In August of his last year of medicine residency, Dr. Delisle had been assigned to a Catholic hospital’s intensive care unit. It was kung fu medicine: new-minted ward interns pitched desperate cases; he parried them back—or to the morgue. It was fight choreography, diagnosis at a glance, therapeutics on the fly. It was a rush: grappling with death, flinging it away for a day, a week, a lifetime.
Eddie Scanlan was one of his cases: squamous carcinoma of the right maxillary sinus. He’d had it awhile: Eddie cared more about drink than facial asymmetry, especially when it came on gradually and hurt no worse than a stuffed head. By the time surgeons saw him, cancer had invaded the orbit and pushed his right eye awry, so Eddie looked at the world cockeyed--his left ahead, right up and away. They’d cut out the tumor, along with his right maxilla, part of his nose, and the floor of his orbit and they’d still left cancer at the margins. Radiation destroyed the eye and so scarred the surgical bed that plastic surgeons despaired of reconstruction. To cover the cavity, prosthetics had fashioned a mask he could hang from his ears like a false beard, but Eddie couldn’t drink with it and had lost it soon after discharge from another failed tour in rehab.
Eddie wound up in ICU with seizures as his cancer recurred in the floor of his skull and gnawed through meninges into brain. Antibiotics and radiation arrested it, but Actinomyces infected his cheekbone. His dressings were fungal orange, and the smell when the intern changed them was of rotting meat and grape must.
Eddie had no family he could remember, or that wanted to remember him. He had no address, insurance, or assets. He’d had drinking buddies, no friends. No one visited, except Sister Alice, who brought the hardest cases prayer and St. Jude medals.
She used to pray with Eddie Scanlan. Nothing controlled Eddie’s infection or his cancer, which ate through the bones of his forehead into his other eye, so that he lay abed blind, and of course he hadn’t been able to talk intelligibly since his upper jaw had gone into formalin.
Sister Alice had asked who had charge of Eddie’s case; the nurse had pointed out Dr. Delisle correcting an intern’s note on a cirrhotic dying of peritonitis. She sat by him, looking at Eddie.
“What will happen?” she asked.
Dr. Delisle thought. “His tumor will squash his brain down his spinal canal. Or his fungal infection will burst into his bloodstream. Or his leg veins will clot and throw an embolism. Or he’ll just die.”
She nodded.
Sister Alice seemed old to him then but couldn’t have been sixty. A slip of a woman, she wore a gray shift over white turtleneck, brown brogans over the knee socks only Catholic schoolgirls wear.
“And how long might that take?”
“Eddie should have died last year, and again last month, and again yesterday.”
“So you know when men should die, then?”
“Eddie tries to die. Whether he should or not, I couldn’t say. I try to stop him.”
“And why is that?”
“It’s what I do.”
She waited, but there wasn’t more.
“And you? Why pray for the dying?”
“Because the living are such a disappointment. But then, doctor, you knew that.”
She went back into the cubicle and said a decade of the rosary with Eddie, pulling plastic beads through his fingers. She left them closed in his hand.
She came back when they were changing dressings, the mess on the bedside table and the travesty of Eddie’s face all exposed. Nurses had the curtains shut, but she came through and watched.
After, she sat with Dr. Delisle at the nursing station.
“It doesn’t affect you?” she asked.
“Eddie’s face? Of course.”
“And yet?”
“See the work, not the man.”
She went back to Eddie’s cubicle with its odors of fungus and iodoform. What that was left of Eddie’s lips tried to move as she prayed with him: a Hail Mary, an Act of Contrition.
In the end, Eddie died of cavernous sinus thrombosis. What remained of his face turned livid, and he died. There was nothing to be done, so they’d done everything: intubation, cardioversion, chest compressions, bicarbonate infusions, intracardiac epinephrine.
When it was done, Sister Alice sat with Dr. Delisle, watching nurses clean up the mess: not just the corpse with half a face and broken ribs and bruised arms and neck on the backboard on the rumpled bed, but electrocardiograph paper spooled onto the floor and saline bottlecaps and used alcohol pads and needle packages and bloody gauze.
“It seems so horrible, dying alone and ruined like that.”
Dr. Delisle kept writing the death note.
“You don’t feel anything?”
He gave her the look residents reserve for people with lives outside hospitals. “I feel everything.”
“You don’t show it.”
His pen paused. “If I let it show, then where would we be?”
“In God’s hands, perhaps?”
“Eddie was in God’s hands. See where that got him.”
“Yes. Sometimes, I have trouble with acceptance. My Mother Superior has pointed that out to me.”
“And so you’re here?”
“In the past, I lacked the serenity to accept the things I cannot change.”
Two orderlies came with a gurney. Through a gap in the curtain, Dr. Delisle and Sister Alice watched them heave Eddie onto it. He went, only a line of lumps under white sheets.
“It doesn’t help,” she said, “anger. I learned that in Mississippi, and Chicago, and home in South Boston. In the end, we all wind up like Edward.”
“Maybe not just like.”
“Why do you do it?”
“Just because we can’t win, doesn’t mean we don’t play the best game we can.”
“So it’s a game for you?”
“For me? No. For God, I think.”
They watched the housekeeper sweep and mop up.
“I shouldn’t let that go.”
“Am I wrong?”
“And your work? It’s just your way of playing the game? You play out your anger against God with the bodies of these people?”
“Sometimes we win. Sometimes what I learn from people like Eddie saves someone else.”
“That’s a finer justification. Less honest, perhaps.”
“Perhaps.”
She stood to go. “Be careful. Anger can be as malignant as anything poor Edward had.”
She touched the hand he’d unclenched, then she left. Dr. Delisle returned to work and closed his fist again.
Eddie Scanlan was one of his cases: squamous carcinoma of the right maxillary sinus. He’d had it awhile: Eddie cared more about drink than facial asymmetry, especially when it came on gradually and hurt no worse than a stuffed head. By the time surgeons saw him, cancer had invaded the orbit and pushed his right eye awry, so Eddie looked at the world cockeyed--his left ahead, right up and away. They’d cut out the tumor, along with his right maxilla, part of his nose, and the floor of his orbit and they’d still left cancer at the margins. Radiation destroyed the eye and so scarred the surgical bed that plastic surgeons despaired of reconstruction. To cover the cavity, prosthetics had fashioned a mask he could hang from his ears like a false beard, but Eddie couldn’t drink with it and had lost it soon after discharge from another failed tour in rehab.
Eddie wound up in ICU with seizures as his cancer recurred in the floor of his skull and gnawed through meninges into brain. Antibiotics and radiation arrested it, but Actinomyces infected his cheekbone. His dressings were fungal orange, and the smell when the intern changed them was of rotting meat and grape must.
Eddie had no family he could remember, or that wanted to remember him. He had no address, insurance, or assets. He’d had drinking buddies, no friends. No one visited, except Sister Alice, who brought the hardest cases prayer and St. Jude medals.
She used to pray with Eddie Scanlan. Nothing controlled Eddie’s infection or his cancer, which ate through the bones of his forehead into his other eye, so that he lay abed blind, and of course he hadn’t been able to talk intelligibly since his upper jaw had gone into formalin.
Sister Alice had asked who had charge of Eddie’s case; the nurse had pointed out Dr. Delisle correcting an intern’s note on a cirrhotic dying of peritonitis. She sat by him, looking at Eddie.
“What will happen?” she asked.
Dr. Delisle thought. “His tumor will squash his brain down his spinal canal. Or his fungal infection will burst into his bloodstream. Or his leg veins will clot and throw an embolism. Or he’ll just die.”
She nodded.
Sister Alice seemed old to him then but couldn’t have been sixty. A slip of a woman, she wore a gray shift over white turtleneck, brown brogans over the knee socks only Catholic schoolgirls wear.
“And how long might that take?”
“Eddie should have died last year, and again last month, and again yesterday.”
“So you know when men should die, then?”
“Eddie tries to die. Whether he should or not, I couldn’t say. I try to stop him.”
“And why is that?”
“It’s what I do.”
She waited, but there wasn’t more.
“And you? Why pray for the dying?”
“Because the living are such a disappointment. But then, doctor, you knew that.”
She went back into the cubicle and said a decade of the rosary with Eddie, pulling plastic beads through his fingers. She left them closed in his hand.
She came back when they were changing dressings, the mess on the bedside table and the travesty of Eddie’s face all exposed. Nurses had the curtains shut, but she came through and watched.
After, she sat with Dr. Delisle at the nursing station.
“It doesn’t affect you?” she asked.
“Eddie’s face? Of course.”
“And yet?”
“See the work, not the man.”
She went back to Eddie’s cubicle with its odors of fungus and iodoform. What that was left of Eddie’s lips tried to move as she prayed with him: a Hail Mary, an Act of Contrition.
In the end, Eddie died of cavernous sinus thrombosis. What remained of his face turned livid, and he died. There was nothing to be done, so they’d done everything: intubation, cardioversion, chest compressions, bicarbonate infusions, intracardiac epinephrine.
When it was done, Sister Alice sat with Dr. Delisle, watching nurses clean up the mess: not just the corpse with half a face and broken ribs and bruised arms and neck on the backboard on the rumpled bed, but electrocardiograph paper spooled onto the floor and saline bottlecaps and used alcohol pads and needle packages and bloody gauze.
“It seems so horrible, dying alone and ruined like that.”
Dr. Delisle kept writing the death note.
“You don’t feel anything?”
He gave her the look residents reserve for people with lives outside hospitals. “I feel everything.”
“You don’t show it.”
His pen paused. “If I let it show, then where would we be?”
“In God’s hands, perhaps?”
“Eddie was in God’s hands. See where that got him.”
“Yes. Sometimes, I have trouble with acceptance. My Mother Superior has pointed that out to me.”
“And so you’re here?”
“In the past, I lacked the serenity to accept the things I cannot change.”
Two orderlies came with a gurney. Through a gap in the curtain, Dr. Delisle and Sister Alice watched them heave Eddie onto it. He went, only a line of lumps under white sheets.
“It doesn’t help,” she said, “anger. I learned that in Mississippi, and Chicago, and home in South Boston. In the end, we all wind up like Edward.”
“Maybe not just like.”
“Why do you do it?”
“Just because we can’t win, doesn’t mean we don’t play the best game we can.”
“So it’s a game for you?”
“For me? No. For God, I think.”
They watched the housekeeper sweep and mop up.
“I shouldn’t let that go.”
“Am I wrong?”
“And your work? It’s just your way of playing the game? You play out your anger against God with the bodies of these people?”
“Sometimes we win. Sometimes what I learn from people like Eddie saves someone else.”
“That’s a finer justification. Less honest, perhaps.”
“Perhaps.”
She stood to go. “Be careful. Anger can be as malignant as anything poor Edward had.”
She touched the hand he’d unclenched, then she left. Dr. Delisle returned to work and closed his fist again.
Stewart Massad is a gynecologic oncologist on faculty at Washington University in St Louis. His fiction and creative nonfiction have been published in JAMA, Discover, and smaller magazines. His short story collection “Doctors and Other Casualties” was published in 1993.