to notice a mass like that in Marsha’s breast? He smiled remembering a girl he had dated in medical school who’d once asked him if he thought about anatomy and physiology when he made love. He had assured her he thought of no such thing. Not then. Not now. But surely he would notice a mass of that size. Or Marsha would bring it to his attention, he thought. He hoped. Lois on the other hand was very evasive and so flat emotionally. But by coming to the appointment and allowing herself to be examined, wasn’t she asking for help?  It wasn’t clear what she wanted, really. Why couldn’t she have been more forthright?

Of course, from the time they’re young girls, women learn to keep things from view, he thought. They keep their menstrual cycle private. Some keep their pregnancies secret for months, sometimes even to term. Not to mention having abortions in secret. Suffering abuse of all kinds for years. How many stories he had heard about those things.  But why would Lois purposefully keep this problem from her husband? What kind of marriage was this? Paul didn’t know Lois’ husband very well, but surely he would have been a support for her. And how was he going to feel being the last to know? Over the course of the day, Paul had grown more annoyed about having been set up to find the tumor on his own, too. What was that about? Was she doing the same with Tom, her husband, dropping hints, testing him somehow? How could a sophisticated woman behave like this? Enough. He was on vacation now.

When Paul and Marsha set out the next morning, their hunch about the flowers proved right. There were broad stretches of brilliant yellow blooms along the roads. They stopped to take pictures, too many maybe, enjoying the luxury of an unscheduled day. With some effort they remembered the way to Dante’s Peak and then headed back to the Golden Canyon. They passed the sign reminding them that they were 282 feet below sea level. A strange concept, especially so far from the ocean, but somehow it created a vague sense of peril. The canyon was as beautiful as they remembered, tempting them to walk farther into it than they had planned. While they could still see their way back, they re-traced their steps and then stopped for lunch over at the Ranch. Paul was reminded that there was a golf course there. On his first trip, the idea of playing golf in Death Valley seemed improbable and even comic. But today it seemed faintly irreverent, disrespectful of the hardships people had suffered there over the years. He wasn’t exactly in a playful mood yet.

After lunch, he left Marsha at the pool for the afternoon and took off to explore more of the valley.  On the tour, he had developed an interest in the geology of Death Valley. Geology was new to him. Their guide had been an enthusiastic teacher, even if a little theatrical at time, pulling out a vial of hydrochloric acid to test a chunk of rock every so often. Driving along today, he saw the vast depositions of salts and remembered the feel of them underfoot at Badlands and Devil’s Golf Course. Today rocky things only reminded him of calcifications in tumors like Lois’ mass, which he was still struggling to get off his mind. For that matter, all the geologic trivia he remembered today seemed to connect to medical things, in loose and bizarre ways. He dwelled on the opportunism of the plants and animals in Death Valley, which reminded him of how opportunistic cancer cells are too. So tenacious and adaptable. Such will to live. Would Lois or her cancer have the greater will to live?  Even these flowers blooming so prodigiously right now seemed to remind him of Lois. He knew that the flowers had seeds that lay dormant for years, blooming only when there was sufficient rain. Cancers lie dormant for years, too. What provokes their perverse blooming? What if Lois had brain metastases, already, one in her frontal lobe making her act so bizarrely? That was a scary thought. Good that he’d scheduled the follow-up appointment. Maybe she was depressed and immobilized by that. Or was she deliberately refusing therapy in order to avoid the scramble of chemo and radiation, all the disruption and choreography of being a cancer patient? He could envision situations in which he would decline treatment too. Maybe in that way he was not so different from Lois. Knowing what’s involved, he had to admit that sometimes refusing treatment makes sense. Were physicians like stock brokers who pitch investments to prospective buyers, but then admit that they don’t own them personally?

He was headed out to the flats. On his first trip he had been intrigued by stories of “the moving rocks,” but they’d never made it out there to see them. Reportedly, individual rocks move, etching obvious trails in the mud behind them as they go. No one sees the rocks move. When he got to the flats, small clusters of people were looking intently at the “moving rocks,” maybe hoping to see one move, he supposed.  At this time of day, the sun was backlighting the flats, clearly showing the little trails behind the rocks. Paul was impressed yet at a loss to understand it. At least he wasn’t finding any connection to breast cancer here.

He took his time driving back to the inn where he found Marsha swimming. Their dinner reservation was for the second seating, so they lingered by the pool, had a drink and watched the sun set before going to their room to change for dinner. They were in good spirits. The pace of the day had been slow. Life seemed good, even if short by geologic standards.  The sense of time here was stark and inescapable. Death Valley delivered a certain icy shock. Like watching someone die, Paul thought. Watching someone die was still sobering for him. As much as he hated it, he secretly thought it was good to confront death in his work. It reminded him not to take things for granted. Being here had the same effect.

After dinner, they watched the stars again for a while, and even saw some falling stars.
In bed later, they kissed and held each other a while. They could have made love, but Paul begged off.  He was holding her in his arms, more companionably than passionately. Marsha asked what was wrong and he assured her he was fine. He apologized for being distracted. No need to spell out the details, but he said that there was something he wanted to ask her.

“If you found something that you thought might mean trouble, like a lump somewhere, would you tell me?  Would you show it to me?”

“What are you talking about?”

“Like if you found a lump in your breast.”

“Well, of course I would. Why wouldn’t I?”

“I don’t know. I suppose you would. I just wondered. Sometimes people might not tell each other.  But I would want to know.”

“Of course. What’s making you think these morbid thoughts?”

“I don’t know. Maybe being so far below sea level.”

They both laughed.

“We won’t come back here again if it’s going to make you morbid.”

“I’m not morbid. I’m just silly. Hug me.”

So she did. Paul grew calmer. Maybe it was silly to have asked her that. Maybe there had been no need, but he felt better for having done so. Marsha lay quietly. She began to trace little circles randomly across his back and shoulders, an old trick of hers to help him sleep. He felt himself drifting off. He pictured rocks making their way across the desert in the dark, leaving their wobbly trails behind, somehow.