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Withering Away on the Outside

You are an angel, undeserving of such tortuous demise.

I bit my tongue to hold back these words I was thinking but couldn’t say to our young, male patient with amyotrophic lateral sclerosis (ALS). The attending physician had just exclaimed, “Foot drop is often one of the first signs of ALS. Do you notice here the distal muscle atrophy, including the intrinsic muscles of the hand, namely the dorsal interosseus muscles and thenar eminence?”

Absolutely! I stood there gazing at the pronounced physical features of a near skeleton, slowly eroding away.

Yet it wasn’t the young man’s appearance that most captivated my attention. Honestly, I was mesmerized by his sheer volume of welcoming joy. As he described his limitations, specifically his reliance on certain equipment for mobility, his demeanor and attitude showed no signs of crumbling underneath such a horrific reality. He knew he would die within the next decade, yet his smile and commentary invoked a disorganized chirping by the treatment team that blended into a harmonious sound, negating all negativity.

I was witnessing a miracle, disturbed only by the sense of urgency to complete rounds on time.

Reflecting now, I cannot begin to imagine fighting that tickllng thought of impending doom he must feel so terribly deeply every day. If I were in his shoes, I’d be consumed with anger.

Most of us who are blithely unaffected by terminal illnesses are still incapable of displaying such compassion for others or appreciation for the marvelous intricacies and lessons of life. It truly is a miracle to embrace such hardship and be a messenger of positivity and happiness. 

One day I hope to share with you what I really think. That on the outside you may be deceptively weak, but on the inside you are deceptively strong. That you taught me amazing things that go beyond medicine. That you bring fresh air to those around you. And that miracles really do exist.

Joseph Tadros
Cincinnati, Ohio


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