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“Good morning this is Dr. Catherine Bocian dictating a consultation letter on Ms. Audrey Wilbur to Dr. Arthur Marshfield at Marshfield Neurology Associates St. Paul Minnesota copy to genetics chart.
Dear Dr. Marshfield comma new paragraph.
Thank you for referring Ms. Audrey Wilbur comma a twenty-year-old woman with a family history of early-onset Alzheimer disease comma for a genetic consultation for pre-symptomatic predictive testing full stop new paragraph.
To review, Ms. Wilbur’s mother Barbara, who is your patient in Minneapolis, recently presented with progressive short-term memory loss. Barbara was diagnosed with early-onset Alzheimer disease based on her mental status examination, and her brain MRI showed generalized brain atrophy. Molecular genetic testing was positive for a presenillin-1 mutation. Barbara’s daughter, Audrey, has a fifty percent risk of inheriting the altered gene and she was referred for a genetics consultation at her local genetics centre.
Audrey is a university student in her third year of an undergraduate psychology degree. In fact, she’s the same age as I was when you dumped me. On the Wednesday of my medical school orientation week, on the phone, no less. I was so looking forward to the big party when I was going to show you off as my significant other. I had a Canadian-born boyfriend, I was in medical school, I belonged, finally. No longer a striving immigrant. Life was good. Boy, was I ever wrong. Delete last paragraph.
Audrey is a university student in her third year of an undergraduate degree. She has decided that knowing her mutation status will be an important factor in planning for her future. Audrey’s mother is fully supportive of her decision to be tested as is Audrey’s father; together, as a family, they have discussed predictive testing at length. Audrey is single and has no plans to start a family, but has not ruled it out for the future. I was planning to have a family with you. Curly-haired boys and girls with your beautiful green eyes.
Les introduced us before any of us got into medical school, but I fell in love with you only after he left for Ottawa. “He’s the best friend I’ve had in Canada so far!” he shouted when I broke off my engagement to him. Yes, we were engaged at one point, unofficially, no ring or anything, but I did say yes. I broke it off because I’d had enough of his crude jokes and lousy manners, even if my husband thinks that I would have been happier if I married him instead. Steve and I have been married for twenty-four years. No, we don’t have screaming, sweaty, panting sex like you and I did, and we don’t do it seven times every night like our first time, but I’m sticking with it. Delete last sentence.
I met Steve several months after you dumped me. I didn’t stop pining after you for another two years, but he persisted – he was besotted from that first time I told him to get lost. He loved my style – the red beret and the designer labels I wore to impress you – but more importantly he knew I needed him. And he knew all about us. He even knows what happened five years ago, when I phoned you in St. Paul.
Steve was invited to give a guest lecture at the Mayo Clinic and I went with him to Minneapolis. I had Googled your neurology practice in St. Paul a few weeks earlier. When I talked to you, you just had to tell me that the boutique hotel Steve and I were staying at was where you had proposed to Beatriz. The name slipped out ever so causally. Just like the information that the hospital where Steve was scheduled to present Grand Rounds was known as in the city as “The Morgue.” Really? Put down by a man who dumped me twenty-five years ago? Yes, he has a big dick, longer and thicker than any of the five I have held in my hand (and I do not mean patients I catheterized), but that dick belongs to Beatriz now. Delete last sentence. I wasn’t going to stand for any disparaging remarks about my husband who is way more accomplished than you could even dream of becoming. So I never called you bac.
Steve and I were married after I finished med school. With honors. And then we were married again two years ago – this time Steve proposed in front of the boys, right after our twenty-second wedding anniversary dinner. A religious ceremony, not some renewal-of-vows crap. The Greek Orthodox Church does not recognize the Roman Catholic ceremony we had, and Steve had been promising to whisk me off to Santorini for a Greek wedding for years. We didn’t fly off to the Greek isles, though, we did the deed at home. I walked down the aisle with our sons and we had a catered gourmet dinner afterwards. Our house was bright with Christmas lights, and warm from the fireplace in the living room. Everybody had at least two glasses of Veuve Clicquot; the priest had three and I had five. Maggie wore a white silk ribbon for the occasion, meowing and rubbing against everybody’s calves to get it off.
Did you get married in a church or a synagogue? I bet on a church, a good solid RC cathedral with tall, twisted spires, Beatriz being Spanish and all. You’ve converted for her, I’m sure. I would have converted to Judaism for you. And I saw that she didn’t take your name, either. I would have changed that immigrant name I carry without your asking. Yes, I Googled her – there aren’t too many medieval anthropologists named Beatriz in Twin Cities. She looks pretty pudgy in that university website photo: that lacy high-collar blouse she is wearing under her oh-so-academic tweed jacket should be buttoned up all the way to her round chin and not splayed open. To impress you I spent my scholarship money on Ralph Lauren dresses and skirts and Polo socks, yes, socks! and here you are married to a woman with no sense of style.
Why did you send me those postcards from England if you had already met her? Why write that you were studying Polish? You signed the postcards from Paris with “Love, Arthur.” I read a whole future into those two words. I went to Paris during my pediatric residency, only because you had had a summer job there two years earlier: I couldn’t be worse. My French was good enough for that. Can’t beat Beatriz, though, with her English, Spanish, French, Italian, German and Latin, can I? Though I do know Latin. And Russian. Some Greek now. And I’m bilingual in Polish and English, but those languages never counted for you.
My father bragged to everybody that I was working at a Paris hospital. He died from complications of alcoholic liver disease five years ago. . My mother rode him hard with her nagging demands and reproaches, so he turned to the bottle. He managed to drink himself into liver failure with beer alone, it took a lot of determination. I miss him. Audrey’s father sounds like him – heart bigger than all outdoors, generous to a fault. But my mother will outlive us all, although she might be losing her marbles these days: my younger son told me that babcia sleeps with a knife under her pillow. I wonder: if I ever develop Alzheimer’s, will you will be the last to go from my memory, or will that honor belong to the scumbag who primed me with “Clockwork Orange” and “Caligula” when I was sixteen and then raped me? You’re the neurologist, tell me: which are the last memories to go – the worst or the earliest? I’m sure Audrey’s last memories will be lovely, even if she inherits her mother’s mutated presenillin-1 gene. Her parents loved her.
I doubt that you ever loved me. What you might have loved was my unadulterated adulation and adoration. How’s that for alliteration? Almost as good as “that fucking scene in front of the fireplace” that had you in stitches when I described “Endless Love,” isn’t it? How I loved to make you laugh – finally somebody was laughing at my jokes and not at my usage of English! I loved everything about you – your Lacoste shirts, your family’s detached two-story house on a tree-lined street (a house, not a rented apartment, it had stairs, I had always wanted a house with stairs and a laundry room, not the communal facility where you always found somebody else’s pubic hair in your towels), your private high school with the sprawling neo-gothic campus right in the middle of the city, the five-to-one student-to-teacher ratio and a black kid named Token. Your insouciant self-confidence. “People are insecure only about three things – brains, looks, and sexual prowess. Once you figure out which one it is, they’ll eat out of your hand.” Worked on me. I loved sex and I never doubted my abilities there, the slut that I was. I felt pretty good about my brains, too, especially after that surprised look on your face when I told you that “a lot” was two words, not one. I had to drag you to the Oxford English Dictionary in the fourth-floor reading room at Robarts Library to prove it, you wouldn’t take my word for it. But my looks, that’s another story.
You know what Les said to me when he saw me after twenty-one years? I complained about how my looks were going-going-gone and he said: “Catherine, you’re like the Sistine Chapel. Up close it’s full of cracks and stains, but it’s still a masterpiece.” I wish I felt that way. In “The Grand Budapest Hotel” – I’m sure you’ve seen it, Wes Anderson is right up your alley – Monsieur Gustave, the profligate concierge, explains to the busboy why he sleeps with older women: “When you’re young, it’s all fillet steak, but as the years go by, you have to move on to the cheaper cuts, which is fine with me, because I like those.” I have not aged well – my body soft and flabby, my hair grey at the temples. Steve talked me into going natural – he thought I would turn into a silver fox, but it hasn’t happened yet. Right now I look like a chubby dyke with a mess of spiky, muddy hair. A cheaper cut.
Over the years neither you nor Les ever looked me up; it was always me snooping around. You know who did look me up, though? That asshole who raped me. Remember? When I told you about him all you said was: “Men always help themselves to what’s available.” Well, fifteen months ago my secretary transferred a call to my office saying that “Robert Green” was on the phone. He used a fake name, but I recognized the voice instantly. He said he wanted to wish me happy nameday – it was November 25th, St. Catherine of Alexandria’s feast day. I pretended not to know what he was talking about. He switched to Polish: “Catsy, you know it’s me.” That cajoling voice – C’mon, we’ll both feel amazing afterwards – I couldn’t breathe, my heart battered against my sternum, my hands shook. I insisted in English that I didn’t know who he was. He hissed: “You deny knowing me? Just you wait.” And he hung up. I sat in my office that whole afternoon, shaking, expecting him to walk in at any moment. He knew where I worked. Would he show up at my house? Were the kids safe? Charlie was just two years old, at home with a nanny. Tommy was four and in junior kindergarten.
I didn’t report the rape when it happened. I was a new to Canada and he was an acquaintance of my mother’s from ESL class she invited for dinner. He was twelve years older than me, and twelve years younger than her. When he started taking me out my mother said that she could steal him away from me if she only cared to. Would Audrey’s mother say that to her? If my mother knew what had happened she would have called me a whore or worse. Insisted that we keep it from my father to “spare him the shame.” Would have never allowed me to call the cops: “A police record isn’t safe, you want the whole world to know what a slut you are?”
This time I did call the police. A female officer came over to my house that evening. A tall, poised black woman in Kevlar, a handgun in a holster, a Taser on her belt, she sat on my Roche-Bobois ivory leather couch and took notes in one of those tiny flip notebooks. She thought that he was just released from jail after doing time for assaulting me. But who would have listened to a teenage immigrant girl with broken English who willingly went to Three Pines Motel on Kingston Road in the middle of an afternoon? I wanted to wait till my wedding, I really did, but he and I were having sex by then, because after that pseudo first time in the cramped front seat of his Renault LeCar, when he showed me his bloodied hand, I just didn’t care anymore – deflowered by dirty-nailed fingers who would. Delete last sentence. But I didn’t want that kind of sex. It hurt like hell, to have it shoved there. Delete. I begged, I cried the whole time, but he did what he wanted. Delete. I remember it all, blood and shit. Delete. My mother was right – I was a slut, I deserved all that I got. Only a respected professional woman, married, with kids and a loving husband would be believed.
The officer phoned me back a week later. She had contacted Toronto Metro Police and they sent an officer over to that decrepit farmhouse that belonged to his deaf aunt, up on Canal Road in Holland Landing where he still lives. The cop who went to see him had conveyed that his contact was unwelcome, she said. But just in case, our London Police Service put our address on their rapid response list. For months afterwards every unfamiliar car on our crescent made my neck hair stand on end, every phone call sent my heart race through the ceiling.
But the joke is on me. Apparently reporting a rape thirty years after the fact is much less credible than reporting it right away. Our DNA lab director said so. He should know – he has done a lot of sexual assault cases as a forensic genetics expert. It is this type of inconsistency that lawyers pounce on. His lab also does molecular Alzheimer testing.
Which brings us back to Audrey. Audrey is a mature young woman who appeared to understand the implications of the genetic testing and who has excellent family supports for this important decision. She also has lovely memories, too. She was advised that she can stop the testing process at any stage up to and including the results’ session. Aware of these options Audrey decided to proceed with testing today and blood was drawn at the conclusion of our meeting. An appointment for disclosure of results will be made when they are available.
Thank you very much for allowing me to participate in the care of this patient. If you have any further questions please do not hesitate to call me at any time.
Catherine J.M. Bocian, MD, PhD, FRCPC, FAAP, FCCMG, FACMG
Professor of Medical Genetics
University of Western Ontario
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This letter was presented as evidence during the disciplinary hearing at the College of Physicians and Surgeons of Ontario on July 27, 2014 regarding Dr. Catherine Bocian’s conduct and fitness to practice following a complaint lodged by Dr. Arthur Marshfield of St. Paul, Minnesota.
The Disciplinary Committee found that Dr. Catherine Bocian committed an act of professional misconduct in that she engaged in an act or omission relevant to the practice that, having regard to all the circumstances, would reasonably be regarded by member as disgraceful, dishonorable and or unprofessional.
Dr. Bocian did not contest the findings.
The Committee ordered the following: a public reprimand, and a one-month suspension of Dr. Bocian’s certificate of registration as well as payment to the College of $4,460 for hearing costs.
At the conclusion of the hearing, Dr. Bocian waived her right to appeal and the Committee administered the public reprimand.
Margaret Nowaczyk MD, a pediatrician and a clinical geneticist, is a professor at McMaster University and DeGroote School of Medicine in Hamilton. Her non-fiction has appeared in Geist, The Examined Life Journal, and Canadian Medical Association Journal, and short stories in Numero Cinq, Intima, and Prairie Fire. She is a co-editor of Polish(ed), an anthology of short stories from the Canadian-Polish diaspora published by Guernica Editions in 2017. She lives in Hamilton with her husband and two sons.