Attribution: Diego Delso, CC BY-SA 4.0 <https://creativecommons.org/
Portrait of a Patient
Dr. David Hopper sat down on Mr. E’s empty hospital bed. It felt good to rest on the blank white sheets for just a minute. Hiding behind the bed curtain, he let his tired eyes close. The wartime sounds of the History Channel fought with beeping I.V. poles and heart monitors.
“Where is Mr. E?” he wondered, opening his eyes.
Mr. E was the last patient on his morning rounds of the neurorehabilitation ward. A bearded man’s photo stared back at him, taped to the wall above the bedside. Blue eyes, red hair, he hugged a smiling young woman turned three quarters away from the camera.
“Mr. E?” he guessed and glanced at his watch.
He flicked off the TV and caught a reflected glimpse of his grey hair and white coat in the crackling dark screen. Families often posted photos to create a familiar and friendly environment for disoriented patients. The pictures were also supposed to humanize the often-uncommunicative patients to the staff. Dr. Hopper paid those pictures little notice. Old vacation snapshots predominated, healthy long-ago avatars of his stroke victims and their consorts on the beach, like an antique Facebook feed.
This wall was different. Many more pictures decorated it than usual, some overlapping. Some belonged to the usual family photo album genre, like the first one he had noticed, but others did not. The presumptive Mr. E appeared in a couple in the middle, but the surrounding pictures mostly had no people in them at all. “Is that an abstract painting or a photograph?” Dr. Hopper asked himself. He scooted to the head of the bed to get a closer look at what appeared to be an aerial view of a crimson river delta. It reminded him of a pathology tissue slide from medical school.
“He is in the scanner at the moment,” a woman’s voice said out of view. Dr. Hopper jumped up from the bed and turned in the direction of the voice, feeling like he was somehow trespassing. A thin elegant fiftyish woman in a scarf stood in the doorway.
“Oh, okay. I’m Dr. Hopper.” he replied. “The neurologist.” He extended his hand. She shook it crisply, brushing the curtain with her elbow.
“Hello. Very nice to meet you. Helen.” she said. He wondered if she was the smiling woman in the picture of the couple at the party. It was hard to tell.
“Nice to meet you too. Uh, are you…”
“Yes. I’m his wife.” Was that a British accent? He pressed his lips together into a smile facsimile. He could not do a proper consult without the patient, but maybe he could get a head start by talking to the wife now and examining Mr. E later.
“Good. I was hoping you could tell me a few things about your husband. Would that be okay?” She nodded. “Why don’t you start by telling me how your husband got here.” Mrs. E arched her eyebrows.
“You know, I just told this story to that young doctor. Perhaps you two should talk.” She actually sniffed.
“Yes, I understand,” he sighed. “Still, it’s best that I hear the original version for myself.”
She obliged him. Dr. Hopper took a blank index card from the stack in his pocket. On it, he wrote a capital E and the last four digits of the medical record number at the top, the minimum identifying information needed to access the patient’s electronic medical record, and he let Helen take the lead. As he wrote, she meandered her way down the descending path that her husband’s health had taken over the past years and weeks. For someone that did not want to tell the story again, she certainly took her time doing it. When she stopped, Dr. Hopper took inventory of what they had discussed.
71 yr old male. Past medical history: Stage IV Gleason 8 prostate CA s/p radiation for bone mets, androgen deprivation. History of present illness: Sudden dense expressive and receptive aphasia, R sided weakness. CT: moderate L sided infarct, mostly confined to language areas. No neuro improvement post 2 wks of Rx. Course complicated by aspiration pneumonia. Abnl swallowing study. Feeding tube placed. I.V. fluids @40cc/hr, antibiotics. Transferred for rehab.
He put the card back in his pocket, thanked Mrs. E, and turned to leave.
“Did you like the picture?” she asked.
“Sorry?” he said with his hand on the door.
“The picture you were gazing at so intently.” Her extended first finger swung toward it like she was conducting an orchestra. “The crimson one.”
He followed her finger. “Oh yes. Very nice.” Dr. Hopper left.
When he came back, she was gone, replaced by Mr. E. lying sideways in his bed. His eyes were still blue , but his hair was white. A plastic feeding tube dangled from his nose. A crust of dried saliva and skin caked the corners of his mouth. He was breathing loudly.
Dr. Hopper leaned in close. “Hi, I’m Dr. Hopper!” He always talked loudly when meeting patients for the first time as they were often hard of hearing. Mr. E’s eyes shifted toward him for a second. “I’m going to examine you now, okay?” He took out his reflex hammer. Mr. E shifted in his bed and blinked.
Later, Dr. Hopper pulled out his index cards and placed them on his cubicle desk. He logged on to Epic, the hospital’s electronic medical record system. The software’s corporate logo came up along with its eyerollingly grandiose tag line:
Like the Iliad or the Odyssey, our electronic health records
chronicle the story of a patient’s healthcare over time.
Epic, indeed. David Hopper’s weary mind wandered: his father, the late Dr. Jesse Hopper, was an epic storyteller. David’s father would regale his family at the dinner table with stories from work, like the time he met a man with three nipples. The elder Dr. Hopper often employed his patients and knew their families, which David found awkward and embarrassing. When the aforementioned man arrived at the Hoppers’ home to fix their water heater, David’s father pointed to his own chest and whispered, “That’s the guy!”
The younger Dr. Hopper did not take over the family practice or grow to rival his father’s narrative powers. The intricacies of the brain fascinated him; the ghost in the machine did not. He loved sifting through the grey details of the neurologic exam and the scans to uncover the golden nugget of a diagnosis. His skill at extracting the essential meaning from a complex world evoked the admiration of his colleagues at Bay Area Neurology Group, but for different reasons. As the managing partner, he built risk-benefit spreadsheets that helped make them the most successful neurology practice in the West.
He pulled out the index card labeled E1962. He typed that into the computer, then clicked on Mr. E’s name. He distilled the facts and sorted them into the predefined data fields: present illness, past illnesses, and so on.
The only narrative part was a short paragraph describing the assessment and therapeutic plan. Rehabilitation patients presented few of the intellectual challenges Dr. Hopper relished, and all of the interesting but, in retrospect, fruitless work had already been done during Mr. E’s ICU stay. The scans showed the whole picture anyway: a dark blotch obscuring the speech center and much more. A pretty bleak picture. Dr. Hopper signed an order for physical therapy and wrote a few formulaic phrases about “monitoring neurologic progress,” though he doubted there would be much improvement, especially in the presence of such an advanced cancer.
When he was done, he found a link to Mr. E’s scanned advance directive from his oncologist, dated 11 months ago. It named Mrs. E as the surrogate decision maker. The box indicating I do not want life-prolonging treatment if I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness was checked. In Section 2.3 (“Other Wishes”), a precise but flowing hand had written: No artificial breathing or feeding.
Dr. Hopper had trouble with advance directive forms. They used commonplace and medically imprecise language, making it difficult for him to accurately ascertain the intent. And how could the old Mr. E know what the present Mr. E would want, in any case? Dr. Hopper felt the forms often revealed grievous ignorance of the patient’s future state and treatment options and thus warranted revision in the face of new clinical circumstances. Instead, surrogates (as family members are known in the vocabulary of such forms) and many doctors treated the forms like holy writs and anguished over their meaning. In this case, the objective evidence, the published clinical trials, did not speak clearly for or against artificial feeding. But the form did.
Come to think of it, why did Mr. E have a feeding tube when the form clearly said he didn’t want one?
Once again, Dr. Hopper clicked through Epic to find the advance directive. He flitted down to the line about avoiding life-prolonging treatment. Check. Hmm.
He frowned, then narrowed his eyes. Inconsistencies and contradictions bothered him, and this was not a small one. There was a lot of debate about feeding tubes for stroke patients. It was not clear that they prolonged life even in patients with moderate sized strokes like Mr. E. Patients’ preferences mattered a lot. Talking to surrogates was far from his favorite task, but he reluctantly wrote on Mr. E’s index card: Ask wife re feeding tube. Bring AD form.
Portrait of a Lover
“You were always as talented a pickup artist as the other kind,” Helen Edgewater told her silent husband lying next to her in the hospital bed. The morning light from the window did his pallor no kindness.
She met Sean at the National Gallery in London. She was copying the 17th century Rokeby Venus, that shameless hussy, for an art history module at University College. In it, a flitty Cupid holds a mirror to his nude mother. Venus lies on her side, vainly contemplating her reflection. When the Rokeby Venus was 265 years old, a suffragette slashed her scandalous canvas flesh in protest of the objectification of womankind, necessitating some artful surgery. Helen thought she looked none the worse for wear.
Helen was struggling to copy the dull and hazy reflection of Venus’ face in Cupid’s mirror. She was perched on the edge of a bench intently erasing pencil shading in her sketchbook when she felt someone looking over her shoulder.
“Better than the original, I think,” Sean flattered her in a broad American voice. She instantly recognized his ginger hair and beard and piercing eyes from his publicity photo in the new Saatchi Gallery brochure.
Trying to overcome the dizzy feeling of nearness to fame, she quickly tried for the upper hand. “Shall I take that as a compliment or an insult from a minimalist?” she quipped.
She intended it as flirtatious banter, but, in retrospect, could he not have thought it absurdly snooty? He laughed anyway and sat down beside her, and they tossed witticisms at each other for a half hour. Then he got her phone number.
Helen fell in love, irretrievably, wholeheartedly, unconsciously, unintentionally, physically, mentally, nobody-could-talk-her-out-of-it in love. Oh, and Sean seemed “quite interested in her too,” she explained to her friends. Her patrician parents thought the age difference a scandal, her classmates thought it a career-ending move, but a hop or two across the pond and Soho Helen Sinclair became San Francisco Helen Edgewater.
Helen felt a wave of nostalgia (and love, again) for the Sean of those heady and passionate days. The paint and brewing coffee smell of his Haight-Ashbury studio came back to her. A national glossy magazine ran a glam picture of them embracing at a posh gallery opening, next to a spread depicting his blue square series. Collectors competed to have him at dinner to show off his cleverness and his paintings, and she was his pretty and witty foil. She wasn’t the only one who thought Sean’s grand plans might come to pass.
They might have, but they didn’t. The solo shows began featuring newer artists, and the dinner invitations petered out. Sean borrowed money to keep up appearances. He changed styles. “I think minimalism has long since reached its maximum,” he wisecracked while theatrically stubbing out his ever-present cigarettes. Late-middle-age found him painting less and teaching at a university better known for engineering and medicine than art.
Helen felt distinctly unsuited for this new role of young faculty wife. Despite, or perhaps because of their increasing emotional distance, she told Sean she wanted a family. Two sad miscarriages later, she felt that she was also distinctly unsuited for procreation. Sean halfheartedly suggested a surrogate mother, but Helen said no one was going to have her baby for her.
Instead, she began restoring paintings at the university’s museum. It was a painstaking job, but Helen was brilliant at it. Sean said she had x-ray vision to see through the grime of centuries to the artist’s vision. She actually did use the radiographic facilities at the medical school to examine the underpainting. Sometimes she saw abandoned figures, overpainted faces, even completely different paintings below their well-known surfaces. She relished those hidden layers of history and meaning. Many more choices went into restoration than most museumgoers realized, far beyond just removing the dirt. Did the artist know the subject’s alabaster complexion would fade to cream a lifetime in the future? Perhaps he was painting for the ages, and Helen’s brightening agents undermined that goal. Sean said no one really painted for the ages, they painted for the moment, or more likely for the money. Still, in her own small way Helen felt she was adding her own story to the work, like the Chinese scholars who put their red ownerships stamps on their paintings.
Sean also adapted and learned from his scientific colleagues. In another radical stylistic shift, he began a series of small, meticulously-painted-over human photomicrographs. Cigar-shaped muscle cells simplified with red and black, globular adipose tissue slices rendered a delicious yellow, and ovarian cancer biopsies boldly streaked grey and green all populated his studio’s easels. Sean told Helen and more than one skeptical art critic that he had invented a new kind of figurative painting, a new kind of interior landscape. He called them microportraits. Helen was half-certain he was half-joking, but she honestly admired the quirky bravado of the statement and the abstract expressionistic visual impact of the paintings. In any case, they did not exactly revive his flagging career.
Neither did the sexual harassment accusation or the threatened paternity suit from a biology graduate student involved in the project. Oh, he seemed sorry, but the prospect that someone else might have had Sean’s child was a deep wound that cut through their marriage. After a trial separation, they managed to paper it over. However, the repair was paper-thin and they withdrew into themselves to avoid testing it. Their playful verbal fencing retreated, and bitterness, sarcasm, and silence took its place.
Interrupting this long internal monologue, she cast her eyes on the back of Sean’s head. “Do you even remember that awful girl’s name? You know, dear, the one that gave us herpes?” Helen asked her mute and unresponsive husband. She willed herself to forget the woman’s name, but did not succeed.
Thus, she remembered, their precious passion wilted away in more ways than one when Sean came home from the urologist with news. “He said Viagra might help us,” a quivering smile peeking from beneath the grey beard. “But it won’t help the prostate cancer.”
But the prostate cancer had helped them, unexpectedly. It tapped a well of kindness under their polished surfaces and damaged connection that neither had heretofore easily seen in the other. She felt for his unmanning suffering and existential distress, and he felt for her fading future as a nursemaid and middle-aged widow. She helped him painfully mount the table where the enormous machine irradiated his cancer-riddled bones. He helped her clean the Bonnard portrait of the painter’s wife, Marthe. After several months, they both took leaves of absence. They spent afternoons roaming museums and cataloguing his work. The emasculating medicine made his skin smooth and soft to the caress, and as he gradually lost weight he regained some his old gauntness. So compassion replaced passion, and some of their erstwhile playfulness returned.
Back in London to visit her parents, they sat again before the Rokeby Venus. Helen reclined on the bench, held out a compact mirror, and, aping the painting, applied some rouge.
“What would you do without me?” she vamped into the mirror. His sad eyes, magnified by his glasses, did not crinkle into amusement as she had hoped.
Instead, he asked her, “What will you do without me?”
She put the mirror down and sat up and looked at him directly. “Sean, really, the doctors said you could live for years.”
“Maybe. What if I don’t want to, though?”
“What do you mean?”
“I mean I already feel so diminished, you know, like damaged goods.” He pointed to the back of Venus’ neck, where she had been slashed. “I wonder if I’ve already done the important things by now.”
“Of course not, you ninny. You can always paint me.”
“That’s the test then.” He continued in an exaggerated Oxbridge accent. “If I cahn’t paint you, I just cahn’t go on.” The mock melodrama hid something, she thought. He touched her face, pretending to adjust her makeup.
Back home two weeks later, she turned to him in bed and he did not answer to his name.
In the ambulance to St. Catherine Community Hospital, she found that she really was not ready to let him go, damaged goods or not. Sean had said no heroic measures, but why should it be up to just him? He had designated her to be his surrogate, but surrogacy was not all she wanted. For a change, Helen wanted to be the heroine, the protagonist, not just the interpreter. She was the one bearing the burden and she welcomed it. She would tend to him and to their lost future. She would continue to restore their love in her own way with whatever time they had left.
The next day, at the suggestion of the intensive care unit nurses, she brought some old pictures to help him remember who he was. She squeezed between the bed and the IV pole and sat next to her husband. First, she taped the pseudofamous magazine clipping of them embracing in the art gallery on the bedside wall where he might see it if he were laying on his side, which he often was since being admitted to the hospital.
“What do you think, Sean,” she asked. “That was a fine party, wasn’t it?” She did not expect an answer, but perhaps the nurses were right and the combination of the image of them together with the sound of her voice would help him. He did turn those baby blue eyes toward him, she thought, and the corners of his mouth rose a bit.
More pictures went up with careful effort over the next half hour or so. She surveyed her handiwork. Adjacent to the first picture, Sean and Helen squinted beside a Roman fountain into a sunrise after a long night out. Below that, they ate pastries in a forgotten cafe somewhere in England. To the left, he had snapped a shot of her looking up from a book at the beach, wrapped against the breeze. To the right, she had taken a picture of him laughing at an unseen joke, paintbrush in hand. Many of the nurses who wandered by paused to take in the “assemblage” as she had begun calling it to herself. As they put tubes in him or took waste out, some even remarked how handsome he had looked.
The day after that, she brought in the catalogue box of his signed microportraits. The doctors said he had lost too much weight, so she took out the fat cell microportrait and taped it in its yellow glory below yesterday’s grouping. For good measure, she found a rhythmic brown one of the protuberant villi lining the small intestine and overlapped it a bit with the fat cells and the pastry picture. Then she tried to spoon-feed him the goo-food provided by the hospital, though he drooled most of it out. For strength, muscle cells looking like red spaceships in their own microportrait flew into the assemblage from the left, but fell short of landing on the beach picture. Spiculated, towering, bright white bone microportraits strengthened the bottom and warded off more painful spine metastases.
Of course, the stroke was the main event. Helen pulled out a fluorescent green neuron network on a black background and attached it to the top of the Roman fountain. She thought this might increase blood flow to the damaged brain tissue. “Come to think of it, maybe the red blood cell microportraits would help the flow too,” she thought, so she taped up a portrait of two groups of red spheres next to the neurons for good measure.
The critics that regularly paraded through the hospital room gave her latest work mixed reviews. Mostly people just filed by and either did not notice or glanced at them and said nothing. A priest (it was a Catholic hospital) said they looked very happy in the fountain picture. When people asked about the more abstract ones, she just said that Sean was an artist and that they were some of his latest paintings. She left it at that. The priest said he didn’t care much for modern art but liked the colors, and he thought the assemblage as a whole had a kind of sacred feeling. “Of course, that happens to me a lot,” the priest added. A phlebotomist said the blood cell microportraits looked like blood cells, so that was a bit encouraging. Not that she gave them much of a clue, but no one seemed to really catch on to her healing intent.
Maybe the problem was that she was not addressing the underlying condition, the cancer itself. That night at home, she searched the web for images of “prostate cancer Gleason score 8” on Sean’s enormous high-definition monitor. The cells looked like estuarine islands viewed from the air. She tried drawing them unsatisfactorily on a sketch pad, which was not surprising as she had not really composed anything since leaving graduate school so long ago. Changing tactics, she printed out a color picture about the size of the other microportraits on heavy stock paper. She covered the islands carefully in crimson paint from Sean’s studio, and painted the river portions a lighter red. She then searched for an image of healthy prostate tissue. It was much more uniform, so she just used the crimson paint for the repeating round parts and a light grey for the interstices. After a moment’s hesitation, she signed Sean’s name to both. The next morning, her prostate portraits joined the assemblage.
Sean’s apparent awareness of his surroundings did not really improve over those days. Worse yet, he began to wheeze and gurgle, and Helen’s heart sank. The doctors said that he had an infection in his lungs that was caused by choking on his own saliva. Helen added a light-filled lung microportrait from Sean’s collection and a salivary gland of her own creation, putting them on opposite sides of the assemblage. The doctors pushed antibiotics through his IV and kept him on his side with his head up. They also told her to stop spoon-feeding him. His breathing seemed to improve.
After ten days, Helen began to realize that Sean might never fully regain consciousness. The intensive care unit doctor asked her if she and Sean had ever talked about this eventuality. Of course they had, and not just that one time in the art museum. Feeling like she was cheating on an exam, she brought out the advance directive form from her portfolio. He had filled it out at the oncologist’s office soon after the diagnosis and showed it to her. She was to take it with her if he were ever hospitalized and could not speak for himself. Three nights earlier, she took out the fine brushes she used for art restoration and carefully whited out the “Other Wishes” section where he had indicated that he did not want artificial breathing or feeding. With a fine pen, she changed the check box from not wanting life-prolonging treatment to wanting it and then adjusted the date to a more recent one. She showed this retouched form to the doctor, telling him that Sean was not ready to give up. Neither was she, and that day they placed the feeding tube in his nose.
Helen realized that, no matter how she felt, healing Sean was not the only or perhaps even the main purpose of her artwork. Maybe the priest had it right after all and she should focus more on honoring Sean’s life and their love. She brought in a reproduction of one of his minimalist blue squares, probably his most famous work. She put it next to the picture of him laughing with the paintbrush. It brought out the color in his eyes. She taped a picture of the Rokeby Venus, in all its evanescent fleshy radiance, next to the fountain photo. Lastly, she placed a photo of Bonnard’s painting of his beloved dead wife, the one Helen restored, next to the Venus.
Then, for the first time since before the ambulance ride, she cried.
The day of the transfer, she brought in her large-format digital camera to document the assemblage. Then she meticulously deconstructed it, image by image, from newest to oldest and placed them carefully back in her portfolio. She rushed to their new room to find a young assistant doctor from the neurorehabilitation team in her way, asking the same tiresome questions they all did. She answered the bare minimum and shooed him off. Then she reinstalled the assemblage in its new spot on the wall where Sean would soon be, oldest image to newest, intermittently comparing this second incarnation to the photos she had taken earlier in the day. She laid down where he would be to check the viewing angles and then went out to the nurses’ station to ask them when Sean would arrive from the scanner.
When she returned, she was surprised to find Dr. Hopper sitting in their new bed examining the prostate portrait. It was their bed now, sort of, and she took silent offense.
He wanted to know the same history that his assistant, or whoever that was, had just taken from her. Annoyed that Sean would be gone for some time, she expanded her role in the sad story. She made sure to mention the herpes and to project an air of selfless doting, but carefully omitted any mention of the advance directive.
“Did you like the picture?” she asked afterwards. He gave a polite but blank reply, like most. Really, people could take more of an interest, she thought on the way home that night.
When Dr. Hopper came back the next day, he looked a bit agitated. He hovered at bedside, blocking her view of the assemblage.
“Mrs. Edgewater, this is not, ah, easy to discuss,” he said after they had talked about the fluids and such, “but I wonder if you and Mr. Edgewater ever talked about, well, about his wishes?”
“Well yes, of course” she said. “His most fervent wish was that he had never contracted cancer of the prostate.”
“Mrs. Edgewater, I think you know what I mean. Did the two of you ever discuss how he would want to be treated in a situation like this, when he was not able to communicate.”
“Do you really think we should be talking about this here in front of him?” she asked. Sean, propped up with a pillow, stared at them. Dr. Hopper nodded and tilted his head toward the door.
Outside the room, he said, “I doubt he can understand us, Mrs. Edgewater.”
“How can you know that?”
“I can’t really. He is pretty debilitated from his cancer. Most of his brain is still fine, but his scans show a lot of damage to the areas of the brain that understand and produce speech. If we’re honest, I’m not sure he will ever recover that ability.”
Helen nodded and started to say that the old Sean would not want to live in the world Dr. Hopper described, his long and fading search for beauty derailed forever, his audience reduced to just her, his stage to a hospital bed. She stopped herself though. How could she be certain of that?
Dr. Hopper brought out the printed copy of the advance directive. “This is a form he filled out in the oncologist’s office a year ago. It might help you. Maybe you have seen it.” He handed it to her.
“I think so,” she said.
“Here,” Dr. Hopper indicated by pointing to the “Other Wishes” section, “he wrote that he would not wish to have artificial feeding. Perhaps he changed his mind?” Dr. Hopper looked back up at Helen.
“Yes, I think his mind did change,” she said.
Dr. Hopper tilted his head and gave her a quizzical look. “Okay. If you’re sure, then you would remember best.” He paused. “And you are sure?”
She looked at the assemblage and nodded. She blinked and thought of bringing out the doctored directive that she had shown the ICU team. Then she realized that it was too similar to the one in Dr. Hopper’s hand.
When Dr. Hopper finally left, Helen went back to the room drew the curtain between Sean and the nearest patient. She nudged his body over, turning him to expose his back, and laid down behind him on this bed built for one. She pressed her chest against his back, propped her head up with her right arm and grasped his waist with her left. She feels him press toward her. Only then, together with their eyes trained on the wall, could they admire her assemblage like he had her Rokeby in London all those years ago.
Now an hour has passed, maybe two, with them lying there. The breath hisses through his dry mouth and she remembers him the way he used to be. Indistinct voices approach and recede behind the curtain.
Self-Portrait of Mr. E
Meanwhile, Sean Edgewater drifts through the eternal, nonaccruing present of his new pared-down life. Nothing is subtracted or added. Ghostly people come and go. They make clucking sounds. They come close to his body and touch him. A kindhearted gibberish comes from their mouths. He feels a sort of awe of the mystery of things, it is all so brilliant. Everything is so endlessly new and beautiful and like nothing else again. He wants to tell them but finds his dry mouth has no way to say it. He shifts his right arm a bit but it is weak. He wants to pull the painful tube out of his nose, but he can’t. Pain runs up his spine. The colors are bright and alive, and he wants to be with them, to keep them, but they hide from him. People come and go and cluck. Now, he is on his side and feels a hand on his waist. He feels love lying beside him, warm, and presses towards it. He looks at the familiar puzzling pictures on the wall, then feels love inside himself, too. He thinks enough is enough.
Editorial Note: The representation of the neurological state of consciousness of this patient was derived from the author’s imagination. It should not be construed as medical fact. End-of-life issues are complex and should be discussed with healthcare providers.