Bruce's Choice

Bruce was a pain in the ass. I'm sure that his premorbid state bore little resemblance to his current condition. He had been a construction worker. Decades of smoking, however, left him tethered to an oxygen tank and in a wheelchair. His brittle and collapsed bones, washed out from years of prednisone use, supported a chronic morphine requirement but little else. He was angry and tired, our periodic encounters focusing on the difficulties of his day-to-day existence.

I was surprised to receive a message that Bruce really needed to talk with me. In the past, he would frequently call to inform me of a variety of medical symptoms. These were the kinds of issues that might or might not represent important pathology. However, any time we agreed on a course of action, he invariably failed to follow through. Some other event in his life would take precedence, directing his attention away from the medical issue that had been troubling him. But this time was different. He sounded scared. Thin at baseline, he had lost an additional 15 pounds and …