Chapter 33: What Would Have to Be True
He took a fresh sheet and drew a line down the middle of it.
On the left he wrote WHAT IT COULD BE. On the right, WHAT WOULD HAVE TO BE TRUE.
I still have that sheet. He gave it to me at the end, which he did not have to do.
“Reactive airway disease,” he said. “Asthma, if you like, although at fourteen months nobody serious says the word without a question mark.”
“What would have to be true?”
“A daytime component. A response to the inhaler. A seasonal signature. Some clustering with colds.”
He looked at my sheet. “You have no daytime component at all.”
“None.”
“In six months. Two naps a day.”
“About seven hundred naps. Nothing.”
“The salbutamol.”
I said I had given it twice, in May, because he had prescribed a trial.
“And?”
“It ended when it was going to end. Forty-odd seconds both times. I cannot tell you it did anything and I would not tell you it did nothing.”
He wrote UNRESPONSIVE — INCONCLUSIVE, which is the most honest phrase anybody committed to paper that autumn.
“Laryngomalacia.”
“A floppy airway,” I said. “You would see it from birth.”
“You would see it by six weeks and it would be improving by now, not lengthening. Next.”
“Reflux.”
“Tell me what would have to be true.”
I said it would sit near feeds. It would show a pattern with the evening bottle. It would be worse laid flat and better upright.
“And?”
“He has the same bottle at half past six every night of his life. Seven nights a week.”
“Including the hundred and fifty-seven nights when nothing happened.”
“Yes.”
Obstructive sleep apnoea. Adenoids. “That would have to be nightly, or near enough,” he said. “Snoring, mouth-breathing, sweating, a particular position.”
“It does not take June off and come back in July.”
“He sleeps quietly,” I said. “He sleeps like a person who has never been worried about anything.”
Seizure. Cardiac. Foreign body.
He went through those three in about ninety seconds, and I will not pretend I followed all of it, and I have since looked up two of the words he used.
A foreign body is a once. A cardiac cause would show in the day, in feeding, in the color of him at rest.
A seizure disorder would not stay silent through nineteen episodes in front of a trained observer.
“You would have seen movement,” he said. “Would you have written it down?”
“I wrote down that his left hand was open. Nineteen times. Because you told me to write down what I saw.”
He laid the pencil across the two sheets and left it there.
“Here is my difficulty,” he said.
“Every one of those is a disease that behaves like a disease. It has a mechanism, and the mechanism is running all the time.”
“A disease does not know what day it is.”
“It does not improve when a man is in the building and worsen when he is in Texas.”
“It cannot do that. There is nothing in the body that can do that.”
He said all of it quietly. He is a quiet man and nothing about him changed.
Then he said: “Miss Carter, in eleven months of this child’s notes I have written the word asthma four times. Twice with a question mark.”
“I am not going to write it again.”
“This is not asthma.”
The clock behind him made the sound it makes on the half hour.
I had been in that room for fifty minutes, holding a paper cup I had not drunk from, and I had not been frightened once until then.
A doctor telling you a thing is not the thing is not a comfort. It is a subtraction.
“Then what is it,” I said.
“I don’t know.”
“You must have some—”
“I have a list,” he said. “It is short, everything on it is worse than asthma, and I am not going to read it out in a room at half past eight in the morning on the strength of one table.”
“Why not?”
“Because you would believe me.”
That stopped me, and I have never been able to decide whether it was kindness or method, and I have concluded that with him there was no difference.
“You are the only person who is with him at two in the morning,” he said.
“If I put an idea into you now, then every observation you make from tonight onwards is contaminated. And your observations are the entire dataset.”
“So I am going to tell you nothing, and I am going to order tests.”
He pulled the prescription pad across and uncapped the pen with his teeth, which is the only untidy thing I ever saw him do.
“And you are going to keep writing down exactly what you see, in exactly the way you have been writing it, and not one word more.”