As if from inside the earth

"I'm a 70-year old basket case," he said.

He was right. He'd been admitted a month before for workup of what was thought to be a relapse of a malignant melanoma--an aggressive cancer. His chart told a story of overwhelming chronic anxiety and depression dominating his adult life and resulting in a near-total inability to care for himself. His mental illness featured prominently in his hospitalization; most mornings, when I scanned his chart, there were notes from the nursing staff about him crying out in the night, and notes from the chaplaincy service about the previous day's existential crises.

For reasons not worth going into, the coordination of his necessary biopsies took the better part of four weeks. No one expected to find anything other than cancer, really, but on this day, we'd gotten a call from a pathologist suggesting that instead of cancer, the patient had an unusual manifestation of a different, fairly common, and eminently treatable disease.

I was sure he'd be happy when I told him the news. He asked for clarification, and I explained the treatment, a long course of intravenous medication. He was quiet for a while, and then: "That's good, right?"

"Yes," I said.

"Hmph."

I put my stethoscope earpieces in my ears and was listening to his chest when he spoke again. I lifted up the diaphragm of the scope--it's impossible to hear breath sounds over voice sounds--and heard his voice, made louder and strangely faraway by the instrument: "I'm a 70-year old basket case."

"What do you mean?" I said.

"I'm a sick, sad old man," he said, and was quiet for a while. Through the stethoscope, his silence sounded like the inside of a seashell. Then, foggily, as if from inside the earth, he said, "Is this worth it?"

I didn't know how to answer his question. Looking back, I cheerily ignored it.

Last week, long after I'd transferred services, he became unresponsive and was coded, then transported to the ICU. I heard about the code later--it had gone on for over two hours. Looking at his blood test results during a quiet moment in the hospital tonight, I can see that he is dying.

Through the computer screen, he is as far away from me as I was from him on that day, when he opened the conversation that I quickly closed. If I had listened to the meaning of his words and his unmuffled voice, maybe I would have heard what he was asking me--if it was OK for him to let himself go.

I should have taken off the stethoscope.