Roger looked up at me over the oxygen mask, his eyes drawn wide by the sores stretching his face. He lifted a hand for me to take.
"I'm glad you're here," Jen had said before I'd entered his room. "They've taken him off a lot of the medication. He's very lucid, but he's depressed and scared."
The previous fall, Roger and Jen had begun couples therapy with me. They were both thirty-two and had been together for ten years. Three years before they came to me, Roger had been diagnosed with leukemia. A bone-marrow transplant had left him cancer-free, but his prognosis was guarded. He and Jen argued frequently, his desire for independence clashing with her insistence on managing his care.
When they first visited my office, Roger shuffled in, bent and thin, on a walker. He wore a baseball cap, pulled low to shield his light-sensitive eyes. When he removed it, I saw that his face was covered with scabs, his bald head mottled in odd colors.
Jen spoke first, asking how much I knew of Roger's medical situation. I shared what I'd been told, being careful not to paint too negative a picture. Then Roger spoke. His calm, thoughtful voice provided a stark contrast to his physical appearance. He seemed remarkably free of resentment about his condition. As he described the ways in which leukemia was shrinking his world, he occasionally smiled faintly and absentmindedly stroked a missing eyebrow.
During our sessions, I learned that Roger had gained a reputation among his doctors as an inveterate fighter, and that neither he nor Jen seemed inclined to consider the very real possibility that he might not survive. I avoided challenging their denial--and soon fell into it myself, despite the fact that Roger couldn't seem to gain weight. Gradually, I fell in love with them as if they were my own children--not always the best move in my trade. Perhaps I felt awed by their courage; perhaps I still ached from the death of my estranged brother the year before.
Roger's hospitalizations grew more frequent and, as the April rains arrived, his individual therapist called to tell me that Roger's current hospital stay was likely to be his last. So I went to see Roger and Jen in the hospital. I felt the unnerving conviction that I needed to do something to help them prepare for Roger's dying.
Death is not a familiar to me. My parents died quickly and far away. I myself am hopelessly hypochondriacal; a new ache can throw me into a panic about my own mortality. I've read the literature on working with the dying, but it's always seemed too formulaic. I felt ill-equipped to help Roger and Jen that day.
The hospital was old and large and Byzantine. I wound my way through the long corridors to Roger's area. Jen greeted me at the doorway and asked me to see Roger alone.
I leaned over the bed, close above his oxygen mask. Straining to breathe, he told me that he was growing weary and that he didn't know if he could continue to fight. But each time he tried to tell Jen, the fear in her eyes stopped him.
I felt myself straining along with Roger's labored breaths. The very determination that drove Roger and Jen to battle his illness, and sometimes one another, seemed now to deny them the peace they so deserved. As the rain sighed at the window, a thought took shape in my mind. I touched Roger's gaunt shoulder.
"Life shouldn't only be about fighting, should it?" I asked.
Roger lay quiet for a minute, then asked me to bring Jen in. She sat down and began discussing his medications. I interrupted, telling her that Roger was having a hard time talking to her--that he was worried that she might not be able to go on without him.
"I can't even think about that, Roger, but I don't want to stop you from talking to me," she said.
"Jen, you've taken a lot from me--"
"Roger, I--" she began. Almost reflexively, I reached to stop her.
"Just listen," I said.
"Jen," he continued, "you are my soul."
With this, I left them together, found my way through the long corridors and stepped out into the pouring rain. Lines from Yeats' poem The Lake Isle of Innisfree were running through my mind:
And I shall have some peace there, for peace comes dropping slow,
Dropping from the veils of the morning to where the cricket sings...
Two days later, Jen called early in the morning to tell me that Roger had died peacefully the night before, with her beside him. Despite her grief, she thanked me profusely for the talk I'd had with Roger, saying that it had calmed him, helped him to reach a different place.
I fought the urge to say that I hadn't done anything--or at least that I hadn't known what I was doing.
Instead, I just listened.
About the author:
Lawrence (Larry) Dyche ACSW is a family therapist in New York City and teaches at the Albert Einstein College of Medicine. A different version of this story appears in Leukemia for Chickens: One Wimp's Tale About Living Through Cancer, a memoir written by Roger Madoff about his illness experience, edited by his wife Jen and published after his death. More information is available at www.leukemiaforchickens.com.