V. Amod Saxena

Presented to the Chicago Literary Club

March 27, 2006

Copyright © 2006

V. Amod Saxena

I met her early 1970s, in the hospital library. I had gone there one morning to look up an article for a lecture I was to give that afternoon. The place was quiet. There, I saw Ona Dangus, an internist at the hospital standing between two rows of tall bookshelves. She was reading a medical journal with a red cover. As soon as she saw me, she put the journal back on the shelf and gave me a smile.

“Are you our new cancer doctor?” She asked.

She was petite and wore a loose white lab-coat that seemed to cover her entire body from her shoulders to her knees. She had dark brown hair peppered with silver gray. She had kept her hair short that accented her large medium brown eyes. The skin of her face had a soft texture that seemed to shine in the artificial light in the room. I thought that she was probably in her mid fifties. The half-moon reading glasses rested on tip of her short and pointed nose. There was a small black mole on her left temple. She seemed kindly, gentle and friendly.

“Dr. Dangus, I have heard about you. Yes, I joined the hospital last week.” I replied. I shyly extended my right hand forwards to shake hers. She took my hand with both of hers and gripped it firmly.

“Welcome to the hospital! We need you here. I almost called you last night about one of my patients.” She said.

Ona had grown up in Lithuania and had immigrated to Chicago in 1940. Ona was then fifteen years old. She spoke little English. Ona’s own parents had died during the war. In Chicago, she lived with one of her uncles from the old country. She took a job with a Lithuanian physician who hired her as his office help. His office was located at the corner of 29th street and Cicero Avenue. The job helped her get through high school and into college.

Ona’s uncle Egon and his wife Dorothy had no children of their own. Egon had come to Chicago in the thirties, also from Lithuania. They took Ona in their home and treated her as their own “daughter”. She never got tired of telling me about them. During the Second World War Egon was drafted in the army. In Germany, he lost his left arm from a grenade attack. After his return from war, he set up a small shop selling auto parts. Dorothy worked as a kindergarten teacher. Slowly they saved enough money so he could sell his shop and start working for a small tool and die factory owned by a German engineer. In three years, the owner promoted him to be the supervisor in the factory. With no children of their own, they regarded themselves very fortunate to have Ona live with them.

When the owner of the factory died suddenly one day, his widow asked Egon to manage the business. Finally, he bought her out and became a proud owner of the company. He was convinced that his success was due to Ona presence in his home. She brought him luck, he would often say. Every evening, he would go in Ona’s room on his return from work and spend time just being with her, talking and comparing their days’ activities. This was the most precious time together for both of them.

Ona continued to work for the physician and enjoyed her job. She would clean the place every day and help the doctor in his office. There was no other employee in the office. Between the doctor and Ona, the patients received their medical care. Ona had even learnt to take blood pressure and blood and urine samples. There was also an X-ray machine that the doctor operated himself. Soon, Ona learnt to operate the machine also. When the doctor was busy, she would take X-ray pictures of his patients. Often, he would do fluoroscopy on his patients with suspected tuberculosis. She would help set up the patient behind the screen and together, they would look at their chest. Live anatomy of the patients under the X-rays intrigued Ona. The ribs, the spine and the motion of heart and lung behind the screen fascinated her. She enjoyed watching the dance of the arteries and veins.

She too wanted to be a physician. She loved her work, loved to talk to patients and felt deep satisfaction in helping people. After majoring in European history, she entered a medical school in Chicago. She was the only woman in her class. She found this very challenging and on several occasions, she thought of giving up medical school and become a nurse. Her uncle, now a successful tool and dye maker, was totally against her idea of quitting medical school. He knew her interest to be a doctor and kept encouraging her to continue. Often, he threatened to put her to work at his plant if she did not stay at the medical school. The idea of working in the factory repelled her. She hated grinding, polishing and handling acid and other chemicals. She finally decided to stay in medical school and graduated in top third of her class.

She completed residency training in internal medicine at a local German hospital in southeast side of Chicago. Early in the last century, a group of German immigrants had started this hospital. It served many poor people in Chicago’s Southside. She liked the hospital, its mission and the staff of the hospital. Thus, after completing her training, she joined this hospital as a staff doctor. Thus, Dr. Dangus began her medical practice. There, she slowly gained patients and made a name for herself as a caring and competent doctor. In the beginning, she would see only women patients. The men did not want to go to a woman doctor. Later, the women began to bring their sick husbands and children to see Ona. Often, when they got sick they asked their wives to call Ona for her advice. Soon, her patients developed a close bond with her.

Once, a loud knock at her door in the middle of night woke her up. When she looked outside, she saw a woman in her nightgown standing there pleading to see her. She immediately recognized her as one of her patients. Apparently, earlier that night, her husband, while drunk, beat her and gave her a black eye. She came to Ona for help. She invited the woman in, kept her in her own house for two weeks, and nursed her. Her husband, one evening came to Ona’s office complaining of chest pain. The man had lost weight and looked drained. He had not eaten well and had trouble sleeping. Ona found nothing physically wrong with him. She then enquired about his wife; he broke down and cried. Ona did not tell him the whereabouts of his wife. It was only after he promised that he would never raise his hands on his wife again that she offered her services to help find his wife. And so she did.

In 1944, Ona met a young man named John Kagan. He had gone to a law school but could not find work as a lawyer. He lived in the neighborhood. He did odd jobs to keep himself busy and earn a little money. He wanted to be a successful lawyer and someday a judge. He was tall and athletic with dark hair and tanned skin. He usually dressed himself in a dark suite, a starched white shirt and a bow tie. One could see him often walking in the neighborhood. One day he saw Ona carrying heavy bags of grocery. He offered his help to carry them to her home. She was immediately attracted to his looks. His kindness overwhelmed her. They began to spend time together, walking hand in hand, shopping and attending the neighborhood German church. They both loved baseball and often went to Comiskey Park to see the White Sox play. In late summer, they got married in a simple church ceremony.

While Ona was busy, starting her medical practice, John, still without regular work, helped her set her clinic. Ona often teased him about his bow tie. She told him that his bow tie was a distraction that prevented him from getting a job. One day, John met an old woman who complained that her landlord was giving her trouble. He had an offer of a larger monthly rent for his apartment and thus wanted to evict the woman on some false pretense. She had no place to go if evicted. John offered to represent her free of cost. He convinced the owner to let the woman stay in her apartment. The word of the incident got out and thus, John started his law practice. Soon Ona and her husband had a busy practice. They had three daughters soon after that.

My friendship with Ona grew. I found her a gentle, caring and hard working physician. She also loved to read, mostly books on European history. John was quiet but nor introverted. I never saw them argue. I spent a lot of time with her and her family. I witnessed her daughters grow up to be young women. The family included me in most important family events. My own life was going on peacefully with a busy medical practice and teaching. Often, Ona would try to match me with some of her friends or their friends but without much success.

One morning in 1982, I was leisurely walking to the hospital. It was beautiful day in early spring. The sun was bright and warm with the high-pressure front that had stayed on for several days over the Chicago sky. The humidity was low and morning was pleasantly warm. As I entered the main hospital, I heard my name overhead. The operator was paging me for an emergency. I picked up the hospital phone and called the operator. She said that they needed me immediately on the seventh floor of the hospital. This was a medical floor.

When I reached the floor, they were putting Ona on a hospital bed. Several doctors and nurses surrounded her. She had intravenous drip running in her left arm. Electrocardiogram wires were attached to her chest and legs. She seemed awake but quiet. I walked quickly towards her, touched her forehead, and felt her pulse to see if she was all right. She smiled and told me that every thing was fine. She just had a little dizziness and they were making a big fuss about nothing.

That morning, she had just started round of her patients in the hospital. One of the senior nurses was with her. Since she was a hesitant teacher, only a few resident doctors went with her on these rounds. On these rounds, Ona was forbearing with her patients. She would walk in the room and sit down before asking about their condition. She spent considerable time talking to them about their family, the neighborhood and other things that did not always had any connection to their medical condition. The young residents resented this as just a waste of their time.However, the patients looked forwards to this visit every day.

This morning, Ona had just finished talking to one of her patients, an obese woman with diabetes and high blood pressure. She gave her a stern advice about her diet. She was now giving her a home tried recipe for losing weight when, suddenly she felt strange light-headedness. She felt her whole body being suspended in air. She began to sweat and felt a sudden chill in the air; image of her patient in front began to blur. The room seemed to revolve and objects in front began to dim. The nurse next to her noticed that something was wrong with Ona, quickly grabbed her before she could fall. She then slowly lowered her on a nearby chair.

Ona recovered quickly and told the nurse not to worry. She had been rather tired and needed a vacation, she told the nurse and her patient. She insisted on continuing but the nurse declined her request.

Instead, she called the operator to page “Dr. Red” that would bring immediate help for a medical emergency. Quite quickly, the hospital’s Emergency Response Team arrived and took over Ona’s care.

They admitted her under the care of Dr. Jacob Black, an internist with practice mostly limited to hematology. This was just as well because he found Ona to be severely anemic. He told her later that normally a human being could not carry much physical activity at this level of anemia. Ona on the other hand, carried a full load of a busy medical practice. Her blood also showed a large number of immature white blood cells when seen under a microscope. This was a definite sign of acute leukemia. Her bone marrow examination confirmed the diagnosis of Acute Leukemia.

I went to see her in the hospital next day. A notice posted on her hospital room asked visitors not to disturb her. Below the notice, I wrote a personal note

“Get well soon, Ona, we miss you”.

That evening, Ona phoned me at home. Her voice was slow and distant. She spoke in a low soft voice.

“I wanted to talk to you. That notice on my door was not for you. I must talk to you,” I could feel in her tone of voice a little irritation and disappointment.

She insisted, “When would I see you?”

“Ona, you need rest and talking to visitors is exhausting. I shall come and see you first thing tomorrow morning. You should take care of yourself. I have talked Jacob; he tells me that everything is fine and you need not worry.” I said trying to cheer her up.

“My blood and bone marrow is full of myeloblasts. I also have a low-grade fever. I woke up sweating this afternoon. My bed sheets got wet. Last week I bumped my arm against the doorknob and it gave me a big bruise. That day I ignored it. Now I know why. My platelet count is low.”

“Ona, Don’t worry, everything will be fine. There are things we can do for acute leukemia. We have good treatments for it.” I lied to her. I knew well that the prognosis was poor for such patients.

“Who are you kidding, doctor? That is not your honest opinion. I need your help, not your pity. My age, anemia, a large spleen, low platelets, a bone marrow full of blast cells, do not look good to me. How could I have missed the spleen? It comes down to my belly button.” She sounded as if she was giving me details about a patient of her not about herself.

I said little and put the phone down after promising to see her first thing in the morning. I slept fretfully that night. In my experience, I had never seen patient similar to Ona survive long. Only a miracle would now save her.

I had gone to a medical convention and thus, did not see Ona for a whole week. When I returned I spoke to Jacob about Ona. He said that Ona was hanging in there. He had given her several pints of blood to stop her bruises. It also brought her hemoglobin up. He started her on a course of intensive chemotherapy. She seems to be tolerating the treatment as well as expected.

Her hospital room was on the seventh floor. It was the oncology floor. Each nurse cared for only two patients here. Each bed on this floor was hooked up to the most modern equipment. When I entered her room, she was sitting on a large chair with several pillows behind her back for support. They were transfusing her blood and a clear yellow fluid. She had fallen asleep with her head tilted back on the pillow. Her mouth was half-open and the lips had dried up. She was breathing quietly.

I sat down on a chair next to her bed. Sunshine filtered through the window glass at a sharp angle in the room. The sunlight on her face sharpened her features. She looked pale and at least twenty years older. Her hair had grayed in a hurry and her eyes sank deep into their sockets. Patches of black and blue bruises covered her both arms. She looked as if she had been in a fistfight with some one and lost. In her left hand she held, reading glasses.

On the wall in front of her bed a group photographs hung. There was Ona, slim and trim with a broad smile. She held an infant in her lap and next to her was a handsome man in a dark suit. Another young girl about seven years old stood in front of Ona. A third girl of about eight or nine stood on the left side of her. I was sure that the photo was taken in happier days of her life some years ago.

She slowly opened her eyes and gawked at me for a few seconds. I was not sure if she recognized me.

I brought my chair closer to hers and gently took her left hand in mine, pushing her glasses on one side. She kept her gaze at me.

“Ona, it is me.” I said softly afraid to startle her.

“I know! Good to see you. I am so glad you came.” She whispered squeezing my hand.

She turned her head towards me while covering her half-naked breasts with her nightgown. She kept looking at me. She had definitely lost weight and looked washed-out. How could all this happen so suddenly? I thought.

“I still have pain but feel stronger now. I wish I could go in a coma never to wake up again. Have you talked to John? He is the sick one in the family. I worry about him. I don’t think he can manage by himself.” She spoke softly.

She turned her head and shifted her eye towards the picture on the wall still holding my hand. She told me that the picture was taken in Wisconsin, on one of their vacation trips when the girls were small”.

“We had a wonderful time there. The older girls wanted to ride the horses but were afraid to get on them. John rode with them one by one. We all had fun. They were good times. She became quiet and sank her head in the pillow under her head. I began to massage the bruise over the back of her hand.

“This pain over my body; I have hard time lifting things. My arms feel heavy and my shoulders hurt. Last night, I was cold and wanted to cover my face with the blanket. It was hard. I never thought that I would suffer like this.

“When I was a young woman, I wanted to be a doctor, marry a perfect man, have a big house in Wyoming and have many children. When I graduated from the medical school people would ask me what kind of doctor I wanted to be. I told them that I wanted to be a good doctor. They hardly knew what I meant by being a good doctor. I also wanted to be a good mother and good wife. I believe I tried hard to be a good doctor. I certainly married a nice man and a good father to my children. I also tried to be good mother. “

“Nothing prepared me for this. I have a lot of pain”. She seemed miserable.

“Why don’t you take pain medication, Ona?” I said

“No, I do not want pain killers. They are just crutches. I can do without them.” She said.

She closed her eyes. She looked tired. Her voice trailed off. I let go of her hand and quietly left the room.

I slept poorly that night. I worried about Ona’s illness. She was dying. Only a few hours ago, Jacob had confided to me that Ona had not responded to the drugs and he might have to try second line of drugs. They did not work as well. That was a bad news.

Next day was a Friday; it was cool and breezy. The spring that year was cooler than usual. The trees would soon begin to grow leaf-buds. Crocuses were just begun to sprout. It would be a few more weeks before the warmer weather would come. I found Ona sitting up in her bed resting her torso on pillows. A meal tray sat on a table in front; she had eaten most of her breakfast. She was sipping coffee from a plastic cup.

She seemed cheerful that morning. She still looked frail and had a mild wheeze. The temperature chart showed that she was running a low-grade fever. I sat down next to her on an easy chair facing her. I kept quiet.

“What is wrong? You look sad today.” She said.

“I don’t know. It is hard for me to think clearly.” I said.

“Why?”

“Because, I am worried about you. I don’t understand all this about your illness”

“Why worry about me. You know, this is it, for me.”

“How can you be so relaxed about it? Why are you not angry?

“Come and sit down next to me on the bed.” She said. I rolled the breakfast table away from her and sat down next to her on the bed. She put her arms around me and gently pulled me towards her to give me a hug. Her body was warm. I moved closure to her mostly for my own comfort. My eyes were wet and I felt a knot in my throat. She cupped my head between her two hands brought it close and planted a soft kiss on my lips and cheeks. I stayed in that position, unable to move. I also, did not want to show my sorrow.

“Look, I was angry when I found out that I had leukemia. Two day ago, I finally told my husband as plainly as I could about this. He just kept quiet. The news probably shocked him. He got up and walked away without saying a word to me. He still has not accepted the diagnosis. He does not want to talk about it to me.” She said sadly.

John’s silence hurt her immensely. She wanted to tell him many things before she died but found it impossible to bring up the subject of her death. He refused to discuss her death. I kept quiet. I knew that she had a happy married life. I liked John. He was good man. He was quiet and compassionate.

“After the girls were born, I lost all interest in sex. We have not had sex, at least for ten years. We both have been busy and there was no time for each other. John never made demands. He left me alone. Love needs good communication as much as physical relationship to grow. Here, I lie with life incomplete with lot of regrets. I kept telling myself that when I get some time away from my busy practice, I would make it up to him in a big way. Now, I feel in the wrong telling him that I love him. I he is resentful of my neglect of his needs”

“Ona, please stop blaming yourself? You will be fine.” I said. She did not seem to pay any attention to me. She kept talking still holding me in her arms. Our fatalistic conversation was upsetting me a little. Yet, I wanted to explore the subject with her. I wondered if she had any idea of death.

“Death is just another part of life; you are born to die one day.”

“Can you really take dying so lightly? It makes me angry to see you die so young.” I said pulling myself away from her.

“There is never a good time to die. Some die young; others die at a ripe old age. Some die peacefully and others die in pain and suffering. Yet, some die horribly. I just want to die peacefully. Today, I feel well because the pain is less; I would rather die now before the pain returns, but time of dying is not in my hands.”

“You are an angel and God has a special place for you. Moreover, you are not going to die.” I said.

“Stop calling me an angel. You know nothing about my life.” She said with irritation.

“You have a good soul. We all have a soul. It makes us what we are. The body is just a physical being, a god given attire; the soul changes its clothes after death. It never dies, Ona.” I responded.

“You are talking about rebirth. It does not happen. When the body stops working, it dies and that is the end of it.”

“You will always be my friend, Ona? Even after death.” I said.

“I will come and haunt you in your dreams.” She said teasingly.

“Seriously, Ona; do you believe in life after death?

“No, I do not. Once we are gone, we are gone forever. Some of my friends believe that there is heaven and hell after death. If you ask me, hell is right here on earth; I went through hell the last few days. Today, I feel great and I have a better understanding of my situation. I am ready to die. I will have to answer god for my deeds on earth.”

“Ona, just think, god made this earth and all of us. He sent us here to experience life. We do both good and bad things. I think god is forgiving; he would never punish us. Some of our suffering is caused by our own deeds here and also in our previous life.”

“You believe in rebirth?” She exclaimed at me.

“I do not know if I truly believe in rebirth. If I did not, I would find life hard to live.” I said.

I did not want to upset Ona in her situation and so I stopped the subject and said nothing more. I did not want this conversation of life and death to upset Ona. She looked at me tenderly and lightly brushed my hand.

“We all die one day and we all have to answer for our actions on earth.” She said with a serious face. I kept quiet. She seemed tired and I told her to rest. I put my hand on her forehead and gently coaxed her to lie down. She closed her eyes and I could see her chest moving slowly up and down with each breath. I felt her pulse; it was strong and regular. I then turned the lights off and quietly left her room, closing the door behind me.

I went to bed without dinner that night. I had lost my appetite. I dreamt of a fierce storm around me. There was this large body of water that surrounded me. I stood on a long and narrow bridge that snaked in front of me without an end. The water splashed powerfully, and tried to uproot me off the bridge. I hung on to its railing. I tried to walk but felt powerless. Large bodies some with wings and others resembling missiles with short fins flew over me with lightening speed. Strong wind, flying objects and fearsome missiles above and around me were terrifying. When one of the objects was about to crash on me, I suddenly opened my eyes to find myself in a catatonic state. A few seconds passed and then I noticed the window of my bedroom and through it, a large full moon hung in the clear sky. I slowly moved my arms and cross them over my chest. My heart was pounding and I was sweating.

Next day, I went to see Ona again, she was lying in her bed writhing in pain. She told me that her pain was unbearable. I came out of her room and found the nurse taking care of her. I asked her about pain medication. The nurse told me that Ona refused the pain medication and forbade any one from giving any medication without her knowledge.

I went back to Ona’s room. She looked up and tried to talk to me; she could only whisper, the pain was too much for her to talk. Even a small movement of her body hurt her, tightening her muscles.

“Ona, what’s wrong with you? Why don’t you take pain medication? You know that it will help you.” I asked.

She took a deep breath and then asked if I believed in mercy? I said, of course I did. I did not want to strike an argument with her. I just wanted to persuade her to take the painkillers. She seemed to gather her strength and said to me,

“It is better to suffer in hell here than to go to hell after I am dead.” She tried to force a smile. I could see the pain on her face.

“Ona, you have helped many sick people in your life. You cared for your family; you are a good woman. Why do you want to suffer?”

She kept quiet for several seconds. When she opened her mouth to speak, she was clear and firm.

“You do not understand.”

“You worry yourself too much? I have known you for many years. I know how much good you have done in your life. God loves people like you. Moreover, do not talk about death; you will soon be well and back to your work.” I tried to console her.

“I am dying and it will not be too long before my suffering will end. Come and sit down. Talk to me. Do you remember, I told you about the doctor I worked for when I was young? He had an X-ray machine. He used to take X-ray pictures of patients to look for tuberculosis in their lungs. ”

“Yes, I do remember you telling me all about him. He was exposing his patients and you with unwanted radiation. I should know, I have seen and heard about the X-ray machines in those days.” I said rather bluntly but refrained from telling her that in my opinion, her leukemia might have been caused by overexposure to radiation at the doctor’s office. No one knows the amount of radiation she received while working there.

She said nothing for a while and closed her eyes but slowly recovered her composure. I began to understand her difficulties, past memories and her fears of not being at peace with herself. Although, her mental status seemed well, her past seemed to be haunting her emotionally. I promised myself that I would spend some time with her daily until the very end of her life. I kept my word. She only lived for three more weeks after that conversation. During this time, she talked to me a great deal, sometimes clearly but later at the end of her life, she just rambled.

She told me about a seventeen years old girl. Her mother, a patient of hers, brought her to see Ona. A few hoodlums in the neighborhood had gang raped the daughter. The mother was concerned that the girl might be pregnant. She was afraid of reporting the crime to the police. Ona admitted her in the hospital with a diagnosis of excessive bleeding and pain in the abdomen. That night she took the girl to the operating room, evacuated her womb, and confirmed that she was in fact pregnant. Ona never reported the pregnancy. When she discharged the girl, she told her and her mother that she was not pregnant. Lately, the unborn baby kept coming in her dreams and troubling her.

Ona also told me about a patient that had been bothering her. This was an eighty-year-old man who had an advanced Parkinson’s disease. He suffered from uncontrolled shakes and pains. Ona treated him with painkillers to relieve his pain and sedatives to slow his shakes. . He became weak and completely bedridden but his mind was clear. One day, the pain became unbearable. She gave him injection of pain medication. He begged Ona for more painkillers. When she hesitated, he became angry.

“Don’t you see how much I suffer? How do you expect me to fight the pain? Dying is a struggle. Give me life that I can bear or let me go.” The patient told her.

Ona wrote down a prescription for his pain. It was a concoction of several drugs. She ordered a large bottle of the mixture. Before she left the patient, she told him,

“It is a strong medicine. Make sure, you only take one dose of this every six to eight hours. More than that might kill you.”

Without waiting for an answer, she gently touched his forehead, leaned over and kissed it.

“God bless you.” She said softly, turned around and quietly walked out of the patient’s room.

Next morning patient’s wife found him dead in his bed. Next to his bed was lying an empty bottle of the mixture, Ona had prescribed. The dead patient too kept haunting her in her dreams.

I believe, Ona was caught up at the end of her life not by its success but by things that she thought were in the wrong. I tried to explain to her that no one should worry about a life lived like the one she had. I told her that I was sorry that she was dying so young and I would loose a good friend. I wondered why a woman of her talent and goodness had to die. Now that she was on deathbed, she still struggled. Death, for some, seems to be a battle.

Next day I visited her again. My eyes were wet and my voice heavy. She looked at me and smiled but I knew she did not know me. She kept saying things I did not understand. Her eyes wandered and her voice trailed off in another world. I quietly left her room without even saying good-bye to her.

© Copyright, V Amod Saxena, 2006