Three days of silence. The world set to mute. It happened so fast. On the heels of so much else. That’s how I knew. But still, how to tell him? This man here for hope. This man that was going to die.
It’s not that I haven’t told a man he is dying. Long-time patients turned to friends. Strangers in the ER. Moms and dad of newborns whose hearts had too many holes. Mothers and sons and husbands and wives. I’ve told them all. Such is the game. The miracle that is life. This nasty soup of Biology. It all drips in wonder and magic. And then it dries up, turns to dirt.
It’s never easy. Saying the words. You can sense their worlds turn to crystal as the letters take shape. The fear and hope on their faces as if dipped in stained glass. The colors of their shirts and their rutted wrinkled fingers like ice. And then the words turn to sound. My voice’s echo against the walls. Each falls like a hammer. And then, exactly then, the world of frozen glass shatters, comes crashing, clanging down.
Then my least favorite part of this thing called doctoring. The search for words to fill the after. The prolonged silence that begs to end. The broken pieces and their bleeding edges that lay scattered like sharpened bones.
But first the before.
And still, how to tell him?
It wasn’t a philosophical dilemma. The squashing of hope. The awkwardness of having just met him. The irony of his daughter’s swollen belly right there in the room. No, this dilemma was pragmatic, more tangible and thus more real. The man had lost his hearing only three days before. The cancer’s latest claim had been the nerves between his ears and his brain. If only he’d come in before. When he could have still heard me telling him he was going to die.
His name was Russel.
Some of our mutual friends had reached out to me in the days and weeks before.
He says his vision’s getting blurry.
The ER sent him home.
He hates doctors. Doesn’t trust a one.
He’s down 30 pounds. Been smoking all his life.
And so too had they told me his stories. How his dirt bike had rode the ridgelines like the wind. How he charged Big Hanalei on a waterlogged relic without a cord. How he bedded more women than five times the number of any men of his time. I had imagined a legend. But here, across this table, the fragile shell of a man that once was.
My hand across the table’s Cloroxed skin. The crackle of its paper sheet amplified by the silence. These close-quartered walls. His daughter’s 8-plus-month discomfort, the improbable girth of her belly on that tiny spinning stool. All this hope and fear and denial and love. His cheeks hung like limp sails from sallow bones, cut like triangles behind his fleshless jaw. His lips looked thin and cracked. His crooked teeth, the ones still there, were tattooed in a yellow crust of excess and marinated in poor choice.
But there, hidden beneath the leather map of time-etched skin, cool blue eyes like spring tidepools. Clouded but present. Russel, not the legend, not the disease. But Russel, the man. Bearing witness. From those azure silent pools.
I pulled out my laptop. My fingers on the keys.
Russel, I’m Dr. Rogoff. Thanks for coming in.
Good to meet you, he said.
Your friends tell me you’ve lost 30 pounds. Seizures. Headaches. Night sweats. Blurry vision. And for 3 days now you can’t hear.
I watched him as he read. His blue eyes in their corniced dunes. They flickered like mosquitoes that zigzag through the night. I saw the upside-down reflections of the exam room’s lights upon his pupils, the screen’s white glow like hands cupped around my words. I imagined their meanings turned to impulses in his retina, the currents of electricity racing down his optic nerve and into the place in his brain where the Russel that was Russel reigned. The kernels of understanding as they spring emotions, clouds of colored fog as they swirl and take the future’s shape. The mosquitoes paused. His attention on me. His head as it nodded. As if he was only now facing the hard facts of his death.
The glow of the screen on my face again. The keys clicking in the silence.
And I read the CT report from the ER. Did the doctor there tell you what they found?
I turned the screen towards Russel. I watched his eyes. I wondered what he thought as I had typed, as he watched me.
Said there were some spots on the liver and lungs. Told me I needed to see my primary. Guess that’s you?
I nodded.
He was wearing a white T-shirt. With yellow marks. And stains. An old V-neck stretched too long in the front. There was a pocket on the right. Johnny smoked Marlboro reds.
I rotated the laptop back to me. I stared at the screen. The screen stared at me.
What if time could stop? What if I didn’t swing the hammer? Would the world stay fluid? Not turn to glass and come shattering down?
I typed the words. The words that called it cancer. The words that said surgery and chemo and radiation would all be mistakes.
I watched as he read them. The flickering mosquitos in the empty night. It was the first time in my life I was acutely aware of the infinite space between a man’s words and another man’s understanding of those words. Time stretched. I watched the emotions as they took root, formed shapes, spread out. Time returned again.
So what now? Johnny asked.
His daughter wore a blue maternity top, the kind with spandex at its bulbous base. Tiny spiral flowers were embroidered in white thread around the neck’s hem. Silver beads were stitched in each flower’s center. I could see at least two flowers whose beads were missing or had fallen off. Inside, tiny fingers, tiny wrinkles, tiny crescents like striped moons at each pink and perfect end.
The clicking of fingers. More words between cupped hands. Not facts. Just opinions. I’ve seen this too many times before. I used to preach the hope. Cling to life at all costs. But so too have I seen the suffering. Too much suffering. It all ends the same.
I spun the screen back to him. Like a gift. Like a curse. I watched. He read. The space in between our intentions and their truths.
They had told me he was a man’s man. All piss and vinegar. 12-pack of Coors Lights on his off days. A lit cigarette between his sleeping fingers in case he wakes and wants a drag. But men only speak of the parts of men that they see. And there is a tender underbelly to us all, the little boy that lives inside hidden with all his fear. I watched his eyes jump in their staccato flight, the sparks and currents, the growing wisdom, the little boy in the shadows, his skin bleeding in the frozen rain.
And then the silence, the solemn silence, the lonesome silence that awaits us all.
He looked at me. Ebbing tides in azure pools. He looked at his daughter, the silence casting that singular act as the most tender I’d yet seen in 20 years. She rubbed her belly in the way new moms-to-be like to do. The new baby. The grandpa she would never meet. A new truth taking root in the fractured broken world.
A blinking cursor on a screen. The light around it harsh and white and cold.
He had come for something else. And yet I had stolen it. Turned the stars and sky to glass and swung my hammer against it all.
But still, that space between words and their hearing. So much of what’s real lost forever in that gap.
Only now, and oh so slowly, I’m beginning to understand Russel’s gift to me. In all the words he’d never said. In the silent tidepools. In the chiseled roadmap of his timestamped skin.