A Model Death

Bob Alexander landed in the hospital one day when his right leg collapsed. He was a middle-aged master carpenter who had renal-cell cancer with secondaries throughout his spine, some of which threatened to transect his spinal cord. But Bob was as tough as ironwood. He referred to his tumors as “dry rot.” Why couldn't an orthopedic surgeon go in and scoop them out? Why couldn't he have his spine rebuilt? This was the kind of structural problem that Bob had mastered in his 30 years of repairing and restoring old buildings. Unfortunately, his experience had not prepared him for the aggressiveness of advanced cancer.

I hoped that my patient would get beyond his angry denial and come to accept the fact that he was dying. But no matter how much I'd try to get him to talk about other things—his family, his interests, his feelings—he would resist. It was like throwing my body against a thick oaken beam. Bob could discuss the cancer only in objective, structural terms. For example, he wanted to know precisely what would happen when the final day arrived.

“Will something collapse?” he asked. “Will I wake up one morning and know there's something missing?”

Bob was not only woodenly opposed to discussing his feelings about dying; he was a demanding patient as well. His nurses never responded quickly enough. The food wasn't good enough. His roommate …