Don, 1979

It’s 3:00 am. Deep in the bowels of the hospital, bright fluorescent lights softly buzz overhead in the windowless snack bar, where a row of vending machines give off a low hum.

Don, my sixteen-year-old patient, and I sit huddled in orange plastic chairs at a tiny Formica table. He is ranting, and I am listening. Neither of us can sleep. Don is awake because he is mad at the world, and I’m awake because I’m the pediatric resident on call.

Don’s left sleeve hangs limply, his arm amputated at the shoulder. A top-notch athlete, he broke his arm sliding into second base. The X-ray revealed an unexpected tumor, a weak spot that led to the fracture. Horribly, irrevocably, it was osteosarcoma, and the whole arm had to go, in an effort to save his life.

His parents are grateful that the tumor was found, hopeful that it’s been amputated in time, holding on to the idea that their boy will grow up.

But not Don; he is pissed. Consumed with fury. He hates how the empty sleeve flaps. Looks stupid, he says. He hates the fact that he can’t button his shirt one-handed.

“I despise those slip-on sneakers my mom bought me! Me and all my friends wear Adidas lace-ups, and I am not going to be seen in dumb slip-on sneakers! Slip-ons are for babies,” he growls. But he’s stuck; he can’t tie his shoes one-handed, and he is not going to ask for help tying his shoes.

He rails against the soon-to-come baldness from the upcoming chemotherapy. He angrily wipes away tears.

I listen. Sure, I’ve studied Kübler-Ross and the stages of grief, but I haven’t lived them or watched them up close. Academically, I know that anger will give way to bargaining, depression and finally acceptance, but none of that is any help as I bear silent witness to Don’s grief. We are too close in age; I’m only ten years older. My friends have little brothers his age. It is too real.

So I just listen and nod. And buy more candy bars for us to eat as he rages. Don fumbles with the Milky Way wrapper, stops himself from hurling it against the wall in frustration, finally rips it open with his teeth. I know better than to help him.

And so the hours pass. Finally he winds down, and I get called away to see another patient. Don returns to his room to try to sleep.

This will be the first of many such nights for Don and me.

But on this night, I know something that Don and his parents don’t know. His latest chest X-ray shows a spot on his left lung—a sure metastasis of the osteosarcoma, a death knell.

We haven’t had a chance to tell Don and his parents yet, but I know that it is highly unlikely he will be alive in two years. In spite of the amputation, in spite of aggressive chemotherapy, the cancer will mercilessly spread and kill him.

At home, I sometimes try to get dressed while buttoning and tying with only one hand. I can’t do it. I try to imagine what I would do if someone told me that I had only a year or two to live. I can’t do that either. I read about osteosarcoma, trying to find one tiny bit of optimistic information that the whole oncology team doesn’t happen to know. I find nothing.

When Don’s parents are told about the lung metastasis, they crumple like tissue paper, not bothering to choke back their tears. They eagerly sign permission for the recommended chemotherapy, the last shred of magical hope.

But not Don. In another late-night snack-bar session, he confides in me, his anger white-hot.

“They think they’re going to give me chemo. Nope, not me. I’m going to go out in a blaze of glory! Remember, my parents gave me a car when I turned sixteen, before this dumb tumor—and I can still drive one-handed.”

The threat is clear. In his anger and grief, he has reincarnated himself as a daredevil. What does it matter now? No need to be careful, no need to worry about getting speeding tickets, no need to fear a car accident. He vehemently refuses chemotherapy, consenting only to some palliative radiation to his chest.

I want to argue. I want to plead with him to take the chemo, to get him to give it his best shot. His parents and his attending physician try. But I don’t have the heart. Who knows? I might do the same thing in his place. So I listen.

I see him in the clinic sometimes, his bushy hair and thin adolescent beard a defiant banner among the bald chemotherapy patients. I expect to hear that he’s died in a one-car high-speed accident. But no: The Fates have something else in mind. Something less dramatic, more plebeian. His lung metastases grow, and he gets short of breath and lands in the hospital, with oxygen and narcotics for pain.

With his loving parents by his side, he fades away in a haze of painkillers. Not a blaze of glory.

He is buried in his baseball uniform, wearing his lace-up cleats. I can’t make myself go to the funeral; I want to remember him alive, feisty, a spitfire.

Today, decades later, I still think about Don. Late-night candy bars, fast cars, particularly elegant baseball players and angry teenage boys all bring him back to my mind.

For him, there was only ever anger.

No bargaining.

No depression.

No acceptance.

Was it better that way? I still don’t know.