Mr. Spano shook his head, and I proceeded to leave. Just as I approached the door, his brother stopped me and asked, “How could this have happened?”

“Your brother injected drugs into his leg. That is the way this infection happened.”

The contemptuous expression on his face upon receiving my answer was the same one I might have made after being awakened from a deep sleep by a phone call from a telemarketer.

Mr. Spano said nothing. Then he whimpered softly, “No, no, further questions. Thank you for helping me.”

“You’re welcome. I’ll go get all those orders in for you,” I said, turning to leave.

His brother stopped me again. “Can’t we get him somewhere better? I’m sure there is a better hospital with better doctors to take care of this.”

I paused before I spoke, narrowing my eyes as I felt the back of my throat constrict and my upper chest tighten. I knew there was no point in saying the first thing that came to mind: How dare you? Instead, I replied, “The treatment of this is very standard and is the same no matter if he’s treated here or anywhere in the world. It would be the same if he were in Timbuktu, Yale New Haven Hospital, or the middle of a medical campground. It’s all the same medicine.”

“Okay, well, let’s just do it, then,” the brother said, as if granting me permission.

“Yeah,” I said. Then I left, letting the curtain flap closed behind me.

My contract stipulated that I was to help this man, to heal him no matter what. I did not like him or his brother. I did not like that they were rude and histrionic. I did not like that they seemed not to take personal accountability for what was happening to them. I felt drained by the patient’s hysteria and his brother’s condescension and demands. But I was there to help.

I quickly entered the orders—monitor, fluids, medications, EKG, labs, cultures, X-rays, and ultrasound—then put a page out to General Surgery, who quickly called back and told me that extremity infection concerns were covered by the orthopedic service. I paged Orthopedic Surgery and waited, and waited. Finally, I called the hospital operator and asked her to notify the ultrasound tech on call, only to be told that there was no ultrasound tech on call this holiday weekend, so we wouldn’t be able to evaluate the dimensions of the abscess in that way. I was well aware that the orthopedic surgeon would need to know the size and depth of the abscess in addition to looking for deeper gas collections in the tissues to determine the appropriate treatment plan.

While I was working on behalf of the Spanos, the ER had been backing up with patients. There was still no answer from Orthopedics, so I picked up the phone again to page the on-call attending orthopedic surgeon myself. It was both a blessing and a curse that our surgical attendings were also faculty at the nearby teaching hospital. The blessing was that it meant more staff, both attending and resident physicians, to care for patients. The curse was that nine times out of ten, they called back angry and affronted because, unlike in the community, academic faculty typically did not have the same incentives to build relationships as the private practice providers who welcomed our calls to be involved in patient care. But still, additional financial incentive or not, it always struck me as strange that a person on schedule to work in his chosen field should be angry when called to do the work he signed up to do.

As I waited, documenting the patient’s condition on his chart, Nurse Jen showed up at my side and asked me to please speak with Mr. Clements.

Yes, I had meant to get back to Mr. Clements! “Sure thing, Jen. He’s next on my list. I just have to speak to Orthopedics, and I’ll be right in.”

“Thank you, because he’s asking for pain medication, but he looks fine. I think he really just wants to speak to a doctor.”

“I’ll be right there. Sorry ’bout the delay.”

Fortunately, the orthopedic resident called back and said he would come to the ER after rounds and after seeing a patient at another hospital. Meanwhile, he requested a CT of Mr. Spano’s leg, as there was no way to complete an ultrasound.

Finally, I headed to Room 18, to see Mr. Clements. As I approached his room, I saw a tall, lean man with long dreadlocks gathered into a trim ponytail grazing his waist. He appeared to be a remarkably youthful sixty-eight years old. With his hands resting resignedly in his linen pants pockets, he paced slow circles in his room, periodically stopping to look up at the TV screen in the corner. I walked to the room and knocked on the open door. I smiled and introduced myself. He extended his hand to shake and said, “I like your hair, Doctor,” indicating my own tied-back dreads.

“Thank you. And yours as well,” I said, smiling. “Mr. Clements—”

“Please, call me Joshua,” he interjected.

“Joshua.” I nodded, smiling at him. “I’m so sorry for all the delays. I understand you’re waiting for a bed upstairs to find out why you have this lymph node swelling all over the place. I also understand you’ve had pain. Do you still have pain?”

“I do, Doc. The pain is coming back. It’s not bad. It’s not like when I came in last night, but a little pain is coming back,” he said, rubbing the front of his abdomen to indicate the location.

“Would you like more pain medication?” I offered.

“I’ve never been much into pills. It’s just not the type of man I am, but yeah, today I’d like some.”

“Of course. Let’s chat about your CT findings also. The doctor on overnight was telling me you have a history of cancer, many years ago?” I asked.

“Yes, almost twenty years ago I had prostate cancer and two big tumors in my liver. I told them they could do surgery to cut them out. They wanted me to do chemo and radiation, too. The doctors kept pressuring me about that, but I didn’t do it, Doctor. I just couldn’t. So many people told me I was crazy, but to me, those supposed cures just felt like poison. Instead, I took herbal supplements and ate healthy. I went on long walks and felt good. That’s just my way, Dr. Harper. I prefer to keep things natural. I know it was a gamble no matter what I decided, but I’ve lived a healthy life and cleansed my body that way. Luckily, I’ve been fine ever since—well, until now. It’s just that I had some pain in my belly last night, so I came in to have it checked out.”

The CT findings indicated a malignancy.

This poor guy, I thought. There’s a macabre medical maxim that says that the good people get the worst diseases. If a person is generous of spirit and comes in with a nagging abdominal discomfort the week after she runs a marathon, we’ll discover she has stage-four ovarian cancer. The racist pedophile who drowns kittens on Sundays survives being struck by lightning and lung cancer as he chain-smokes into his nineties. I was almost certain—almost—that there was no truth to this rule, apart from it proffering an emotional cocoon for us to fold ourselves into during difficult conversations.

I never liked being the doctor in the ER who, after knowing a patient for mere moments, and with only the benefit of a CT report and no definitive result such as a tissue pathology, had to introduce the word cancer into the discussion. But I knew it was cancer. I knew, too, that he wanted to know. I sensed that this man preferred the truth served up straight because it honored his right to choose.

“I see, I see. Now, did the doctor last night tell you that whenever we see lymph nodes like this, we get concerned that it’s from cancer somewhere?”

“Nah, she didn’t really tell me. She was kinda talking around in circles about swelling and nodes, but she didn’t say the word cancer. Honestly, she didn’t have to say it. I know what these findings on a CT mean. So, what’s happening now? What’s next? Will I just stay in this room all day?”

“You know, Mr. Clements—Joshua—that’s an excellent question. Right now there are no beds in the hospital, and it looks like there won’t be any for a long time. Maybe not until later this evening or even tomorrow.”

“Oh, Dr. Harper, I can’t stay here. I’m a vegan, so I can’t even eat hospital food. And I haven’t eaten since yesterday afternoon.”