I opened the email from my patient, J., a 44-year-old environmental activist and farmer, sent seven months after his leg was amputated for aggressive sarcoma. The subject line read: To Make You Smile, Also, Thanks.
The attached photo didn’t succeed in making me smile, instead I laughed out loud at the sight of J., steadied on crutches in his Halloween costume, the white cloth of a sweatshirt and pants adorned with colored flaps of paper, the tube of the missing leg pinned back almost to his groin, a shock against his long form, an emptiness that took up space.
Beside him, his wife N., dressed as a small child with a big stick. The size of their grins bent the screen.
A broken piñata, he had written below, see?
I saw. I remembered.
***
A rare laugh brought my daughter to find me in my room, three mini Snickers as an offering, bottoms starting to melt from the heat of her palm. She was at the age to understand the portent of her peanut allergy, to recall the tingle on her tongue and the rasp in her throat and to separate her candy without having to be told. She added the Snickers to the naughty pile along with Butterfingers, Reese’s Cups, Reese’s Pieces, Mr. Goodbars. And for the hate of coconut and just to be safe, all the Almond Joys.
“Who’s that?” she asked over my shoulder, her cheek at my cheek, ear to ear. Mouth sticky and voice garbled from the non-killing candy, the Milky Ways and Three Musketeers, Sour Patch Kids and Rolos.
“My patient.”
“Why doesn’t he have a leg?”
“Cancer,” I said.
My daughter nodded wisely, at an age to understand cancer, dying, death, and dead, because of me. Because of my work. Because of thin walls and the forced proximity of 900 square feet and the calls that came, it seemed, always during dinner, watching TV, while car-singing to Katy Perry or at the mall. Calls where the odd set of words I spoke to the hospice nurses had been repeated so often in her presence they took on morbid, sentient meaning, when before I had been able to shield her.
Because I was at the age to have left my marriage and brought her here to an apartment with hallways that smelled of cabbage and steep sets of stairs that took our breath away. Three rooms and no place to run to when the death pronouncements came.
“He looks happy,” she said.
***
J. came into the clinic screaming, begging for us to cut his leg off right then and there, with a box cutter, if necessary. The same leg he flung over horses and up into tractors, the leg he used to walk the wild perimeter he was growing on the corners of his property for migratory birds to rest, full of weeds for butterflies. He told me he’d inherited a cruel legacy and wanted to do better. Better for the land, for the animals, for everyone. And now he wanted it off, the leg crowded with cancer chewing its way north, ravenous for muscle, hungry for nerves, most desirous of bone.
“C’mon, doc,” he’d said in my clinic room, “I promise not to sue. Just get a tourniquet and have at it. I’ll help.” He gripped his upper thigh and squeezed. “How about starting right here?”
His wife N. rolled her eyes as way of an apology. “He can’t help himself,” she said. “Once a jokester, always a jokester.”
J. once told me, “Going through cancer without a sense of humor is like taking a walk in boots without socks. You get where you’re going just the same, but it hurts a helluva lot more than it has to.”
Going through divorce without a sense of humor felt the same, some wounds self-inflicted, prone to festering and leaving scars. But I couldn’t find my lost sense of humor amongst the droning of financial disclosures, bitter text exchanges, endless lawyer-speak, or hear my old friend over the sobbing squall of my daughter’s nightmares.
I missed being able to laugh, I imagined, the way J. was missing his leg. Oh, the frailty of the word ache.
***
You’re only dead once a doctor says you’re dead. We have to check the body, say certain words, announce the time. It’s state law, but law tends to go soft when a death is expected and a doctor isn’t present. The hospice nurse calls me instead, having laid their eyes and hands on the dead in my absence. She or he tells me the time and I repeat it back. I say, “I am happy to pronounce”, which I know is an awful choice of words, because I chose it. I’m not pleased to pronounce, I’m every other possible emotion. Sometimes annoyed. Sad. Detached. Grateful. Just not happy.
“He is happy,” I said to my daughter as she looked at J. “His leg was hurting him terribly.”
“So they cut it off?”
“They cut it off.”
She nodded, ready to move on to additional hits of sugar and unrestricted access to the Disney Channel, then stopped. “Show him our picture,” she said. “Can you?”
How could I not?
I pulled up a photo of my daughter and I as witches, black pointy hats and smudged eye makeup, ragged cloaks and snarling faces. My expression not pasted on for the costume but revealed by it. We matched, my daughter at the age to revel in choosing a co-costume, taking as much pleasure in the act of dressing me up as in trick-or-treating.
I attached the one she chose, a head and shoulders shot with our faces scrunched together, delight in our blackened eyes and bared teeth.
“Good?” I asked.
“Good,” she said, now not in a hurry to leave my side. Divorce had turned her cuddly, needing more skin-to-skin time than she’d wanted as an infant, more than prescribed by the NICU nurses during her weeks in that sterile, buzzy-with-light place, a feeding tube taped to her sunken, yellow cheeks.
“Can you come with me?” she asked. “Liv and Maddie’s on.”
How could I not?
***
J. woke up sweating, grasping for his leg. When he felt its absence in the bed he howled like an animal. For two days he wept and shook and swore and fought, tearing at the sheets, looking for what he’d lost.
On the third day, he said, “Hey, doc, if I get through this, I’m going to dress up as a piñata for Halloween. I swear I will, and I’ll send you a picture.”
His wife N. nodded, as way of confirmation. “He’ll do it, she said. “And I’ll hold the stick. I might even use it on him if he doesn’t shape up in here.”
And just like that, he found a pair of thick socks for worn boots.
***
The first time my daughter figured out what the calls meant, while I stood in the bathroom holding my hand over the phone, whispering, “I’m happy to pronounce”, my daughter waited on the other side of the door to destroy me.
“When you say that, it means someone died, right?”
Damn, I thought, I’m a fool. Our tiny couch, ragged from cat scratches, came up to meet the back of my legs.
“Yes,” I said, hating myself for telling the truth and hating myself more for having to.
“Isn’t it sad?” she asked. “Aren’t you sad?”
“Sometimes, yes, but sometimes not. Some of the people are ready to go. Some of them are so tired of hurting, it’s better if they go.”
My daughter climbed into my lap, barely fitting, and reached her arms around my neck. Held me there while I cried.
***
Sometimes our patients are our teachers. J. was mine, and still is.
Finishing the email, below the witchy picture, I wrote back to him: To Make You Smile, Also, Thanks.
Thanks for the laugh, I didn’t say. My first laugh in these months of breathless dread and cabbage smells, getting blisters I didn’t need to get, walking the rutted road in threadbare socks.
Thanks for reminding me that what is broken needs to go.