It was easy to miss her sadness. It lay deeper, occupying a soundless, dark, expansive space, and herself a satellite, flung from the bosom of a warm world a long time ago, constantly moving through the darkness, perhaps even believing at times she was escaping it, but its edges raced perpetually beyond, and she remained in a place where time forgoes its gentle wearing, where things exist in a permanence unbound from imagination.

“I’m worried it’s like my husband. That I’ll die,” she said.

She was short of breath. A common malady with a universe of consequences. I studied her X-ray: incandescent bones and the blackness of lung tissue—essentially normal. But then my eyes were drawn to the left upper lobe to a collection of white specks, like pebbles spilled across a chalkboard. Brighter than bone, foreign by all appearances, unnatural but not obviously malignant. Oftentimes infiltrates are thought of as invaders, entering spaces they did not belong, but the appearance of these lesions were different. They didn’t belong but they weren’t invaders, more like pilgrims. They’d buried their flags and burned their boats. They believed they belonged and had stubbornly remained, haunting her since their inception.

She did end up having what her husband died of—idiopathic pulmonary fibrosis—a cruel disease where the normally elastic and spongy lung tissue becomes scarred and stiff to the point where the heart cannot pump blood any longer to exchange oxygen. We found that out later. The day I did the chest X-ray, I let her know there was nothing obvious to explain her symptoms, but we’d get to the bottom of it. When I mentioned the fragments in her lung, her sadness came to the surface. I’d known it was there. I’d seen glimpses of it in past visits, but not in the way it was then. The pieces in her lung were fragments of a bullet. A lifetime ago she’d gently placed a gun against her chest and pulled the trigger. Decades later the wounds had healed but the shrapnel remained. A moment she’d regretted and repressed best she could until the X-ray brought the remnants back to life.

A year later, she made me promise I wouldn’t let her suffer at the end. I promised I wouldn’t but didn’t think we were at the end yet. The sound of her oxygen tank pushing air and her gasping inhalations broke the silence between us and challenged my prognosis. In the following months we struggled to keep her heart and lungs alive with diuretics, specialists, and hospital stays. She came to my office after our final desperate attempt to keep her out of the hospital. It had failed. I tried to avoid staring too hard into her blue eyes, didn’t want to watch her shaking hands too closely, as I risked blurring my vision and seeing double. Who she was before and who she was now were one and the same. She’d been a woman desperate to escape and now she was a woman desperate to hold on—both looking for reprieve.

She went home instead of the hospital. I signed the order and the hospice team kept her from suffering. Alone in my office, I pictured her at home in those final moments, a quiet solitude despite being surrounded by family, having a private communion with her former self, asking forgiveness and understanding, knowing that both entities were facing their own fear—fear of the end, fear of it all going forward—and understanding that at times both can be unbearable.

SR Schulz is a writer who sometimes thinks too much. He’s also a doctor among other things. His work has been published by McSweeney’s, Pidgeonholes, Rejection Letters, and others. Most of his work can be seen at www.SRSCHULZWRITING.com

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