Clinical, Featured, Internal Medicine, Pediatrics
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Croquet in the Tall Grass

The following manuscript was submitted to the October 2017 Complications theme issue.

The grass grows tall outside my uncle’s home — he only cuts it when we play croquet. He blazes a crisscrossing trail through the sea of weeds to form a maze-like playing field. We push the white wickets into the earth, grab the mallets, and drop the balls to the ground.

A gentleman’s game ours is not — it is a treacherous family affair. He steps on my ball. I kick his ball into the brush. He gouges divots into the ground in front of me. I throw sticks in his path. We chide each other and cry foul to my aunt, whose laughter drifts over from the rope hammock that creaks between oak trees.

My uncle always wears the same thing: a black ribbed A-shirt tucked into faded black jeans. Tall and tan, he keeps his hair slicked back above a toothy grin. His chest and arms, broad and powerful, speak to his work as an inventor of exercise equipment. Playing croquet, he looks like a superhero with a toy hammer.

Early in medical school, my mother calls to check on me. She updates me on family news including an aside about my uncle: he’s coughing and thinks he has pertussis. A year passes and the story replays: still coughing — pertussis again. He should see his doctor, I say. Oh, he hasn’t seen a doctor in years, she replies.

And to my shame, I leave it at that.

Over the following months his appetite wanes, his energy fades, and the cough persists like the bell of a distant alarm. He eventually finds himself lying on his back in the CT scanner of a community hospital. The doctor says there is a mass — the size of a small loaf of bread. It might be a simple cyst, but it could be cancer. The doctor keeps talking, but I doubt my uncle hears anything else.

Rooted high in the abdomen, the tumor triggers his cough by irritating the diaphragm above. Although my uncle misdiagnoses himself with pertussis, his description is not incorrect. Pertussis, commonly known as whooping cough, comes from the Latin roots per, meaning intense or thorough, and tussis, meaning cough. But pertussis lasts for weeks to months, not more. My failure to appreciate this distinction means missing the chronicity of his symptoms. Making the connection would not have immediately led to the correct diagnosis, but it would have been enough to recognize the wrong one. Although the error is subtle, I struggle with a sense of blame. Later, as a resident, this burden metastasizes into fear: what if I make the same mistake as a doctor?

My uncle agrees to the recommended intervention: resection. The surgeon opens my uncle’s belly and eyes the smoldering mass, caught in the light for the first time like a deep-sea monster. The tumor balloons into the abdomen and envelops the adjacent vasculature. Another surgeon looks in and shakes his head: there is nothing to do. We soon learn that chemotherapy and radiation will not help. In sum, medicine has little to offer my uncle apart from symptomatic care. He goes home with a single scar, a mark of the battle that ends before it begins.

Though rare, the untreatable diagnosis is one of medicine’s most frustrating complications. Years spent studying and training feel inadequate. Medicine’s extensive resources seem limited. Desperate, I search for any last way to intervene: experimental trials to slow the course, novel therapies to thwart his decline. But sometimes it does not matter how much the players try to cheat — the game is already rigged.

I drive to my uncle’s old home. The tall grass spreads past the trees to where the house once stood. The grass bends in the wind, forming a crisscrossing pattern that reminds me of our croquet games. I imagine the faded wickets hidden in the field, still propped in the dirt. Observing the quiet scene, I think about how this place has changed and how it has changed me.

Image credit: Croquet by Meagan licensed under CC BY 2.0.

Matt Lorenz, MD Matt Lorenz, MD (1 Posts)

Resident Physician Contributing Writer

Brown University

Matt is an internal medicine-pediatrics resident at Brown University in Providence, Rhode Island. A former teacher in Spain, he is passionate about issues related to global health and medical education. He grew up in Tennessee, but his adopted home lies in Andalucía.