I don’t usually get to do kids. I don’t know why. Kids are just as fragile as their parents, after all – even more so, maybe, the way they fling themselves at the world so hard as if nothing is going to break them.
I suppose, with kids, some find it hard to be dispassionate. Adults, I think, generally respond well to calm frankness, even when the news is bad, especially when the news is bad. Because when they’re faced with mortality, they don’t want it clouded by hysteria. They don’t want my sympathy. I’ll say ‘I’m sorry’, but it’s a matter of form, it acts as a sort of verbal stepping stone between the verdict and the inevitable questions that follow: the how long untils, the will it hurts, the is there anything to be dones? And there’s panic, I’m sure, but all that comes after, that’s nothing to do with me; if I’m calm, then they’re calm, and I believe that they’re grateful for that, and the moment I pass judgment and sentence them to death I treat them like equals, I give them the illusion we’re all in this together. And in that togetherness, as we seem to collude against the illness and the suffering to come, I’ve surprised them, I’ve shown them how dignified they can be. And that dignity is something they can look back on and aspire to in the darker days ahead.
Kids don’t do that. Kids are unpredictable. Some cry, some call for their parents (because their parents can fix everything), some ignore me altogether and stare out of the window, stare down at their socks. Sometimes they laugh. They even laugh. What’s up with that?
I know people who say there is no greater tragedy than the death of a child, and some of them are even quite intelligent, some even quite good doctors. They talk about all that wasted potential. I, respectfully, disagree. I see only people who haven’t done anything yet. I would far rather mourn an elderly man, say, who has spent a lifetime learning through experience and achievement – just think how much further he could have gone! The cure for cancer isn’t going to be discovered by a twelve year old, it’ll be discovered by an adult long in the tooth with the weight of years on his shoulders, by an adult lucky enough to get as clever as he can be and not be felled by some silly disease or another along the way. I suppose it’s just a different way of looking at it. I can’t mourn a child. It’d be like mourning an embryo or a pupa. I don’t mourn the elderly, I must admit. I don’t mourn anyone. But I would mourn the elderly, I think, in principle.
And when I first met Steve Herbert I saw nothing to be impressed by. He had flung himself hard against the world, he’d had an accident on his bicycle, or scooter, or some such thing, and the accident no doubt had been his fault, and there he was in the emergency room grinning from ear to ear like it was all some big adventure. I suppose it was, at that; his whole body had been X-rayed to check for broken bones, and I imagine the sort of kid who gets his kicks from scooters is probably one who’d get kicks from X-ray machines too. There were no bones broken, he’d escaped with bruising. I didn’t know why I’d been called in to look. Nurse Johnson showed me the X-rays; she didn’t tell me what else they had found during the examination, she said she’d let me see for myself. And then she looked on, hopefully, as if I would tell her that she was wrong, as if my second opinion could make everything bad go away.
At first I didn’t think it was a real cockroach. For a start, cockroaches aren’t as big as that – certainly not in this country, at any rate. And secondly, how had it got inside? The kid couldn’t have swallowed it, he’d have choked. I assumed it must be some strange growth on the heart that just looked like a cockroach. But then I checked against successive X-rays and I could see that the wings had moved, that the mandibles had flexed somewhat – this was a giant cockroach, about the size of my fist, and it was clinging on hard to the boy’s pericardium, its wings obscuring the whole of the right auricle, its pincers piercing both of the atria. And it was alive.
I asked the boy whether he’d noticed any discomfort in his chest. He told me he didn’t, much; sometimes, if he went running, he’d get out of breath, he’d start wheezing; recently, if he lay in bed on one side for too long, he’d have the same problem. But there was no discomfort, really; certainly, no pain. I told him I was surprised. That there was a large hostile parasite fixed fast to his insides that was lacerating his vital organs. That I had never seen such a thing before, and wasn’t sure there was much I could do about it, and the chances were he was going to die.
He didn’t cry. I’ll give him that. He didn’t ignore me, and he didn’t laugh. Nurse Johnson said his parents had been called for, and I asked Steve Herbert whether he’d rather wait until they got to the hospital before we discussed the matter further, and he thought about it, and he said that he would.
As I say, I don’t usually get to do kids.
His parents were dreadful. The calm frankness didn’t work on them at all, it was tears and pleading right from the start. And I recognised the type, too; had I been telling either of them they were the ones about to die, they’d have been as dignified as could be, they’d have kept all that fear bottled up for form’s sake. But for their child, though, they just couldn’t rein the emotions in. The mother began to sob, and it was quiet enough, but somehow all the more irritating for that, all the more embarrassing – and the father kept on saying, “But why Steve? It should be one of us! Why isn’t it one of us?” And, privately, I agreed. If only it had been, everything would have been so much less dramatic.
I admired the boy. He was patient with them both. He took his mother’s hand and squeezed it. To his father he said, “I’m sure the doctor will do his very best.” I said I would.
The parents calmed enough that I could run them through the various options available. We could put Steve on a course of radiotherapy, and try to kill the cockroach with radiation. Or there were various drugs we could administer with chemo. Both treatments would have side effects, of course – we could attack the cells of the invading pest, but inevitably some healthy cells belonging to the patient would be destroyed as well. Or we could try direct surgery, but I pointed out that there were severe risks to that – from the pictures we could see that the roach had punctured the heart in several places and the tissue had actually grown over it, and that pulling the creature free might cause extensive damage, that ironically it might be the very presence of the insect keeping Steve alive, blocking his wounds, keeping the heart beating – “Rip it out of him!” the mother positively snarled, “just get that fucking thing out of my son!” And the father nodded, and the boy shrugged assent, and that was that.
Before the operation I read up on insect anatomy, and it didn’t take long; they really are remarkably simple creatures. I had removed all sorts of lumps and bumps from inside people’s chests, but I had never performed a dictyoptectomy before – I saw no reason to tell the Herbert family that. We opened up the chest, and there was the cockroach, bigger than I’d even expected, it had wrapped itself right around the heart and now that it was exposed to the light it unfurled itself, and opened its wings wide, and quivered. I had no desire to harm the cockroach, but it wasn’t my patient. I cut through its legs with a laser scalpel, until I felt the insect had loosened its grip sufficiently so I could lift off the bulk of it without much force – still, though, it found a way to cling firm, it hugged into the heart with an obstinacy that seemed almost possessive, and when at last I managed to pull it free it came out with a sick sucking sound. Then I had to remove the leg stumps that were still embedded in the myocardial layer; I had not appreciated how deeply the cockroach had punctured the heart until I pulled that first stump with a pair of forceps – out it came, long and sharp and wet, and quivering still, as if there was life in it yet, as if this weren’t just some reflex action. The holes that had been gouged in the heart now seemed big and black, but there was no blood, and for all the tissue damage I hoped that they might heal and that young Steve might affect a full recovery.
Steve was very proud of the new stitches on his chest. He called them his war wounds, and said he couldn’t wait to show them off to his schoolfriends. The skin was swollen and enflamed, and I could tell it must be sore, but the boy was having none of it, he told me he felt fine, he thanked me for all my hard work. The parents demanded to know whether their son was cured now, whether he was going to be all right, and I told them I didn’t know. He’d have to come back in a week so we could X-ray him and find out. The parents looked sulky and betrayed. Steve gave me a smile and said he would look forward to it.
I was annoyed that Steve brought his parents back for the consultation, but he was only twelve, and I suppose he needed someone to drive him. I showed them all the X-ray. “That,” I said, “is what I was hoping not to see.” I explained that we had tried to remove the whole cockroach, but it seemed we’d been unsuccessful – part of the insect had been left behind. And now the pictures clearly showed that what looked like hairy twigs were poking out of the gashes in Steve’s heart; one of the legs had grown back so fast that it had even begun to taper out at the end into some sort of carapace. In only a week we could see that the cockroach was rebuilding itself, and at this speed I didn’t doubt it’d be at its full size once more by the end of the month.
I pointed out the positives. The heart was still basically healthy; if it weren’t, the cockroach would have no means for sustaining itself. The shock of the operation alone would have caused a weaker heart to fail, but Steve’s was strong, and that could only be a good thing for the long battle ahead of us. Mrs Herbert cried again, of course; she didn’t like the use of that word, ‘battle’.
We bombarded the cockroach with radiation, but if anything it seemed to thrive beneath it; it grew at still greater speed, and even under X-ray I could see how its body glowed with a new smooth sheen. I had read, of course, that a roach could outsit a nuclear war, but I had still hoped that a concentrated blast would have been too much for it. We pumped it full of poisons, some of them highly experimental, and the roach seemed only to get fatter. It seemed to me that with each X-ray it gazed out with even greater triumph; it was fine; it was sitting pretty; it would squat in its new found home forever. Steve wasn’t doing as well. His hair fell out, and his skin got pasty and paper thin. I asked him if he was in much pain, and he would smile at me, and I could see that his gums were bleeding, and he assured me it was nothing he couldn’t handle. I could see it wasn’t true. He’d make jokes with me, one time he said his veins must be more acid now than blood, and he laughed, and when he did so he couldn’t help it, I saw he winced terribly with the effort. He told me, when I pressed him, that he threw up a lot. That was the worst thing. He hated all that throwing up. He hated all the mess. He hated being a burden on his parents. They had enough to worry about already.
One day I had to tell Steve that we’d failed. There was nothing more I could do for him. We would have to let nature take its course. The parents wept, both of them this time; both got angry. Steve hugged them, and told them it was going to be all right. He told them that he’d grown to love his cockroach. When he tried to sleep at night he could hear it hissing to him, deep inside; he thought it was trying to encourage him on, or just trying to communicate; he thought maybe it was lonely too, and confused, and just wanted to have a friend. He said it was all right. The cockroach was a part of him now, and he called it Tony. Steve said, “Please, I want to speak to the doctor alone.” His parents left.
He said to me, “Don’t feel too bad, Doc.” And I wanted to tell him he was mistaken, I didn’t feel bad at all, this was the sort of thing I did every day. But my eyes were brimming with tears. I told him I was so sorry. Had it been a giant housefly on his heart, or some sort of woodlouse perhaps, then we’d have beaten the bugger, I was sure. But cockroaches are such tenacious beasts. He said, “We did our best, didn’t we?” And he offered me his hand, and kids never offer you their hand, and I accepted it, and he shook mine, strong and hard. “You take care now,” he said to me.
I never saw Steve Herbert again. And I like to think that maybe he’s still all right. Maybe he found a way to coexist with that cockroach perfectly happily. Maybe the two of them are out there, and both thriving. I suppose that’s unlikely.
I went back home that night, and my wife said to me, what’s wrong? She can read me like a book. And I said that nothing was wrong, on the contrary. I told her that I’d been thinking it through, and I’d decided we should have a kid. I wanted to have a kid. I wanted a kid who was just like Steve Herbert, who was the bravest kid I’d ever known. I thought my wife would be happy. When we’d first got married it was the biggest problem, for a while I thought she’d divorce me over it. She’d wanted a baby, I didn’t. I didn’t see the point of them. “I see the point of them now,” I said. But she told me it was too late. She’d got used to the marriage we had already, she’d grown to like the compromise, she had made it work for her. I couldn’t now just come along and open up wounds that had healed over. It was too late. She told me, you can’t meet one brave child and assume all children are going to be brave, it doesn’t work like that. Any more than it had when I’d met children I’d despised, and had assumed ours would be a child too I would despise. That’s not what people are, she said, you can’t predict them. I begged. I actually begged. “Please let me have a brave little boy,” I said. And she said she was too old now, anyway; she was forty-five; I was a doctor, didn’t I know that the chance of birth defects rose substantially in older mothers? And I wanted to tell her that’s what I had wanted. I wanted a child with birth defects. I wanted my wife to drink a lot whilst pregnant, and smoke, even though she didn’t smoke already, maybe she could start? I wanted a child who would be brave. I wanted a child who would grow up needing to be brave.
I said I never saw Steve Herbert again, and that’s true. I did phone his house a couple of times. He didn’t answer, once it was his mother, the other his dad. I didn’t want to ask how their son was, I thought that would be impertinent, it wouldn’t suggest quite the right level of dispassion. I didn’t say anything and waited until they got cross and hung up, and then I put the phone down. Oh, and one time I parked outside his house. I was a little drunk, I think, and I sat in the car and waited to see whether he’d come out. And then I realised it was late and he’d probably be asleep, he was only a little kid, so I thought I’d wait there til morning, I’d wait until he left the house to go to school. I just wanted to make sure he was all right. I wouldn’t have even spoken to him, probably. But in the morning he didn’t come out. And that doesn’t mean anything, he might not have had school that day, it might have been the holidays, I don’t know when school holidays are.
Over the next couple of years I had three more patients who had cockroaches on their hearts. They were all adults, they’d lived their lives, one of them was an old man, what was he still hanging on for? They were all very upset when I broke the news. None of them had cockroaches even half the size of Steve Herbert’s cockroach, I told them, what they had was nothing; I once met a twelve year old with a cockroach who was twice as brave as you! They didn’t take much comfort from this, they were scared like little babies, and, to be fair to them, not a one of them survived the surgery.
My time will come. Of course it will, and for all my experience, I have no idea what to expect. I’ll be there with some doctor, and he’ll ask me to sit down because it’s always better to hear about death if you’re sitting down, and he’ll be the one to break the news to me, and he’ll be dispassionate, I suppose. He’ll show me the X-ray, and maybe I’ll look at my own cankered innards with the same detachment I felt for everybody else’s, maybe I’ll assess my own chances for survival with calm frankness. I now know how to behave. I’ll behave like Steve Herbert. Steve Herbert has shown me the way. And I want a cockroach. No, I want two cockroaches. I want to do better than Steve Herbert. He was only a kid, I have to be better. I want two cockroaches, and they’ll be nestled around my heart, one each side, my heart will be enveloped between their embrace, maybe they’ll be spooning? No. I want an egg, I want to see on the X-ray a big white egg, my heart has gone altogether and what’s hanging there is just this egg, and it’s starting to crack, you can see it’s already hatching, and maybe, maybe, from the crack you can glimpse the odd leg wriggle out towards life and freedom. I want to hatch a dozen cockroaches, more. I’ll be a father after all. And I’ll listen to the doctor deliver the judgment with dispassion, always such dispassion, and I’ll thank him, and explain to him why I think in this instance further treatment would be unnecessary. And I’ll phone my wife, and tell her the good news.