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?”
“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 stilclass="underline" 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.”