After examining him, I purposely sat to his right so that his face was in profile. From that angle he appeared to be much like any other old-timer in our department whose life was unravelling. He seemed tired, drained and indifferent to my presence, and I was just about to leave when he passed his right index finger over the bridge of his nose, winked at his grown son and smiled weakly. I glanced surreptitiously at the younger man, hoping to gauge his reaction. I saw his tense features soften, as if he had been reminded of a lifetime together.
Was it really so long ago, I imagined him thinking, that those arms, once strong and taut, had swept up his small body and he had felt the scratch of whiskers against his cheek and the sting of his father's work-a-day sweat rising reassuringly to his own young nostrils? Then the younger man smiled and reached for his father's weathered hand. For a moment the world was whittled down to these two men. No words passed between them.
I was an undeserving witness, for I had examined him less with an inquiring, clinical eye than with a gawking, morbid curiosity. This was a man who for years had been unable to speak or to walk down the street without anxiety. Yet here he was, still able to reach out to those around him, those who remembered who he was and how he had been, who could see, and yet not see, what had been taken from him.
“Cancer of the sinus, thirty years ago,” read his chart, “treated surgically.” A minimalist had penned these words, surely. For the scalpel and related instruments had excised most of the left side of his face: the globe, the maxilla, the zygomatic prominence and hard palate, along with all associated soft tissues. Where once had been a twinkling left eye and a high cheekbone was now a shocking chasm. I had stood at his left side and peered into this cavern, half expecting to see the spongy folds of his brain — but, instead, looking down toward his mouth, I gazed freely on the workings of his tongue. I had only ever read about war wounds of this gravity; I'd never seen a human face so disfigured intentionally.
Later, as I drove home in the dark, the full force of a West Coast rainstorm slapping against my windshield, the lights of a passing car illuminated my rear-view mirror — and I was momentarily aware of my reflection. A memory washed over me like the headlights of that fleeting vehicle. I recalled reading about a youngish poet who had lived in the city where I had served my residency. She had been diagnosed with a form of bone cancer that invaded her mandible. She made the decision not to have surgery that would have maimed her face. I imagined her as having traded a life she could not accept for a death that she could, her mouth able to pronounce the sweetness and sorrow of her earthly existence until her final heartbeat.
Had my patient been thankful for the years that his operation had allowed? I began to wonder about the effects of such radical surgery. Perhaps because I would have found it unbearable, I questioned how he could have coped with the years of forced speechlessness, unable even to say hello or good-bye or thank-you. And I wondered, too, if he had felt locked in a frightening Halloween mask, afraid to venture outside his house for fear of terrifying children or inviting derision? Perhaps even worse were the polite reactions, the averted gazes by those unwilling to be caught staring at his deformity. Were there not moments when he longed to scream, like John Merrick, the Elephant Man, “I am a man! I am not an animal!”
At home that night before bed, alone in the stillness of a sleeping household, I stared into the mirror and tried to picture my face with half of it carved away. I considered how my wife and children might react. Would it be with acceptance or pity? Would they recoil from me?
My thoughts drifted back to the old man's simple gesture, his train ride of life clickety-clacking to a halt. And it came to me, finally, that he had signalled to his son, “It's okay. I'll be all right. I love you, as I always have.”
Brian Deady Emergency Physician New Westminster, BC