Despite his group home attendants’ best efforts to feed him carefully, he still has frequent episodes of food aspiration and chest infections that leave him wheezing and gasping for air. Whenever this happens, he is immediately brought to our emergency department for treatment. We dutifully admit him to the medical ward and start him on oxygen, regular suctioning, bronchodilator inhalations and intravenous antibiotics. Sometimes he becomes so ill we have to intubate him and put him on a ventilator.

He has some relatives who have power of attorney over his affairs. They live less than an hour away. In the nine years I’ve known Harry they haven’t visited him once. I’ve called them on two occasions to ask whether they’d consider switching his code status to “do not resuscitate.” Both times their answer was the same: “Keep him alive, doc – we’ve been thinking about coming up to see him sometime.”

So the battle to save Harry continues. Day after day I go into his room and watch him struggle to breathe. It’s a Greek epic being played out in a hospital bed; an endless tragedy with a cast of one, viewed by an audience of one. To me, Harry embodies the combined suffering of Prometheus, Tantalus and Orpheus. Sir Laurence himself couldn’t evoke such pathos.

He cranes his head to the side in an attempt to look at me whenever I place my stethoscope on his misshapen chest. His moist, cow-like eyes roll in all directions. I often wonder if he’s going to bite me. It’s an irrational thought; Harry is wholly incapable of aggression.

Does Harry have thoughts? If so, how does he perceive this world? Is it a magical place or is it an unending horror? Are we his saviours or his tormentors? Does he admire us or despise us? Does he hope for life or death?

It may well be that his mind is a blank slate. If that’s the case, perhaps we shouldn’t stand in his way the next time we see him lumbering towards the brink.

Some Patients Are Never Ready

Two years ago Max noticed a trace of blood in his stool. Colonoscopy revealed bowel cancer. Staging investigations didn’t show any evidence of tumour spread. It was felt he had a good chance of surgical cure, so arrangements were made for a bowel resection.

The surgery went well. To everyone’s relief, the sampled lymph nodes came back negative for cancer cells. In the weeks following the operation it became evident that his surgeon and his oncologist held opposing views regarding the potential benefits of adjunctive chemo. After carefully considering both options, Max declined chemotherapy.

Six months later I was in the radiology suite looking at a surveillance x-ray of Max’s chest when I noticed a small lesion near the apex of his right lung. Uh-oh. Hard times ahead.

“What does it mean?” he asked when I saw him in my office the following day. “The cancer hasn’t come back, has it?”

“I hope not, but it’s possible,” I answered evasively. “I’m going to send you back to the cancer clinic. They’ll run some more tests and then do a biopsy.”

The scans confirmed our worst fear – the spot on his lung looked cancerous. No other traces of malignancy were found, though. The chest surgeon was hopeful the lesion was a new primary rather than a metastasis. If it had arisen de novo, removing it could be curative. If it turned out to be a metastatic subsidiary of the original cancer, his long-term prognosis would be abysmal.

Max’s lung surgery was uneventful. A month later he was back in my office to review his pathology results.

“Did they get it all?”

“It looks that way, judging by the reports.”

“Was it related to the first cancer, or was this one brand new?” His voice quavered slightly.

“They’re not sure – the pathology findings were inconclusive.”

“How could I have gotten lung cancer, doc? I never smoked a day in my life!”

“Well, every once in a while a non-smoker gets lung cancer. Just bad luck, I guess.”

“What happens next?”

“Chemotherapy.”

The chemo left Max weak and hairless, but he didn’t care. Anything to reduce the chances of a recurrence.

Six months later an abdominal ultrasound picked up a new lesion on his liver. Max nearly cried when I told him.

“What do we do now?” he asked. I sent him back to the cancer treatment centre. The chemo regimen he was given failed. So did the next one. After the third failure I tried to gently broach the topic of terminal cancer and palliative care, but he recoiled. “I don’t want to know how long I’ve got. I’m not ready to die yet.”

Max has undergone many more chemo and radiation treatments. Each successive scan shows more lesions than the one before.

My patient now weighs about 90 pounds. We’ve run out of treatments to offer. Although his emaciated body is riddled with cancer and his candle is slowly guttering, he’s still not yet ready to talk about dying.

I don’t think he ever will be.

Shotgun Bubba

“My husband and I are worried about Bubba. He’s been acting really weird lately and we think his schizophrenia might be getting out of control. He’s got this idea there are people hiding in the attic and they’re plotting to kill him.”

“Gee, that’s too bad. We may have to increase his antipsychotic medication.”

“Thanks, doc. Things have gotten so out of hand Bubba’s even refusing to go outside because he’s worried he’ll get kidnapped.”

“That sounds pretty paranoid. Is he saying or doing anything that makes you feel nervous or unsafe in any way?”

“No, nothing like that.”

“Are you sure?”

“Well, come to think of it, a couple of nights ago I was sitting on the toilet in the middle of the night when all of a sudden the bathroom door banged open and there he was with a shotgun in his hands!”

“A shotgun?”

“Yeah.”

“Was it loaded?”

“Oh yes, we always keep our guns loaded. Sometimes we get bears on our property.”

“Good grief!”

“Since then he’s taken to walking around the house with the shotgun all the time. He says he’s seeing spooky faces in the windows and holding a gun makes him feel safer.”

“Your paranoid, psychotic and hallucinating brother is patrolling your house night and day with a loaded shotgun and that doesn’t worry you?”

“Why should we worry? He never points it at us.”

Disneyfied

Little Tiffany’s dad has brought her in for her four-month well-baby check. She’s been healthy and so far everything looks normal. While I’m examining her eyes I ask her father: “Do you have any concerns about her vision?”

“No doc, as far as we know, her eyes are fine.”

“That’s good,” I reply.

“And she sure loves her Disney!”

“What?”

“Disney movies, doc. The cartoon ones! She just loves them!”

“She watches Disney movies?”

“Yeah, she can’t get enough of them!”

“But she’s only four months old! How long has she been watching television?”

“Oh, since she was about a month and a half. We put the TV right up beside her crib and prop her up on a pillow. Sometimes she’ll watch an entire movie! You should see her smile!”

“Um, several studies have suggested it’s better for kids to not watch television until they’re at least a year old.”

“Those guys don’t know what they’re talking about.”

Slippage

Things are slipping. It’s a steady, relentless process. Every day another inappropriate behaviour crawls out from under a rock and suns itself in plain view. What’s going on? And where will it end?

Not that long ago even the snarkiest adolescent would at least have made a token effort to not swear within earshot of an adult. My, how times have changed. Some of the language you hear from kids nowadays is harsh enough to make your ears bleed. More than once I’ve had to hastily round up my children and flee a playground in order to escape the profane chatter exploding all around us. I’m not just talking about the odd expletive being lobbed around. That doesn’t even make me blink anymore. No, I’m talking about the air being saturated with verbal shrapnel from continuous f-bombing. It’s like a sonic blitzkrieg. I’m no choirboy, but I’ve got my limits.