THE BATTLE

“I don't think your wife wants any more cornflakes, Mr. Johnson.”

He pretended not to hear me. He didn't turn around. He remained sitting on the edge of the hospital bed, gathered another spoonful, and inserted it delicately into her half-open mouth. She chewed slowly, and swallowed with difficulty. He gathered another spoonful.

“Mr. Johnson,” I said more emphatically. He paused. “When people are dying, they're not interested in food.” He bristled. His eyes showed determination.

“You don't know anything,” he said. “She is not dying, there is no cancer, her blood pressure is not as low as you say.”

“As a matter of fact . . .” I started to correct him, but he kept talking.

“Every morning you barge in here, you listen to her lungs, you talk about tests, and specialists, and second opinions, and she doesn't get any better. Yesterday you had that woman doctor examine her . . . she has had radiation ‘down there’; it hurt her and accomplished nothing.”

“She specializes in cancers of the . . .” I couldn't interrupt him.

“When someone brings a car to my shop, I figure out what is wrong and I fix it. I give them back their car, and everybody is happy, and life goes on. I have brought you my wife, and you offer only tests. You don't know what you're doing.”

I straightened, and locked my knees. I drew back my white coat at the waist, placing both hands on my hips. I felt like a sheriff in the Old West. Instead of a badge and a revolver, I had a white coat embroidered with my degree, my department, my authority. I knew all the test results, and I knew why there was no curative option. I was prepared to defend the treatment plan.

He wore a coat too. It was camouflage—Vietnam era I guessed. The sergeant stripes suggested he spent many years as a soldier. He knew all about fighting. The ribbons on his jacket spoke to his courage. I saw a purple heart—he knew what it was to be wounded. At one point, he must have been an imposing soldier, but now his coat was baggy, he walked with a cane, and he squinted through large round spectacles. He was an old man.

I exhaled, and said nothing. I was tired, and fighting would not change anything.

“I know what my wife needs,” he continued. “She must eat. Then she will regain her strength. Then she will recover.”

Mrs. Johnson was motionless in her bed. She was emaciated, worn out from her long battle with cancer. She wore a wig with thick luscious brown curls, which seemed out of place against her wrinkled forehead and wasted temples. She wore pink toenail polish—unevenly applied, but fresh. Above the bed were several pictures of her and her husband: at the beach, at the ballpark, barbecuing by the river. Every picture was local, and included only the two of them. He often carried a bag of supplies, and she often wore t-shirts with sarcastic slogans. They had big smiles.

Her infection was causing her blood pressure to drop, but mentally she stayed attentive to the conversations around her. Throughout her weeklong hospitalization she had seen every specialist in the hospital, patiently allowing each to examine her, review her diagnoses, and explain that nothing more could be done. She listened politely to what they said, but she obviously cared most about what her husband thought. Even when her eyes assumed a far-off look, her gaze remained directed at him.

“Come now, and eat some more breakfast,” he instructed.

“I know you want to help your wife.”

“I am helping my wife.”

“I promise you, if I had a medicine that would make her live longer . . .”

“No more medicine. She needs food.”

“It's too late for that, feeding her will only make her uncomfortable.”

“This is what she needs!”

“She doesn't need cornflakes!”

“You're supposed to heal her, but you only speak of death! I give her . . .” He trailed off, and gathered another spoonful. We both turned toward her.

“Mrs. Johnson,” I asked, “do you feel hungry? Do you want more cornflakes?”

Everything stopped. She silently looked at her husband, then turned her head and looked at me. I saw determination in her eyes. She turned back to him, leaned forward, and took a spoonful of his cornflakes.

“You see, I know how to take care of my wife,” he said flatly.

I stepped back. On the first mouthful, I watched her swallow with difficulty. On the second mouthful she gagged. She prepared herself for a third, but I couldn't tolerate watching anymore. I stepped forward, interposing myself between her and her husband, blocking her view of him.

“Mrs. Johnson,” I repeated, “do you want any more food?”

She said nothing, but her gaze fell, and she sank back into her pillows. He put down the cornflakes. The room was silent except for the ticking of the wall clock. He spoke first.

“You should have eaten more at home, like I told you. Then you would not be so weak.”

“Mr. Johnson, it's not her fault. It's the disease.”

He wiped tears from his eyes and repeated weakly, “It's not your fault. It's the disease.”

Her breathing was shallower than before. He moved closer to her on the bed, and took her hand. I quietly left the room, leaving them alone together. I trusted the nurses would keep her comfortable.

My day proceeded as usual: morning report, rounds with the attending, noon conference, admissions, and discharges. I reviewed lab results, I taught my intern, I read progress notes. Usually, this daily routine absorbs all of my attention and causes me to forget that, for each patient in the hospital, every day is far from routine.

A nurse paged me late in the afternoon. “Mrs. Johnson just died, and we can't find her husband anywhere.”

I went to her room, pronounced the death and filled out the necessary paperwork. An hour later he was still missing. I stalled for time, not wanting him to return to an empty room. Through the window I watched the sun set. The creeping shadows made the nearby George Washington Bridge seem ominous, standing 200 feet above the swirling currents of the Hudson River. The paper clip I was playing with broke in my hand, and I reminded myself to unclench my jaw. I hoped he would return. Eventually, I found a relative's phone number in the chart, and notified the family of Mrs. Johnson's passing. I signed my pager over to the night resident and headed home.

In the lobby I saw him, standing alone and staring blankly out the window.

“Mr. Johnson, thank goodness. I'm so glad I found you.” I was taken aback by the fear in his eyes. “Um . . . we need to talk.”

“Is she . . . dead?” He stammered.

“Let's go upstairs and talk about some things.”

“No. I'm not going anywhere until you answer me.”

“She died an hour ago. Let me take you upstairs to say goodbye.”

He did not move, but only stared into the distance. “Why did this happen?”

I thought about the cancer, the infection, her blood pressure, and saw that was not his question. “I really don't know, Mr. Johnson.”

We rode the elevator in silence. He leaned on his cane more heavily than before. Outside her room I sank into a chair while he went inside, and we cried.