He is not the first person to tell me that he’d rather be dead than alive. He is the first person to do so so publicly. We sit side-by-side in orange, plastic chairs in a recessed, rectangular room awkwardly crammed in the middle of the unit. There is a nurse behind me taking the blood pressure of another man while he climbs stairs, part of the rehabilitation process for individuals receiving Ventricular Assist Devices in this hospital. Next to the nurses’ station stands a physical therapist, after whom I’ve been tailing like a cheerful retriever as part of our medical school’s homogenized introduction to hospital care. She chats merrily with a coworker about the Mets and the U.S. Open and how sunny this weekend will be. But the blinds in our room are closed, so he can’t see how the street gutters seven stories below are still running with water from last night’s thunderstorm, clogged with muddy casts of orangey-brown leaves. He hasn’t been outside for weeks.
He wears his hospital gown with utter apathy and indifference. It’s likely that his rear end is sweat-glued directly to the chair he sits on, but I don’t think he cares at all. I’m a medical student; my abridged white coat hangs cautiously over my shoulders as I realize the depth of information it can summon up from strangers. He’s just shown me scars from his procedure, exposing — without being prompted — his angry-red wounded chest in front of the young children sitting with their parents across the room. He quietly quips that it’s a good thing he’s got a battery to make his heart beat for him; he needs some 21st century technology to compensate for the willpower he left behind in the 20th century. I laugh uneasily. I’m not one to shy away from morbid humor, far from it. But this isn’t humorous and there isn’t a punch line. He’s dead serious.
He tells me his wife left him a few months ago. She hasn’t been to visit him. He has three sons. The youngest came to see him a day or two after he was admitted, but the elder two “haven’t found the time.” They’re busy, and they’ve probably had enough of this, he supposes. His chief complaint, ironically, is that his “heart wasn’t in it anymore, either.” I haven’t taken cardiology yet, so I have to blindly, awkwardly grapple with more technical language. He pities me, I think, but lets me wrestle with ignorance anyway. We play what feels like an irreverent game of twenty questions until I have all the “right words in some kind of order,” he says. He is firm, but polite; emphatic, but quiet; sharp-witted, but blunt.
He is not the first person to tell me that he’d rather be dead than alive. He is the first person who has ever shocked me into silence with the attestation. The people I’ve known who yearn for death will claim many reasons but never cast-iron, apodictic ones. Or so I’ve felt. I used to work in a psychiatric unit and in a research lab studying affective disorders, and I’ve known several people throughout my life who have privately confessed the same desire to me. I’ve stood in that room many times: seven-story high windows cast open, a soothing breeze fluttering the curtains, and a suffering soul on the ledge, staring into a rainy abyss that gazes back on them with soft, comforting brown eyes (not the jet-black glare of malice imagined by the unacquainted, the inexperienced). These metaphors aren’t novel to me anymore; if anything, they feel slightly cliché. “They taught me an algorithm for this,” I think. There’s a high-risk protocol, rigid in its “if x, then y” parameters, that I was instructed to use in the lab, the hospital. Between the decision matrices that I’ve been taught, and the conversations with trembling friends that I’ve tried so hard to learn from, I feel, well, comfortable dancing with suicidal partners. To be clear, the words “I don’t want to live anymore” make my heart sink to my stomach, but it’s not a nausea that I can’t dismiss. And yet–
He has taken all that self-assurance away. My experiences are useless: drawing upon those memories produces blank sheets. I want to comfort him. I want to cautiously offer motivation and optimism. But — and this is unlike anyone I’ve met so far — his whole life is a diathesis and his heartbeat is the stressor. Every sensation he describes only furthers his desire to sense less. Mindfulness does not work here; his mind has decayed. He “cannot write music anymore,” he says. His family — what family? He has no hobbies that can be pursued. He cannot walk. He can’t even see the sun outside, nor autumn’s precipitation. When he is discharged, he’ll be going to a rehabilitation facility. “A shit one,” he grumbles. I don’t know how he knows this, but I’m inclined to trust him. For if he feels it’s shit, who am I to tell him it’s not? He is kept alive by a dispassionate machine that trundles on, oscillating rhythmically to the beat of a designer’s drum — not his. He tells me he’d rip through the stitches on his chest to take the battery out if he had the strength or the energy.
He tells me about a family history of dementia and quips that “switching off the Energizer Bunny” would be prophylaxis. Immunization. He knows that’s not how vaccines work — he quickly informs me that he was once a physician himself. But he doesn’t have to clarify the metaphor; I understand, warily.
He tells me he has been on antidepressants his whole life. They have helped a lot, he says. But they only helped to color in a picture that already existed. If the pictures don’t exist, there is nothing to fill in with color. There are no black and white images in his life, only greyscale. No lines, no objects to color in. “Do you understand?” he asks. Just grey. Like a grey computer screen, overwhelmed by static. Antidepressants can’t make a picture out of nothing, he mourns.
He tells me his wife left him for a friend.
He is not the first person to tell me that he’d rather be dead than alive. He is the first person to strip me of my ability to argue. He calmly wrestles me into submission. He’s persuasive. I find myself being able to say nothing more than, “I’m so sorry.” He mercilessly invalidates his entire life, shrugging off every patient he helped, dismissing every moment spent with his sons. The pain that I feel listening to him speak means nothing to him. He is more engaged now; as I myself become more subdued, he becomes more zealous. His dark skin turns darker still as rainclouds circle overhead like vultures. I haven’t once tried to convince him of anything, only listen. “Bear witness to the pain.” The life. Am I hurting him here?
My physical therapist preceptor returns from her conversation about the Mets. We help him up. We walk him back to his room. We try to close his gown in the back to spare the hallway behind us, but he growls at us not to take a hand off him, lest he fall. My preceptor chatters away, effectively neutralizing his complaints, maybe mistaking his boisterousness for vitality. I think he’s just being difficult. He doesn’t care about falling.
We lay him down in his bed and he grumbles. I tell him I have to leave to talk to another patient. I don’t tell him that I’m rushing off because we arranged to meet three more patients before 5 p.m., at which point I am to leave the hospital because class is over. I don’t tell him any of this because I don’t have to; he knows I am a still a student. He remembers.
I leave him lying in his bed. I leave him with humbled acquiescence.