The three most dreaded words in the English language?
"Internal Revenue Service"
That's how a "tax-resolution" firm opens its radio advertisements, pitching to non-filers, delinquent payers; those facing wage garnishment; those threatened with the loss of a business and a home. Pretty scary stuff.
But to a forensic accountant, who, in his full-employment years, delved into some untidy and occasionally devious financials as an independent business-evaluation specialist, the acronym IRS does not give him pause. What did stop him was the acronym TUR:
"Trans-Urethral Resection"
More specifically, Trans-Urethral Resection of a Bladder Tumor.
But then, that's six or seven words.
He parked his 1993 Volvo in the public library parking lot to avoid the congestion in the lot that services the nearby diagnostic imaging center, where SUVs of young moms bulge over guideline stripes and crowd the older sedans that are misaligned despite the conscientiousness efforts of ancient drivers. His path from the library lot to the DI center takes him past a nursery whose rows and rows of Christmas trees and wreaths send out aromas that stay with him even as he is handed the DVD of his recent CAT scan and the accompanying radiologist's report.
The report is typed. No minimalist chicken-scratch or hieroglyphics to decipher. Even with the anatomical argot, the legibility is clarifying:
CAT scan of abdomen and pelvis "was performed with oral and intravenous contrast; reconstruction images were obtained in the coronal plane."
Lots of good news: "The lung base shows no abnormality. The liver and spleen are normal. The pancreas and ... normal. Both kidneys are normal, showing no hydronephrosis."
With some anticipatory radar, he passes quickly over the clipped sentences noting "considerable stool" in the colon and rectum. Yes, no surprise that the prostate gland was enlarged, "with calcification."
Then the lines that conveyed the "impression" that had been relayed to him by the internist who had read the radiologist's report; the lines that would be confirmed by what the urologist would see through a cystoscope - inserted through the urethra:
"... suggestion of nodule within the bladder. The nodule could be a carcinoma of the bladder.... Bladder mass, possible neoplasm."
As he walks back to his car, some few words repeat to him
• nodule
• neoplasm
• carcinoma
• bladder mass
But, on the way back to his car, by some wind of good flora fortune, he inhales more profoundly the nursery's seasonal scents: the clumps of flat Western Cedar, pine cones and pine garlands, the Fraser Firs, the Balsam Firs, the eucalyptus wreaths, the cinnamon brooms.
He stops and inhales the cinnamon and the pine. He stops and smells the eucalyptus.
He has the great good fortune of getting an appointment with the head of urology oncology at a major medical center. While this relatively young surgeon - supremely credentialed and justifiably renowned - studies the radiology report; the urologist's write-up of his cystoscopy findings; the internist's history of examinations, blood work, and urine samples; the forensic accountant audits the room. The early morning sun-shafts that have found their way through the labyrinth of skyscrapers highlight the many diplomas and citations clustered on one wall. On the window sill, on book shelves and ledges, on wall nooks, there are photos of child ballerinas and Little Leaguers. Anatomical trans-sections are consigned to the chambers where the nurses takeover.
The surgeon invites him over to a credenza where a large screen computer displays the CAT scan images. In white relief, his vital organs appear to take the shapes of gourds and roots and vegetables stalks and vined fruits, set against a black interior. As the surgeon moves through the scans, the organs (in outline and then as figurines) appear to reassemble themselves in a cornucopia. The images might have been made by a child prodigy who had been given white paint, a fine-tip brush (hairs from the winter coat of a Siberian male kolinsky), and a piece of charcoal black construction paper to serve as a canvas.
"There it is." The surgeon points to a shelf or layer of something inside one of the "residents" of that cornucopia.
"There, you see the filling defects; the wall abnormalities."
He thinks he hears the surgeon speak of the bladder as a wine sack; a pouch, that has to remain supple, to be as functional as it was meant to be. Or maybe that was the kidney; some vacuous organ.
He is transfixed by the reassembling images in the cornucopia. He thinks he hears something about impediments - even low-grade potential malignancies - that have to be removed. He thinks that is what he hears; the images arrayed in the cornucopia of organs have captured his attention.
Who thought of a device that could take such pictures? Who designed and built such a machine?
"Could be low metastatic potential," says the surgeon. "Not necessarily radically life-altering." The forensic accountant translates into his own risk-array and forecast spreadsheet. But he repeats back to the surgeon the phrases "low metastatic potential" and "not necessarily life-altering." The surgeon returns a warm, assuring nod of the head.
"But we have to remove the growth. Let's get you scheduled so that we have the biopsy back before Christmas."
Comfortably, in words and phrases that substitute comprehension for medical menace, in words pre-teen ballerinas and Little Leaguers could hear, the surgeon recaps: put you to sleep, insert tube, a little scraping, anti-cancerous wash.
Somewhere, as he heads out the hospital lobby, the forensic accountant picks up the fragrance of Christmas. On the busy city street he looks up and down in the hope of spotting a vendor whose cart sends up the aroma of chestnuts roasting on an open fire. No roasting chestnuts, no open fire, to be found - but still there is something seasonal in the air.
On the way home he determines to find a nursery. Since his wife's passing, no plant has come into the house. None could survive his inattention and neglect. Following her death, there was no carryover of her fascination with cultivating still more life. The pads and such in his high-school son's two hockey bags surely have enough fungi or other alien organisms growing therein. His daughter grows - whatever she grows - in her college chemistry lab.
Antidotes: On his way home, he routes himself to that nursery by the diagnostic imaging center. He'll stop and inhale the cinnamon and the pine. He'll stop and smell the eucalyptus.