Those Gallant Days Are Long Behind Him

It’s 7:30 in the evening and I’ve been at the office since 8:00 this morning. I’ve seen twenty-three patients thus far—a respectable number, though nowhere near my record of thirty-seven. The average life expectancy is eighty-eight, and the cancer business is booming. People are growing old, yet their golden years are fraught with disability and misery. The American Way, however, is never to give up. We stave off death for as long as we can, come what may.

I’m late to Rachel’s charity event, but I still have one patient left to see, Mr. Toczauer, whom I’ve been treating for three years. Yesterday was his eighty-sixth birthday. He spent it in the hospital, just like he did his eighty-fifth and eighty-third birthdays. He got a reprieve on his eighty-fourth, managing a short bout of good health, which—like all good things—ended quickly, landing him back in our care a few days later.

Before Mr. Toczauer became a near-permanent ward of the National Healthcare System, he had worked for forty years in middle management for a plant that manufactures breakfast cereal—a terrific vocation for a man of Mr. Toczauer’s abilities. His job was to work with a team of analysts to crunch the numbers and then make strategic decisions accordingly. I’d never thought about it before Mr. Toczauer had explained it to me, but there are trends in breakfast cereal consumption. For example, in 2022, an “anti-GMO” lifestyle craze swept through the entire West Coast. Virtually overnight, all cereals made from Monsanto’s GMO corn stopped selling, from Seattle to San Diego. The grocery stores couldn’t give Frosted Flakes or Cocoa Puffs away. Realizing this, Mr. Toczauer ordered all corn-based cereal production to be relocated from their plant in Riverside, California, to their plant in Martel, Ohio. In its place, he shifted all production of granola. This spell of genius saved the company millions in shipping costs. Mr.Toczauer was deemed a hero, and for his efforts his photograph was hung in the lobby of the corporate office in Topeka, Kansas.

But those gallant days are long behind him. The man lying in hospital room #122 would be virtually unrecognizable to anyone who knew him in his prime. In fact, he’s been in this state of indefinite twilight for so long that I’m not sure even his own family can remember what a strong and adept man he once was. Unfortunately, it’s this condition—as a dependent, as a burden, as a man who can’t feed or bathe himself—that will forever be his legacy.

Mr. Toczauer’s condition is called Agnogenic Myeloid Metaplasia. It’s a real mouthful to say, and I always stumble over the words as I give the diagnosis to a patient and their family. Every time, I have to repeat myself because my audience gets hung up on the words themselves, rather than what they represent. Mr. Toczauer’s state is so bad that for the past year he’s been completely dependent on blood transfusions just to stay alive. But now even this has ceased to work.

When I enter his room, Mr. Toczauer is surrounded by his wife and grown children, a son and daughter. The man’s cheeks are so hollow and gaunt that the yellow skin on his face hangs off them like dead weight. When he gasps for breath, I notice that there are more teeth missing than not. His head, which I was told had once been thick with blond, curly hair, is now bald and flecked with liver spots.

“Hello, Mr. Toczauer,” I say. “We have your blood test results. I’m afraid your anemia has worsened. I’d like to speak with you and your family about the next phase of your care.”

“We’ve fought the cancer like hell, haven’t we, Doc?” the old man stammers. “But I’m tired now. I know when I’ve been licked.”

“Don’t you talk like that,” his wife objects. “You’re a fighter. You still got a few good rounds left in you, I know you do!”

The wife is a nervous, birdlike woman with grey, straw-textured hair and very thin lips.

She incessantly touches her face as she talks. Her son puts his arm around her.

“He hasn’t been eating, Doctor,” she says. “Is that because of the anemia?”

“Your husband is very sick, Mrs. Toczauer. His bone marrow is rapidly being replaced by scar tissue, leading to abnormal red and white blood cell production. This is causing his spleen and liver to become extremely enlarged.”

The son, a chubby, ruddy-faced man of fifty, takes control.

“So what’s the next step here?” he inquires.

“In situations like your father’s, I’m required by the Quietus Law to inform you of the euthanasia option.”

“Euthanasia?” the wife asks.

“The intentional ending of a life,” I say, “to relieve pain and suffering.”

“That doesn’t sound so bad,” Mr. Toczauer cautions. “Is this a normal thing for people to do?”

“It’s not particularly common, no. Regardless of a person’s condition, it’s generally human instinct to cling to any semblance of life, no matter how poor its quality. However, just last month, I had a patient meet his end with great courage. He had a terminal case of non-Hodgkin lymphoma, and he decided it was his time. He conferred with his friends and family, and they scheduled a date that worked with everyone’s busy schedules. Those closest to him were able to be by his side. It was quite beautiful, actually.”

“Hell, I’m sold!” Mr. Toczauer exclaims, turning toward his wife. “What do you think, honey, should we invite Cousin Wayne to my death party?”

“How can you even joke about such a thing?”

“This is nonsense,” the son says. “What other options are there?”

“We can move your father into hospice, where we can make him as comfortable as possible.”

There is a collective gasp from the family.

“No, no, no,” the wife cries. “None of this is any good. Please, Doctor, anything that might save him.”

“The only other option is another heavy dose of chemotherapy, followed by a bone marrow transplant. But you have to understand, these are extremely invasive procedures that will cause your husband extreme and unnecessary pain. The odds he’ll survive them are less than five percent.”

The mother and children confer. The daughter makes an emotional plea about the sanctity of life and how it must be preserved at all costs, while the mother and son nod.

“I can’t stress the point enough,” I interject, “this series of procedures would be extremely painful, torture really, and, again, the chances of their success are very small.”

I can tell these words are falling on deaf ears. Each of them has embraced their own brand of absurdity to rationalize an inevitable conclusion. In an effort to appear he’s tempering his foolishness with a modicum of reason, the son asks a final question.

“And what about the cost? Will we have to pay for this out of pocket or would it be covered?”

“These procedures are extremely expensive. The costs for them and the subsequent months of care, assuming he survives the initial chemo and transplant, will cost millions of dollars. Of course, your father, as a citizen, under the current laws of the National Healthcare System, is entitled to these services, if that’s what you choose.”

The three huddle for a final consultation. After less than fifteen seconds, a decision is reached.

“He is our blood,” the son announces, “and we have a responsibility to him. As long as he’s still breathing, then we have to continue doing everything we can to make sure he lives.”

“And is this what you want?” I ask Mr. Toczauer.

“If it’s what my family wants,” he says, “I’ll do it.”

“Are you sure you believe this is for the best?” I ask the family. “It’s my professional opinion that there are more humane options.”

Mr. Toczauer tries to speak but is cut off by his son.

“We’ve made our decision, Doctor. Thank you.”

“Very well,” I say. “We’ll get your father scheduled to begin his chemotherapy.”

Copyright 2018 Matthew Binder. Published by Black Spot Books.