SCENES FROM A PRACTICE Hazel’s Miracle

She was rude, distrusting, and sarcastic-yet something magical saved her.

I HAVE SEEN THREE OR FOUR MIRACLES IN my practice, Most of us think of miracles as divine events, representations of God’s grace. So I think about Hazel’s miracle a lot.

I first met Hazel at church. Some names seem to fit certain personalities, and my experiences with women named Hazel did not make me look forward to knowing her.

I had been practicing at the medical school for about five years, long enough for folks to have a word-of-mouth assessment of my competence. Hazel, fond of word of mouth, decided to seek me out in her own territory, She was a member of the Altar Guild, and she approached me after church in the undercroft, which had become my informal Sunday clinic.

“You know anything about blood pressure?” she asked.

“I beg your pardon?” I said, somewhat startled by her blunt manner.

“Simple question,” she said, obviously annoyed. “Do you know anything about blood pressure?”

Hazel was about 60, short, heavyset, and dressed “sensibly,” as she later defined it for me. She had on a warm cardigan, black granny shoes, and glasses on a chain. Her face was unsmiling and her stare was direct. Her silver hair was (always) pulled up into a tight bun on her crown, and she (always) assumed her attack posture: her back ramrod straight and inclined a bit forward.

I had come to leam that simple questions are not always simple. More than once, I had answered a simple question with a direct answer only to find myself in trouble, having to follow up with qualifiers and disclaimers about “your specific case.”

“I see many patients with hypertension,” I told Hazel.

“1 should like to see you Tuesday at 11 a.m.,” she said, whisking out her pocket calendar from her cardigan, unclasping her pen, and sliding on her glasses. She was about to whirl about and leave when I stammered that perhaps Tuesday would work, but I would have to check my calendar to be sure.

“Very well,” she said. She stood there and looked at me, calendar in hand and pen poised. I realized that she expected me to produce my calendar so we could get on with it. She gave me an “I gotcha” grin when I said that I did not carry my appointment book to church or out of the office. She sighed and instructed me to have my “girl” call her Monday before 10 a.m. with an appointment.

“Any later and I shall be on errands.”



BUN, GLASSES, AND CALENDAR APPEARED in the office the next week. I was perhaps 10 minutes late seeing her.

“Running a bit behind, are we?” was her greeting, with the “gotcha” smirk again.

“Of course, it must be difficult keeping on top of everything with such a small office.”

Hazel was short on trust. I understood this later when I learned that she had lost her only child to leukemia. She and her husband, Lester, had spent the last 20 years in bitterness and distrust. They were active in the community but had no real friends. All of their public works seemed like acts of contrition and were performed with astounding conscientiousness and thoroughness, but with no joy.

Hazel’s hypertension was not difficult to treat, but Hazel was. She limited my incursions into her life and well-being. It was fully two years later before she would permit a routine pap smear. She suffered the indignity with expected rejoinders.

“Done many of these, have you?”

And of course, we discovered a problem. Hazel had two large polyps protruding from the os cervix. They were benign by cytology but bled easily, and clearly they needed surgical attention. The credentials of the consulting gynecologist were defended, calendars were consulted, informed consent extracted, and Hazel was hospitalized.

I stopped by her room the morning after her admission. She was a “to follow” case on the operating room schedule. This meant she was in line but with no definite call time.

“I suppose you have no control over how things are run at your hospital, do you?” was her greeting. “I have a miserable pain in my back,” she continued. “Your mattresses are just too soft, but I guess you’ve never slept on them. 1 don’t know if I shall be able to tolerate this.”

I should have expected Murphy’s Law to apply here. The operating room ran late, and the last case was the one just before Hazel. The next morning, she was gone. The gynecologist was apologetic. He explained that she signed herself out of the hospital, complaining that her back hurt too much from the mattress and that we would have to deal with the problem some other way.

My summary was that Hazel was just frightened of the loss of control that came from hospitalization and the particular loss of control that comes with general anesthesia. She had seized on any apparently acceptable reason to dismiss us and leave the hospital.

I was wrong. Her back really had hurt. About three weeks later, I got a call from the emergency room. A resident said that Hazel was there and that he thought she had a spinal cord compression. I was incredulous but the examination con-finned the diagnosis. Hazel was paralyzed from the waist down and had no sensation below her navel. The pain she had complained about persisted after she left the hospital. She had noticed some gradual weakness, and suddenly she collapsed at home and was unable to move her legs.

For the second time in her life. Hazel was swept along by events she could not control. A compression of the spinal cord is a medical emergency, and there was no time for her calendars or qualifiers. Myelograms, the introduction of radio-opaque dyes into the spinal canal, confirmed a complete spinal cord block between the eighth and 12th vertebrae. Later that day. Hazel was in the operating room where the neurosurgeons decompressed her spinal cord. There was a mass curled around the cord, squeezing it in the narrow confines of the bony canal. The pathologists diagnosed the mass as a mucinous secreting adenocarcinoma, a tumor that never originates from the spinal cord or adjacent tissues. This meant that the primary cancer was somewhere else and that this lesion was a metastasis. The most common primary site of such as a cancer is in the gut, but where? We had no inkling that Hazel was hiding a cancer. She had not lost weight, had no change in stools, no abnormal laboratory tests, and no localizing symptoms.



HAZEL RECOVERED ALMOST COMPLETELY from the surgery. Motor and sensory functions returned and she was able to walk without assistance. But she wasn’t happy. She wasn’t grateful.

“I told you I had back pain!”

We did the obligatory search. Barium in every orifice, CAT scans, lab studies, mammograms. We removed the uterine polyps, probed and prodded everywhere. All negative.

“Can’t find it, eh? Well, I guess we all have our limits.”

We decided to watch and wait. There was nothing else to do.

A year passed with no change. I went to the pathologist and we reviewed for the third time the tissue removed from surgery. There was no doubt about the diagnosis- mucinous secreting adenocarcinoma, definitely metastatic.

It has now been 12 years. Hazel and Lester continue their self-appointed rounds of duty in the church and community. I don’t know if Hazel has cancer or not. I suspect not. I believe that a miracle visited Hazel.

Some would argue that the spontaneous remission of cancer is not miraculous, only not understood. Perhaps. The miracle to me is that this special event happened to Hazel. And to me. Aren’t miracles supposed to happen to the innocent or the holy? Neither Hazel nor I qualify-Hazel was mean and I was delinquent. Perhaps it is miraculous punishment. Hazel lives on in a spiteful life and I am constantly reminded of my failings by her presence in my church and in my office. No matter what conclusions I draw, the mystery of it-the miracle behind it-will remain unchanged.

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