The Man Who Couldn’t Sleep

by C. E. Chaffin (5,514 words) He was seventy and thin. His neck was scarred from biopsy and radiation. A denuded thatch of white hair sprouted from his crown, topping a scalp red and flaky from too much sun, beneath which a thin monk’s fringe of white barely topped his ears. His face looked pinched, with a hawk-like nose and hollow cheeks, and seemed fixed in the frustrated stubbornness of one who believes he will not be believed. His mouth was straight and grim and his blue irises, circled in senile white, stared at me as if I were guilty. What was my crime? “So, Mr. DeVries, tell me a little bit about what brought you to the hospital.” “I can’t sleep, pure and simple, nothing fancy. about it. I just can’t sleep.” “How long has it been since you’ve slept?” “Goin’ on three months.” I suppressed a smile. “And during that time you have not slept at all?” “Not a wink, Doc. I lie down at night and pretend to sleep, but I don’t. I just lie there and stare at the walls and try not to disturb my wife.” “Is your wife here with you?” “No, she left already.” “What would she say if I asked her whether or not you sleep?” “How would she know? She’s always asleep when I’m not sleeping. How could she tell if I was?” “I thought she might have gotten up at night and noticed you snoring or something,” I replied.

“Not a chance!” “Hmmm ... This sounds like a very difficult problem. Perhaps it would be helpful if we went back a little and talked about the things that happened before you couldn’t sleep.” “Not much to tell. Earlier this year the doctors said I had some kind of problem in my neck with the lymph nodes. Took a piece of one of them They said they could cure it with radiation. So I went with the treatments. Then they had to give me thyroid medicine ’cause the radiation hurt the gland. At my last check-up they said there was nothing there. Which makes me wonder if there was ever anything there. And look how thick my skin is here on my neck where I got the treatments. How could you find anything there now, anyway?” “Did they do an MRI?” “A what?” “Did they stick you in a big tube and tell you to be still for fifteen minutes while they played with some dials?” “Yeah, I remember that.” “Well, Mr. DeVries, that’s the best test we have for monitoring recurrence of tumor. If the oncologist tested your blood and did the MRI, that’s the best he can do. Or am I missing something?” “How did they even know I had something? I felt fine. I was workin’ out in the garden, minding the cows, doin’ everything I usually do. If I hadn’t noticed the lump shaving, and if I hadn’t told my wife, none of this might have happened.” “None of what?” “My sleep problem, damn it! Haven’t you been listening to me? I can’t sleep. And this all started after this gland problem.” “When you say you can’t sleep, do you mean you doze off a little and wake up frequently, or that you wake up too early?” “No. I don’t sleep at all. I just lie there.” “Do you feel nervous?” “No.” “Any thoughts of suicide, bouts of crying, or feelings of depression?”

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“I’m not suicidal or depressed. I just can’t sleep. If this goes on, maybe I will commit suicide, but only to get some sleep.” “Do you feel tired?” “Of course I feel tired! Wouldn’t you if you hadn’t slept in three months?” “I think I’d be more than tired. I’d probably be dead, because humans aren’t made to survive that kind of sleep deprivation.” “You’re telling me!” “So how are you able to survive?” “You tell me, you’re the doctor.” “Could it be that you doze off occasionally, but wake up with no memory of sleeping? For after all, no one knows if they’re sleeping while they’re asleep.” Mr. DeVries looked puzzled, as if he’d not considered the possibility. Reflexively he stroked his disfigured neck. Then he shook his head. “No, not a chance. I wish I could say I had dozed, but I’m up all the time. Always awake. Sometimes I close my eyes but it doesn’t matter. Sleep won’t come.” I could see this line of questioning was fruitless, so I decided to role play and let the patient be the doctor. “What do you think caused this problem Mr. DeVries?” “Hell if I know. But I sure didn’t have it before they started messing with my neck. All I can figure is that all that radiation must have done something to my brain.” “So you think your sleeplessness may be a side effect of the radiation treatments?” “Don’t know what else it could be.” It was clear that direct confrontation of the symptom only produced increased resistance. I decided to gather the necessary background information. “Have you ever been hospitalized for psychiatric problems before?” “Of course not. Been in the dairy business fifty-five years. And as far as I’m concerned, this isn’t a psychiatric problem. This is a sleep problem.”

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“Of course. Could you tell me what medications have been tried to relieve your insomnia?” “All kinds. Can’t remember them all. Desyrel was the last, which just made me fuzzy and it took me longer to pee, which is bad enough for a man my age already.” “Can you remember any others?” “Oh yeah; some placebo called Dalmane which didn’t do anything. And something that sounds like “Maril” which only made me nervous.” “I believe that might have been Mellaril.” “Right. Didn’t do no damn good, but I had the peein’ problem plus my mouth was dry as toast. Try staying up all night when you feel like that and it’s even worse.” “What medicines are you taking now?” “Just this thyroid stuff.” “When was your last blood test for thyroid?” “A couple weeks ago. The doctor said it was fine.” “And are you taking any other drugs, over-the-counter or illegal, like stimulants?” “Are you kidding me? Just what I need, stimulants! I do drink one cup of coffee in the morning, if you call that a stimulant.” “Any alcohol?” “Rarely.” “Anything else that might help me understand your problem?” “What’s there to understand? I can’t sleep, that’s all that’s wrong with me, and I doubt if you shrinks can do anything to help me, but my wife and my regular doctor told me this was the place to go, so here I am.” “Very well, Mr. DeVries. I’ll see you again tomorrow. During the admission process we’ll be getting some blood tests and the nurses will get your vital signs and take another history, OK? Do you have any questions?” “Yeah. When do you think I’ll be able to sleep?”

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“I wish I could answer that now, Mr. DeVries, but I assure you we will do everything in our power to help you.” With a doubtful stare he left my office. I reached for my dictaphone. “Name: DeVries, Peter. Chief Complaint: Insomnia of three months’ duration. History: This 70-year-old white male complains of three months of continuous insomnia without relief. No third party corroboration but patient insists it’s true. Problem began after diagnosis and treatment of a lymphoma of the neck, low grade, now in remission. Denies anxiety or depression. Thinks radiation treatments may have damaged his brain’s ability to sleep. Medications: Only medication is thyroid replacement, recent levels by history show him to be euthyroid. No known allergies per intake questionnaire. Habits: Denies use of stimulants other than 1 cup coffee A.M. Alcohol rarely. Past Medical History: Pertinent history includes the failure of Dalmane, Mellaril, and Desyrel to help insomnia. Family History: not pertinent. Mental status: Exam: Patient is well-groomed but has obvious sun damage to his scalp and hands consistent with his occupation. Affect is somewhat frozen with touches of anger; patient has very little hope we can help him. Speech is logical and sequential without slurring. Patient is oriented times three. Recent and remote recall appear intact though formal memory testing not performed. Impression: Anxiety disorder with insomnia as symptom of massive denial of fear of death brought about by cancer diagnosis. Defenses are rigid; all conflict concentrated in symptom of insomnia. Plan: Thorazine 100mg p.o. at bedtime with Cogentin 2mg. to prevent restlessness with frequent nursing observation to confirm sleep. Therapy directed at underlying fear of mortality, though patient is a poor candidate for insight-oriented therapy. After dictating my admission note I looked at the Wyeth print in the corner of my office, which loomed directly behind the chair in which patients sat. It was a bleak study of a dead crow, sideways but belly-up, its pencil-thin legs crooked and rigid in death. Stubbles of wheat in a long-since harvested field formed the background beneath a wintry slate sky. Some colleagues had questioned my choice of the print, to

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which I replied it could be used as a projective test, like a Rorschach. That seemed to silence them. Myself, I found a comfort in the portrait of a natural, non-violent death. On rounds the next morning I read the nursing notes in Mr. DeVries’ chart. “2AM–Patient seems to be sleeping. Did not wake when flashlight waved. No signs of dystonia from medication.” Afterwards I questioned the night nurse personally. “Judy?” “Yes, Doctor.” “How’s our new admit?” “You mean the old guy, DeVries?” “Right.” “What do you want to know?” “Were you the one who checked up on him last night?” “Yes.” “Did he look asleep?” “His eyes were closed and he didn’t stir when I moved the flashlight around the room. He wasn’t snoring or anything, but he didn’t open his eyes.” “What time was he in bed?” “Let me see the chart. Thanks. Here, Linda wrote ‘Lights out at 11PM, in bed at 11:15.” “He got his meds at ten.” “Did you or anyone else see him stir last night for any reason, wander the hallways, go to the bathroom, anything?” “The other nurses are in report but I’ll poke my head in and check.” She returned in a few minutes, laughing, with a fresh cup of coffee. “Hey, where’s mine?” I asked.

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“Sorry, nurse’s privilege .. Doctors get their own nowadays. It’s not like it used to be,” she said, smiling.” “Yes, yes, I’m well aware of that. But what did the other nurses say?” “No one saw anything. As far as we know he was quiet as a lamb.” “Thanks, Judy.” Grasping the chart I walked slowly to Mr. DeVries’ room. His bed was empty but I heard noises in the bathroom. I decided to wait for him to emerge. His bed was not disheveled but did appear slept in. The covers were pulled back and wrinkled, and the soft impression of his body persisted on the sheet from the underlying mattress. The pillow looked well-creased and sported a couple of saliva stains. Mr. DeVries emerged from the bathroom showered and shaved, though hardly refreshed. His brown plaid bathrobe had a tattered hem and a few random holes, but was still respectable enough for a mental institution. He ran a towel through his hair, stroked his neck, then noticed me sitting on his bed. He managed a nod of recognition, as if my appearance was inevitable. He dropped the towel to his side, then walked unsteadily to the hamper, which reassured me that he had swallowed his medicine. As he turned back from the bathroom our eyes met. “So, Mr. DeVries, how’d you sleep?” “I didn’t.” “Not at all?” “Not a wink.” “That’s very puzzling. The nurses recorded that you appeared asleep when they carne in to check on you last night with a flashlight. Do you remember that?” “Of course. I remember them corning in, pretending to be quiet as mice when they were really loud as elephants, and I remember the flashlight in the eyes routine.” “So why didn’t you open your eyes and tell them you were awake?” “I didn’t want to bother them. Too much trouble. So I just pretended to be asleep. It was easier than getting up and explaining.” “So let me get this straight–although you appeared asleep, you were only pretending to be so in order to be less trouble for the nurses.”

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“You got it, Doc.” “But Mr. DeVries, you are in a hospital for your own benefit. Isn’t that taking politeness to an extreme?” “What’s the use? I knew I couldn’t sleep. Why did they have to know, too? Isn’t it enough that I tell my doctor?” “Even your doctor needs help from other observers. So if this happens again, I want you to speak to the nurses so they can record that you are awake. By the way, did you have any trouble with the medication?” “Just the usual plumbing delay and a little grogginess and dry mouth. It did seem to make it easier to lie in bed and pretend I was asleep, like a sedative. But it didn’t make me sleep.” “Very well, Mr. DeVries. please get acquainted with the ward routine today and maybe meet some other patients. It’s almost time for breakfast. Which reminds me, how’s your appetite?” “Always been a light eater, but it hasn’t changed.” “Good. I’ll see you in my office at 4PM, unless you’re napping,” I joked. “Fat chance.” The knock on my door came promptly at four, and I ushered Mr. DeVries in. He looked the same–grim and weary. He folded his arms and looked out my window for a moment, then faced me with his tired blue eyes. “So how are you feeling this afternoon?” I began. “Tired as usual. The food’s bad. And there isn’t much to do. Don’t have much use for crafts.” “How was group therapy?” “Is that what it’s called? what a waste of time. A bunch of whining babies in there, people who had slit their wrists and what not. And then there’s the real crazies, who don’t talk much sense and look at you funny. Schizos I guess.” “So I take it you didn’t find any patients to relate to?” “That’s for sure. I don’t think I belong here. I can stay awake at the farm just as well as here. Are any of my tests back?”

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This was the first indication of anything like curiosity in his own condition, so I decided to make the most of it. “I reviewed your blood tests this morning.” “And?” “What are you concerned about?” “I just want to know if there was anything abnormal.” “Like what?” “I don’t know–you’re the doctor. You tell me.” “You seem to have something in mind. Is there something you’re afraid of?” “Me? No. I just want to know if you have any more answers.” “But there is no blood test for insomnia, so what answers are you expecting?” His face went blank for three seconds and his eyes seemed to moisten imperceptibly. Did his chin tremble? This was the closest he’d come to an emotion since admission. “Well, I guess--” “Yes?” I believe “My doctor said something about checking my white blood cells from time to time. Did you check them?” “ “Yes. “So how were they?” “Which kind?” “How do I know which kind?” “Mr. DeVries, you do not strike me as a stupid man. you know which kind you’re interested in.” He paused again. A shadow passed over his face, like the shadow the dead crow in the Wyeth painting behind him. His face slackened, then quickly re-configured into stubborn granite.

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“The L-kind of blood cells, you know---” “Lymphocytes?” “Yeah, that’s right, the lymphocytes.” I had exposed a chink in his psychological armor. The cancer he didn’t believe he had was real enough that he wanted to know his test results. I could have told him a number of things–that lymphoma often doesn’t show up in the blood until the tumors are widespread and that a normal lymphocyte count was no guarantee he was cancer free. Or I could have lied to him, tried to pierce his denial with the announcement that his count had climbed dangerously, just to watch his reaction. The former would fuel his hidden fears, the latter confirm them, but neither was strictly fair. Deceit may break denial but afterwards, once discovered, it only hardens it. There was really only one course for me to take, tempting as the opening had been. But before I took it I wanted to drive the wedge in just a little further. “And why would you be so interested in your lymphocytes?” I asked .He looked away to the window. He stroked his neck with his sun-reddened hand. He looked at the ceiling as if the myriad holes in the acoustic tiles might explain the hole doctors made in his body. “Because the doctors said ..... “ “Yes?” “Because the doctors said that if those cells went up, those lymphocytes ..... “Uh huh?” “It could mean something.” “Like what?” “Like–I don’t know!” he said in exasperation, now freely rubbing his neck. “What would it mean, Mr. DeVries?” “That the uh ... “ He was clearly uncomfortable now, shifting in his seat, avoiding eye contact, crossing and uncrossing his legs. “That the thing–the thing they said I had–that it could be coming back.”

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He wiped his brow in relief as if he had expelled some demon, and the lines of tension on his narrow jaw faded back to the usual mask of resignation. I ought to have accepted that, but I pressed on to hear the dreaded ‘C’ word from his lips. “And the thing that might come back, what is it?” He stiffened, then folded his hands together on his knees as if to pray. He looked down at his lap like a boy in catechism who would rather be out playing baseball. “A growth,” he mumbled, without raising his head. “I’m sorry, I didn’t hear you.” “A growth,” he repeated a little louder, still avoiding eye contact. “What kind of growth?” “How should I know?” he spat out at me, his hands now clenched in anger. “Some kind of a growth!” “You mean the doctors didn’t tell you what it was?” “Well, sort of … ” “Mr. DeVries, are you telling me you let the doctors cut into your neck and give you radiation without telling you what this growth was?” “No!” he yelled. “I wouldn’t let anybody do that. My wife put me up to it. There was really nothing wrong.” “Is that so?” “Yes!” he said, “Goddamed!” His red face went vermilion. He shook his fist at me and his lower jaw extended so his platysma muscle fanned out to his collarbones like a threatened lizard. His defenses were brittle but holding. I waited for him to calm down. We stared eye-to-eye. Behind his anger I was seeking to touch the fear that drove him but he merely re-adjusted his mask, slumped back in his chair, ran his fingers over his stringy hair and exhaled. Then he fiddled with his hands as if running the brim of a hat through them. “So what about my test results?” “What would you like to know?” “What was my lymphocyte count?”

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“Normal.” “Figures,” he said, exhaling deeply. “It’s always been normal, just like I’ve been saying. A bunch of fool doctors tell you you’ve got something serious and you go through all this baloney and then your tests are still normal. No wonder I can’t sleep! You can’t trust the doctors, the lawyers, the ministers, or especially the damned government. Someone’s gotta stay awake to make sure everyone else doesn’t get ripped off!” The faint smile that creased his lips was his first attempt at humor, a more advanced defense than denial. It seemed as close as he could come to expressing relief. I felt the session was over.. That night I arranged for Carl, our maintenance supervisor, to set up a video camera in Mr. DeVries’ room. He went over the particulars with the night nursing staff until they felt comfortable operating it. My only static came from the charge nurse, who asked me if I’d obtained written permission from the patient. I got around that by explaining that the recording was part of the general therapeutic treatment to which he’d consented upon admission. She frowned and made a note in the chart to protect her ass. I didn’t care. I also increased Mr. DeVries’ Thorazine dosage to 200 mg. to insure that he would actually sleep. Since he showed few untoward effects from the 100 mg., I figured a double dose wouldn’t hurt him. The nurses crept into his room at midnight while he was motionless and breathing regularly with his mouth open. They set up the tripod and camera as quietly as possible and put in a long-running tape. One of them addressed him in a normal voice: “Mr. DeVries, are you awake?” No answer. They never saw him stir. They were instructed to remove the camera before dawn to insure he hadn’t seen it. Everything went according to plan. On rounds the next morning I received the tape. I put it in my briefcase then went by Mr. DeVries’ room. He was sitting on the edge of his bed, dressed in blue-striped white flannel pajamas, staring into space, his brown robe pooled at his feet. “Mr. DeVries?” He looked at me as if I was out of focus, squinting to get a better fix. “Doc?” “Yes, it’s me.” “Wow. What did you give me last night, an elephant tranquilizer?”

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“No,” I said, laughing. “I just doubled your sleeping medicine. How are you feeling?” “Like I was kicked in the back of the head by a Brahma bull. I’m almost afraid to stand up.” “Let me help you,” I said, and I put my arm under his armpit and gently yanked him up. “You OK?” I asked. “I don’t know–gotta get my bearings. Want to make it to the bathroom.” I walked him over to the bathroom and meanwhile used my grasp of his arm to check for muscle stiffness, one measure of the drug’s side effects. There was none. He was just groggy. “Will you be all right in there?” I asked him. “Sure, as long as I take it slow.” Some minutes passed until I began to be concerned. I knew I had given him a stiff dose, but that was the point–I wanted to prove he could sleep. So I opened the bathroom door a notch to see how he was doing. He stood doggedly over the toilet, slightly swaying, trying to pee. “Wouldn’t it be better if you sat down?” I suggested. “Damn it, Doc! Did you have to interrupt me just when the old millstream was about to flow? Now I gotta start all over again.” Embarrassed, I retreated back to his bed to wait for the telltale flush that would announce another victory over his aging prostate. Five minutes later I heard it, after which Mr. DeVries ambled out in slow motion and creakily lowered himself next to me, looking like the Tin Man in need of fresh oiling, thoroughly dazed. His cupped his reddish chin in his hands and continued to stare distractedly. “So?” I began. “So what?” he said, speech slightly slurred. “How did you sleep?” “I didn’t.” “Not at all?”

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“Not a wink.” “Did anyone disturb you last night?” “How could they?” he said. “I was so drugged I could hardly move. I probably looked asleep, but I guarantee you I wasn’t. I just couldn’t move with all that medicine in my system. “So you didn’t move all night?” “Hardly.” “And you didn’t notice anything unusual?” “Not unless you mean my eyes going fuzzy and my plumbing shut down and my feet feeling like lead weights.” “Sorry about that. Those side effects should improve as the day goes on. I’ll see you in my office at 4PM today again, OK?” “OK,” he said and lay back down on his bed. I was dismissed. I spent my lunch hour fast-forwarding the videotape to find the best segment for Mr. DeVries to view, though my hope of puncturing his denial with real evidence was slim. Unfortunately the audio contained no snoring, and he barely moved all night. The best I could get was slow, shallow breathing and some close-ups of his mouth half-open and drooling with his eyes closed, and of course, the non-response to the nurse.. I scanned his eyelids for signs of REM sleep but the resolution wasn’t good enough. Besides, Thorazine tends to suppress it. By 4PM I had the television and video player set up in my office. At Mr. DeVries’ knock I had the sinking feeling that it was all for naught. responses. Still, I could study his reaction. “Come on in,” I said. He sat down in the usual chair in front of the Wyeth print. “I have a little show and tell for you today, Peter. You don’t mind if I call you by your first name, do you?” “Not at all. What do you mean by show and tell?” “Let me lower these window shades. Last night while you were in bed we made a tape of you. Since you appeared asleep to us, we thought if you saw yourself on tape you might believe you slept.” I had caught him off guard. He stared at the television suspiciously.

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“So that’s what all the hubbub was in my room last night,” he said. “I wondered what was going on.” “I thought you told me nothing disturbed you last night.” “Of course! How could anything disturb me when I could barely move my limbs! But that doesn’t mean I wasn’t aware of what was going on!” “So why didn’t you say answer the nurse?” “I was distracted by that contraption they were setting up. Maybe it was more radiation, what do I know? I didn’t know you were going to make a movie star out of me.” His lips curled up with sarcasm. “Well since you are a ‘movie star’ now do you have any objection to watching part of the tape with me? “No.” I put the tape in and let it roll. We watched the inert form of Mr. DeVries on his side, covers up, breathing slowly, eyes closed, saliva beaded at his lip’s edge, mouth open. The nurse spoke; he failed to answer. I watched his face as he watched this and it displayed only the smug satisfaction of one who knows a truth others are just too dense to see. For five more minutes I let the tape run in silence. Then I took an objective approach. “Peter, if you could imagine this person were not you, and you were a betting man, would you bet the subject was awake or asleep?” “Asleep,” he answered without hesitation. “Then why do you think you were awake?” “I don’t think–I know I was awake. I just pretend to look like I’m asleep because that’s what you’re supposed to do at night, isn’t it?” “But what about the breathing? The spittle on your lips? Do you drool when you’re awake?” “Sometimes. Got these bad-fitting dentures. And when I take them out at night sometimes I drool even more while my mouth readjusts. Besides, that drug you gave me makes it more difficult to swallow and stuff. I still don’t feel right.”

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“So let me get this straight–although you didn’t actually sleep, you give the impression of sleeping throughout the night for the sake of convenience, to match our expectations?” “That’s right. And even if a man doesn’t sleep, he’s got to rest, doesn’t he? So I lie awake and rest all night.” “But why don’t you open your eyes, or change position? In six hours of tape you don’t open your eyes once.” “Why bother? It’s dark anyway, what’s there to see?” I think he enjoyed my frustration as he nonchalantly embraced the self-evident truth the expert couldn’t see. So we sat in silence for a while, watching the video, when suddenly his expression changed to horror; his eyes went wide, his mouth flew open, and his forehead furrowed in arches piled to his scalp. He began to rub his neck, look away from the TV screen, then look back. Each time he looked back he became more agitated. Finally he spoke. “Doc,” he whispered. “What’s that?” “What’s what?” “That thing on the screen, that dark thing upside down right over my face–it looks like a dead bird or something!” “I don’t see it. Describe it.” He finger shook as he pointed. “Like a crow lying on its back with its little feet up– right there–over my face! What is it? Turn it off, please!” Somehow the crow had been projected on the screen by light bouncing off the print and back onto the video. But I was not about to explain how this had happened, for Peter was sobbing now, sobbing into his callused palms. He wadded a bunch of Kleenex together but was powerless to stop; his tears kept flowing through his palms and down the inside of his leathery arms to become dark spots on his brown polyester slacks, shiny at the knees. I let him weep in silence. After ten minutes he looked up at me through bloodshot eyes, embarrassed, pleading, pleading for what? Reassurance? Absolution? “Doc,” he croaked between sobs. “Yes, Peter?” “I want to go home.”

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“Home?” “Yeah. I want to go home. This place isn’t helping me any.” “I’m sorry to hear that. But could you tell me why you were crying?” “Oh, it’s nothing, I guess,” he said as he rubbed his neck and dabbed his eyes with a baseball-sized wad of tissues. “It just came over me–I don’t know, the medication, lack of sleep, you know--” “But what about the bird?” “My eyes must be playing tricks on me. Just some strange reflection on the TV or something.” “But why did it affect you so?” “The critter just looked so sorry, you know, I felt sorry for it, lying on its back in a field with no one to care for it, just dead and discarded, you know? I keep a lot of birdfeeders out in winter and we get a lot of birds. I guess it made me want to be back at the farm, to have everything back to normal.” “Oh,” I said. “Can I go now?” “Sure,” I said.” That night I lay awake thinking about Mr. DeVries. I thought about his years as a farmer, his sturdy belief in the everyday reality of cows and feed, summer and winter, planting and harvest. He had wept like a baby when the superimposed image of a dead crow marked his face, though he consciously never made the connection with his cancer and fear of death. Like most of us he assumed he was immortal until the day death would surprise him, and he did everything in his power to keep that possibility out of mind. Being cannot imagine non-being. We live out the myth of our own immortality each new day, and we must, because hope cannot tolerate the reality of death, no matter how old or sick you get. And who was I to bring a man to his knees with a knowledge too painful to tolerate? If I opened the dam of his grief who would patch him up so he could go on living and trusting life? And once he went back to his farm and his church, who could he talk to about such things? As an intern I could never forget my first patient with a heart attack. Though he survived, he was terrified and tearful, constantly demanding reassurance because the

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thought of his own death had never occurred to him. Lucky man!-- lucky, like most of us, to be blind. By morning I had made up my mind. Much to the nurses’ astonishment I discharged Peter that very day. It’s true he never admitted to sleeping, but I told him that based upon my investigation it was perfectly all right for him not to sleep as long as he rested at night with his eyes closed for six hours. He was agreeable to this. In a younger patient I might have pushed harder, but to rob a septuagenarian of his main defense against mortality seemed cruel. To sleep is to die, in a sense, and if he needed to believe he was always awake so the grim reaper couldn’t surprise him, it was all right with me. Who was I to rub his face in it? He didn’t have to say “cancer.” His death would come whether he believed in it or not. Until then he didn’t have to sleep.

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