For some time, I’ve been experiencing sudden drops in blood pressure, an internal imbalance which means that, on a daily basis, I frequently feel as if I were on the verge of fainting. The symptoms are quite clear: cold sweats, pallor, a feeling of inner weakness, a decrease in body temperature, and, of course, the slight dizziness anyone experiences before a fainting fit. I told you all this. And you noted everything down. You asked a few questions. Then you checked me over, took my blood pressure, “120 over 80,” you said, adding: “Very good.” Then I mentioned the article I’d read and told you that was the reason I’d come to see you. You just smiled. I swear to you I felt sure I’d finally found a doctor I could trust.
At our next appointment, and you’re bound to remember this, I arrived with the results of the tests you’d advised me to have done. A complete blood count and a lipid profile. You were just as friendly as you were the first time. We even joked a little, talking about my ex-wife, about women and ex-wives in general. I felt we were making some progress in our relationship. You told me that you were married and had two children. I told you that, fortunately, I hadn’t had any children during my failed marriage. Anyway, then we got down to medical matters. You said that the test results were excellent and that I was fine. That was impossible, I told you. I was still getting the dizzy spells. Perhaps you didn’t like me being so insistent. But I had to do it. I was the one who was going to faint, not you. In fact, I said just that. Then you assured me that I was in perfect health. That I wasn’t going to faint. That it was a physical impossibility. On that occasion, you asked me to believe you, to trust you. And I did, Dr. Miranda. Now I’m the one asking the same thing of you: believe me, have faith in me, trust me . . . please, answer me!
Hoping to hear from you soon.
Sincerely,
Ernesto Durán
When Miguel arrives, Andrés is already sitting at a table slightly apart from the other tables, drinking his second whisky and ice. Miguel looks harassed and preoccupied.
“Sorry I’m late,” he says as he sits down.
Andrés merely makes a vague movement with his head, neither a nod nor a shake, as if hoping, nonetheless, to communicate something by that gesture. His face almost breathes unease and distress.
“On the phone you said it was something serious,” says Miguel, “but now that I see your face, I feel quite frightened. Whatever’s happened?”
Andrés points to the two envelopes on the table.
“Have a look at those,” he says, almost in a murmur.
Miguel picks up one envelope, takes out the X-rays, and holds them up to the light. First, those showing the lungs, then the images from the brain scans.
“There’s no mistaking the signs. There’s no other way to read them,” says Andrés. “Or is there?”
Miguel turns toward him, tense, not sure what to answer. The waiter approaches and before he can say anything, Andrés cuts in with:
“He’ll have a vodka with ice and lemon. A double,” he tells him emphatically, deliberately, his eyes fixed on Miguel.
“I have to perform a fistula operation this afternoon,” Miguel says in answer to a question no one has asked, although he doesn’t sound very convinced.
“Just tell me what you think. There’s no hope, is there?”
Miguel doesn’t so much sigh as snort, before turning back to the X-rays. He again holds them up to the light, looking at them almost obliquely. The contrast between the blue and the opaque white reveals spots, dark irruptions, shadows that should not be there.
“It’s a spinocellular carcinoma, isn’t it?” Miguel asks, still scrutinizing the results of the scans.
“Stage IV,” says Andrés. Then he points to one of the CT images. “With cerebral metastasis,” he adds, his voice breaking.
“Whose X-rays are they?” Miguel asks rather fearfully, looking straight at him now.
“My dad’s,” says Andrés.
They sit staring at each other for a moment, not saying a word, wrapped in that rare complicity that comes with friendship.
“Shit!” is all Miguel can manage to say after that pause.
Andrés quickly talks him through the sequence of events: first, the fainting fit, then his own presentiment, the results of the blood tests, that presentiment again, the chest X-rays, and the CT scans. Miguel tries to get more details, to find other possible explanations.
“If he weren’t my father,” Andrés says, “you and I would have looked at the plates and concluded that there was no hope, that it’s the mother of all tumors, that the patient is basically screwed,” he adds, his voice choked with emotion. “There’s no need for a biopsy, there’s no point in opening him up.”
“Maybe, but . . .” Miguel would like to say something, but there’s nothing to say. He can’t fool Andrés.
“Why do we find it so hard to accept that life is a matter of chance?” Andrés asks suddenly, a lump in his throat.
They both fall silent. Another whisky, another vodka. Miguel makes a phone call to cancel that afternoon’s operation. Andrés puts the X-rays and CT images back in their envelopes.
“And your dad, of course, knows nothing.”
“No.”
“You’re not going to be so stupid as to tell him, are you?”
“That’s what I always do, isn’t it? It’s what I’ve always said, the position I’ve always defended: the transparent relationship between doctor and patient.”
Another silence. Then Miguel tells him that he’s never agreed with that approach. Andrés nods, as if he hadn’t heard him, as if it were merely a mechanical, involuntary movement made while his mind is elsewhere. Perhaps he’s listening to his memory, watching all the sick people he’s treated and their families parade past; seeing all those who were going to die and for whom there was no hope. Perhaps he’s remembering how he put into practice his theory of transparency. Some people even found him hard and inhuman. Others thanked him. Andrés always preferred to share the clinical truth with the objects of that truth, with those weary bodies, transformed into medical material, the recipients of needles and chemicals. It had often fallen to him to say: “I’m sorry, there’s no hope. There’s not even any point trying somewhere else, going to Los Angeles or Houston. You have, at most, two months to live.”
He has always insisted that it’s best to be completely open with a patient. Even at the risk of inoculating him or her with a fear as terrible as the sickness itself. The likelihood is that the patient already suspects it, senses it, is secretly listening to the warnings coming from his or her own body, to the final note sounded by the sickness.
“We all have the right to know that our life has an end date, a deadline; we all have a right to know when and how we will die, that’s what I’ve always said.”
“But now it’s your father who’s on the other end of the stethoscope. It’s absurd, Andrés, think about it. You and I know how fast a cancer like this spreads.”
“And he’s never even smoked, damn it!” mutters Andrés. “Not a single bloody cigarette in all his life!” he exclaims, pressing his lips together, as if he had bitten on an ice cube.
“That’s what I mean. Don’t you think he’s going to say precisely the same thing and ask the same question? What point is there in him knowing the truth?”
“I can’t deceive him now. It wouldn’t be right.”
“I’m sorry, but that’s total bullshit.”
“No, it’s not. It’s part of our history, part of what we’ve been through together, as father and son.”
“The big question is: can you do it?” While he speaks, Miguel fidgets on his chair, leans forward, gives a certain confidential tone to his words. “I mean, it’s easier to say such things to a patient, to someone who isn’t a member of your family. It’s upsetting, but it’s not the same; it’s different having your father there before you, and having to say to him: ‘Dad, you’ve only got a few more weeks to live.’ That’s what I mean. Can you do that?”
&
nbsp; “No, I can’t.”
Miguel nods, picks up his glass and takes another thoughtful sip before glancing first at his watch and then back at Andrés.
“Let me tell you about a case we had in the department recently,” he says at last.
Miguel is a nephrologist and, as well as having a private practice, he has worked for years as the director of a dialysis unit in a state-run hospital.
“There’s this one patient, he’s sixty-eight, a grumpy old thing called Efraín. He’s a diabetic, at least that’s his main ailment. He’s in the final stages, his kidneys are pretty much buggered, and he’s nearly blind. He has a terrible time on the dialysis machine. He screams and cries. He drives the technicians and the nurses mad. He’s become very bitter and fed up with life. Worse still: living for him equals suffering. He has to come into the unit three times a week and follow a ghastly diet, he finds walking very difficult and his life expectancy is reducing by the day, so you can imagine what his life is like. One afternoon, one of the nurses asked if she could speak to me alone. I was a bit puzzled by this at first, but we went into the office and sat down. Then she told me that Efraín wanted to die. I was really surprised. I thought perhaps she might be joking. Of course he must want to die, but the tone in which she said it implied something else. She said again that he wanted to die, that he was fed up with the whole business and tired of living like that. In principle, the procedure was simple: he just had to stop coming for dialysis. That’s all he needed to do. If, for one reason or another, he stayed at home, that would be that. His body wouldn’t be able to stand it, some organ would simply stop working and he would die. You could almost call it a natural death.”
Andrés nods silently. He signs to the waiter and asks for another whisky.
“That’s what the guy wants,” Miguel goes on. “He just wants the nightmare to end. So do his family. They’ve had enough, they’re as ill as he is. His illness has infected them, it’s killing them as well. They’ve spent years in the same hideous situation. You know what it’s like. The man can’t do anything for himself now, he’s half-blind, he stinks of bicarbonate from the machine, he has to take special medicines; they have to ferry him back and forth, keep an eye on his blood pressure, feed him, wash him . . . Viewed coldly and objectively, for his family it would be a great relief, in every sense, if he were to die. And there’s another point too: if you consider the situation from an institutional point of view, from the point of view of providing a public service, it would suit society as well if old Efraín were to die. You and I have discussed this kind of thing before. He’s nearly seventy and, given his age and state of health, he has no chance of being selected for a kidney transplant. But he’s taking up a place, a turn, on a dialysis machine. At the time, there was a seventeen-year-old girl on the list, waiting for a chance to start treatment at the unit. Wouldn’t it be fairer for that girl to be there, rather than Efraín? I know that someone else, hearing this same story, might think it was tantamount to sanctioning homicide or murder or assisted suicide. But at the time, we all thought that Efraín’s death could be a blow for justice as far as the girl and her family were concerned, and for Efraín as well. As you yourself said: he already knew what his end date, his deadline was. All he wanted was to exercise his right to hasten that moment and not to continue this painful, long-drawn-out death. I talked to a priest about all this once. He, of course, gave me a sermon. I waited, and when he’d finished, I asked him: is masochism a sin? He was surprised, he hesitated, and then he said, yes, it was. Well, Efraín didn’t want to go on sinning. Living, for him, was a masochistic act. He simply wanted his death to be a gentle one, he wanted his death to put an end to the torment of his life.”
“What are you getting at with all this? What did you do?”
“Do you know what happened? We decided to take the risk. All of us in the unit. If anyone had found out, we would have been in big trouble. The media would have had a field day, but that didn’t frighten us; we decided to take the risk anyway. I took it on myself to speak to Efraín’s family, to his wife and his eldest daughter. It was rather awkward, as you can imagine, one of those conversations in which no one says exactly what they mean; we spoke as if in code. There was a silent, secret pact. Efraín agreed to it too. He would go home, stop coming to dialysis, and that would be that. But it came to nothing. It all fell flat. And do you know why? Because we needed a signature, we needed one member of Efraín’s family to sign a piece of paper, saying that Efraín Salgado had stopped coming to the dialysis unit of his own free will. It was just a way of protecting ourselves, so that no one else in his family could come to us later and accuse the unit of refusing to help a patient.”
“And what happened?”
“No one would sign! Not one of his relatives would dare! They felt that by signing that piece of paper, they were confessing to a crime. And it was that one apparently foolish, trivial thing that brought the whole plan crashing down. What I considered to be a mere bureaucratic detail, a mere formality once we had sorted out the really important matter, became for them a kind of definitive symbol. The person who signed that paper would somehow be responsible for his death, would have Efraín’s corpse on his or her conscience. As if scribbling your name on a sheet of paper would immediately convert that act into a crime. At least, I think that’s what they felt. They needed to be able to turn a blind eye, they needed everything to happen as if by chance, as if it really were unintentional. They needed to feel that the old man was dying of his own accord, without any of them knowing anything about it.”
Miguel orders some curried prawns. Andrés isn’t hungry, he sits there mute and absent. His cell phone rings. He checks to see who’s calling and decides not to answer. The phone continues to ring on the table. It’s a pointless, futile sound. Andrés doesn’t offer an explanation, he just sits and says nothing. Miguel looks at him and suddenly feels rather embarrassed.
“I don’t really know why that story came into my mind,” he says, somewhat regretfully. “I don’t know why I told it to you. What connection does it have with your father and with what we’ve been talking about?”
“I’m not sure,” says Andrés. “But perhaps there is a connection.”
Miguel shakes his head.
“No, I just suddenly remembered it and felt like telling you, although now I really don’t know why. I’m sorry.”
Deep down, Miguel would like to take back that anecdote, to feel around on the floor for the crumbs of that story and return it intact to his memory. What made him think of it? Why had he got so carried away and told Andrés? It really wasn’t what his friend needed just then. It wasn’t what he was hoping for from him. He had asked to meet in order to tell him that his father has cancer, that his father’s going to die, and instead of being supportive and consoling, there he was telling him that macabre tale about a man who wants to die and about a wife and children who want their husband and father to die as well. Why? What for?
“Don’t worry, it’s alright.” Andrés shakes his head again. His eyes are sad, but he’s smiling slightly.
“No, it’s not alright. There you are, in a state of complete shock and what do I do? I start telling you some entirely irrelevant story.”
The waiter comes over with the bill, and the usual battle of the credit cards ensues, the battle to decide who pays. Miguel insists on making the bill his penance, and he wins. When the waiter leaves, Andrés says to Miguel, “I know what made you think of that story.”
Miguel listens, but continues to shake his head.
“Basically,” Andrés goes on, “your memory came up with a story about how dying isn’t as easy as it seems. That sometimes knowing what’s happening or about to happen doesn’t help. Nothing more. The word ‘death’ casts a very unpredictable spell. ‘Keep the truth from your dad. Don’t tell your dad the truth,’ that’s what you were saying.”
While Miguel makes a visit to the bathroom, Andrés thinks that perhaps this is one of the most t
ragic consequences of illness: it destroys all other appearances, it won’t allow death to dissemble, it ruins any chance of death taking place as if nothing at all or else something entirely different were happening.
By six, Andrés is on his way back home, caught up in a terrible traffic jam on the highway heading to the south of the city. All five lanes are completely blocked. It’s the typical urban image that appears to fascinate so many people: hordes of cars, one after the other, all breathing slowly beneath the indifferent, mustard-colored sun. For the first time in that whole painful situation, Andrés doesn’t feel gripped by bad temper or by the need to get home as soon as possible and to have a sense that the day is finally over. Perhaps it’s the effect of the whisky. On the passenger seat lie his father’s X-rays. Andrés is briefly aware of them in his peripheral vision. He closes his eyes. Only for a second. His eyelids feel stiff and painful. He knows what’s going to happen and that it’s inevitable. In a stupid, futile gesture, he turns on the radio, trying to stop the unstoppable. He flips from station to station, but they’re of no use, those intersecting voices and songs. He can already feel the tears pricking at the edges of his pupils. It’s unpleasant. It stings. He’s crying, but he’d also like to scream, to thump the steering wheel. His saliva has grown thick. He can’t hold back now, he can’t stop crying. He doesn’t know how.
Dear Dr. Miranda,
I don’t know how much longer I’ll have to wait for an answer. I thought that, after my second letter, you would reply within a day or two. Not so. I’ve been making some enquiries and I’ve been told that e-mails do sometimes go astray, that it often happens. This means that perhaps you did reply to me, but your reply got lost and ended up in someone else’s inbox, for example. It also occurred to me that perhaps it would be best if I printed out these letters and went in person to the hospital to give them to you. Although, before I do that, I would much prefer it if we could get this system to work and you could at least tell me whether or not you’ve received my messages. That’s all I need: for you to send a letter with a “Yes” or a “No,” nothing more, just that. Then at least I’d know we were in touch.
The Sickness Page 3
