Episode 2: “Timing Is Everything”

The preceding episode may cause readers to think that Matt Sarisob, MSW, LICSW, is a repulsive, secretion-obsessed juvenile. However correct this may be, the reader should be cautious not to lose sight of her own Sarisobian proclivities. After all, aren’t we hard-wired to abide, and sometimes even enjoy, the smell of our farts? Don’t we occasionally bring the soiled toilet paper noseward to discern the constituent elements? Does not the human mind light upon sexual fantasies at oft-inopportune moments? The reader can surely relate to Sarisob’s predilections and doubtless relishes her own covert cheese-cutting, or the wetness-inducing memory of her tryst in the HVAC closet with that cute Maintenance guy.

Therefore it should come as no surprise that the other half of Sarisob’s double life is that of a highly-functioning citizen, respected at work and active in the community. Sarisob was beating his meat that chilly morning while waiting for the B-Line to bring him a short walk from Massachusetts General Hospital’s Yawkey Center, where he works as an Oncology Social Worker. Loved by his patients and colleagues, Sarisob has carved out a comfortable niche in his eight years at MGH. Only the keenly observant can descry his fart-centric behavior: in the way he suddenly ducks into bathrooms for longer-than-average visits, lingers over smells, and brings his fingers to his face more than is necessary and hygienic. The keenly observant have so far consisted of Sarisob’s parents, Monique and Roger, and a series of ex-girlfriends who gradually discovered that their soon-to-be-former beau was either unable or unwilling to change his personal habits. The ex- that stung Sarisob the most was Stephanie S., a fun-loving librarian at the Athanaeum whose classical music collection was even larger than his. Determined not to repel the willowy brunette, he was remarkably successful at keeping his smells to himself during their seven months together, and was shocked when she abruptly broke it off one morning during their ritual pre-work breakfast at the Fill-A-Buster restaurant. Stephanie, quieter than usual, barely touched her grilled bran muffin and diet Coke, although she did eat two of the three fried eggs. Her eyes beginning to well with tears, she said "Matt, look, I'm sorry—I think I need some time to think things over. I'm so sorry," and rushed out, covering her mouth as if she were about to throw up. He never heard from her again, and stopped attending the Victorian Literature book group that brought them together. To this day Sarisob wonders what it was he may have done that snuffed their flame, and will always feel a pang over losing the second woman he could have married. And the second woman he could have married breathes easier, having never told Sarisob about the months of anguished forbearance that led to her breaking point. Stephanie, you see, loved Mexican food, and decided that a man who couldn't eat so much as a Chile Relleno without turning the sumptuous bed that was her prized possession into such a toxic Dutch oven was not the man for her. She didn’t have the heart to tell Sarisob the extent to which he farted in his sleep.

Still chuckling over how he surreptitiously “pulled it off” on the platform, Sarisob made it to work a little after 8, with his customary blueberry scone and Peets coffee. (After testing all of the coffee chains, Sarisob found that Peets inspired the strongest laxative effect.) He took off his windbreaker and scarf and before doing anything else opened the bottom drawer of his desk, which contained, among other things, three pairs of chinos. Mindful that there was a not-insignificant probability that coffee, food, urine, shit, diarrhea, or semen might stain his pants during the workday, he had to be prepared to maintain his professional image. He keeps three pairs in the drawer because one particularly embarrassing day he had to change twice—and only had one pair in his desk! From then on, three pairs was the rule; even Sarisob could not conceive of having to change his pants four times in a workday. He withdrew a pair, and went to one of the two unisex bathrooms around the corner to change his pants. Sarisob loved these bathrooms: their proximity to his office, the heavy, sound-shielding wooden doors with locks that communicate “Occupied” or “Vacant” to those outside, and best of all the fact that his female colleagues use the same stalls, a thought that lent piquancy and potency to his near-daily work-jerk.

He returned to his office, settled in, and dialed up his favorite of Bach’s “English Suites”, the 4th Suite in F major as played by Glenn Gould, on his computer’s Windows Media Player. A classical music lover, Sarisob outfitted the computer with Altec-Lansing speakers and subwoofer, to better convey the dynamic range of his beloved Vienna Philharmonic. Between sips of coffee he opened the electronic medical record of his 10 a.m. new patient: Rick Landsman, a 53-year-old father of two, investment banker from Newton, being treated for Stage II laryngeal cancer. He has completed one-third of the prophylactic course of radiation therapy that followed his successful surgery. The most recent progress note from the referring radiation oncologist, Dr. Harry Morganstern (Sarisob’s bi-monthly bowling buddy) revealed the scenario that inspired many a head-and-neck cancer patient to see a social worker. Landsman dismissed the warnings about the difficulty he would have eating and swallowing during his course of radiation, the painful exhaustion, the hyper-inflamed throat, and insisted with pre-treatment bravado that he’d get through just fine by drinking liquid meals pureed in a Vita Mix. He fought against the surgeon’s insistence that he have a feeding tube, known as a PEG (percutaneous endoscopic gastrostomy) tube, surgically implanted into his abdomen to maintain his weight by taking liquid supplements through it when radiation side-effects make it all but impossible to swallow food. “Mr. Landsman has lost twelve pounds since his surgery,” Sarisob read from Harry’s note. “He reports acute pain swallowing, and discontinued taking meals orally three days ago. Mr. Landsman has begun taking Ensure via the PEG with extreme reluctance. Mr. Landsman and his wife report difficulty adapting to the PEG, so I am referring him to social work for a consult.” Sarisob had a pretty good idea how this arc would go: Mr. Landsman would spurn his offer of joining a support group, and work through his anger issues pretty quickly as he makes the shift from hating his PEG tube to accepting his PEG tube to, in many cases, loving his PEG tube. Once head-and-neck patients realize they can maintain their weight while enduring the hellish side effects of radiation, they begin to view the PEG tube as a savior rather than a freakish abdominal protuberance. More than a few patients actually preferred using it to eating and were unwilling to have it removed! Sarisob finished his coffee, took a bottle of odor-neutralizer from his desk, and hurried around the corner for his morning dump.

“Look, Matt, all due respect, but I could care less for this. It's all for my wife that I’m here,” Landsman said in a hoarse whisper later that morning. He was a slight man with close-cropped black hair and intense dark eyes. The tone of his voice, Sarisob divined when they met with a firm handshake, revealed that Rick Landsman was not one to suffer fools. “I don't belong here talking to you; you don't belong here listening to me. Well, I shouldn't say that—you probably spent good money to get your degree. But don't fool yourself: all you are is a necessity for me, another hoop to jump through.” He slumped in his chair dejectedly, tugged at the sleeve of his black nylon sweatsuit, and took a pull on his water-bottle.

“I understand that, and I'm flattered for the opportunity to be one of your hoops. But this isn’t about me, Rick—it’s about you and your wife getting through this. You’re a good man for coming here and helping put her at ease. It’s never easy to talk with someone—“

“—There’s nothing to talk about, Matt. There’s just me, the tube, and my painkillers. This fucking feeding tube is all I can think about, OK? (cough!) Last night I dreamed it was strangling me. Shit, I forgot to tell Dr. Morganstern to renew my Fentanyl.” He spoke slowly, slurring his words due to the Fentanyl and the mucus buildup that plagues head-and-neck patients.

“I’ll tell Dr. Morganstern for you, so consider it done. I know how painful this can be—but you have to know, Rick, it’s just temporary. You know the PEG is only here to help you through the radiation. And you know that if the radiation goes as planned you’ll have a 72% chance of long-term survival. Better than fifty percent, Rick—you know all this, Dr. Morganstern discussed it all with you. You’re on track to long-term survival!”

“I know, I know—my wife tells me that like 30 times a day. ‘You’re going to survive this, you’ll be there when our kids graduate from college.’ And all I can think to myself is it's gonna be a lot easier for you to survive it honey—you don't have a fucking tube (cough, hack!) sticking out of your gut! I don’t know, Betsy’s being a trooper...I’m a piece of work even when healthy. But she still flinches when she sees the tube, and I’ve had it for two months now. I hate the feeling that I have to hide it from her. (COUGH!) Hey, can you refill my water?"

Sarisob went out to the water cooler in the Social Work office and filled his bottle. When he returned, Rick took a sip and looked at him with greater attention.

“I’ll bet...” Rick said, nodding at Sarisob with squinted eyes, “you’re a Socialist.”

“Me—a Socialist?” Sarisob laughed. “I’m flattered! Why would you think that? ‘Cause I’m a social worker?”

Smiling for the first time in the session, looking down at his folded hands, he said: “Because of your concern for your fellow man. And I know how poorly paid social workers are (cough, hack, cough!) paid.”

“Ha, ha, yeah, well none of that’s so terrible, is it? I bring home peanuts, and make it a little easier for you to get back to work and make millions for your clients. Rick, I should let you know: my colleagues and I run support groups that could be helpful to you and/or the missus if she would like. Would you like more information on this?”

“I’ll run it by her, but I’m sure we won’t be needing that.” His demeanor hardening, he took another pull on the water-bottle and sat up in the chair. At this point Sarisob felt a little fart coming on, and considered releasing it in front of the patient. The fart was nudging at his anus, but the clinician’s instinct said to tighten his sphincter and save it for later. This was not the right time to fart in front of Rick Landsman. One of Sarisob’s, shall we say, unconventional therapeutic modalities was to allow himself a single fart in front of each patient, with strict requirements as to when to let fly. And he knew deep down in his colon that this was not the time. As it is with so much in life, thought Sarisob as he handed Landsman the support-group FAQ sheet for his wife, timing is everything.