The Last Kleenex

Charlie, a fifty-year-old gay man and my patient for many years, comes for an office visit. His complaints are a cough and listlessness.

He is an outgoing, highly respected architect who teaches at a prominent university. He’s left few precious stones unturned in his life and has been remarkably successful. He has a wonderful, loving marriage.

To offer further insight into Charlie’s character and personality, some time ago he received treatment for a malignancy. Before embarking on treatment, he scoured every conceivable therapy and developed a thorough knowledge of the pros and cons of each one. Every step of the way, he shared the details of the investigation with me. I was greatly impressed by his ability to control his life so admirably and effectively.

My contribution to his detailed search for the right approach was to suggest that he accept one of the many treatment options, then do his best to deal with the uncertainty surrounding medical treatment.

“If you don’t,” I said, “you’ll drive yourself crazy.” Charlie has repeatedly expressed his appreciation for my having made this suggestion.

Over time, we’ve developed a relationship in which we can share humor and irony as a way of handling life’s outrageous or not-so-outrageous fortunes and misfortunes.

In the past, Charlie has shared his concern for his loving but stubborn and ailing mother, who has finally agreed to move to an assisted-living facility closer to my patient. He has also repeatedly described how, for decades, he’s been alienated from his father, who cannot accept his sexual orientation. Unfortunately, all of Charlie’s attempts at reconciliation have met with painful silence.

After his exam, he tells me, “Just before last Thanksgiving, I wrote to my father again. Nine months later, I got a letter back that said, ‘I’m trying understand, but I cannot forgive you.’ ”

As he says this, I can sense his palpable grief. I see the agony on his kind and sensitive face. I turn away and look at the chart. I long ago learned that there are no words that can relieve this kind of existential pain, born of abandonment.

Suddenly, tears roll down my cheeks. I look over and see the tears rolling down Charlie’s cheeks, too.

I reach for tissues for him and for me.

There is only one left in the container. I hand it to him and say, “God damn it! F**k! Why do I always have to take care of the patient first?!”

In the midst of the grief and the tears, we smile and tightly embrace each other.

Joseph Fennelly
Madison, New Jersey