He knows the end is near when he begins to dream of himself as he is, rather than as he was. No more dreams of bounding through the woods, rows of trees admiring his movement and cheering as he passes. No more dreams of running beside his wife in the springtime, listening to her gush over the blooming flowers that line the road while they breathe air heavy with the coming rain. In Larry’s dreams now he moves slowly, painfully, always through a fog of fear, always counting. The same way he moves when he is awake.
Larry wasn’t alarmed at the initial swelling or the light rash on his left leg. He just assumed it was an allergic reaction. His doctor reassured him that it was probably nothing serious. They tried creams, ointments, antibiotics. When nothing worked, his doctor referred him to an allergist, who, after finding no allergies, was equally confounded. Larry returned to his primary care doctor, who prescribed a different antibiotic and said sometimes we see this, an unexplained cellulitis – a skin irritation – and it takes a few months for it to respond to the antibiotics. Then it clears up and we never know the cause. Keep up the antibiotics and let me know how it goes. Larry took the drugs diligently, but he could tell that the rash and the swelling were worsening. The swelling increased after a run, but Larry pushed through, relying on his years of experience running through discomfort in the military, on all the runs he’d logged while tired or sick. After six weeks of no improvement, Larry sought out a new general practitioner, Dr. Goodwin. When he described how his symptoms hadn’t changed over a couple of months, Dr. Goodwin ordered an abdominal ultrasound. Larry asked why, and Dr. Goodwin said I just want to rule out any arterial issues.
He stares at his white bathroom ceiling, and the tiny shadows cast by the popcorn surfacing remind him of the surface of the moon. Living in a hot climate, he’d organized his summer training schedule around the moon’s phases. Though he knew the moon emitted neither, he saw it as a source of both heat and light, an ally against the encroaching darkness and falling temperatures of night. The full moon brought his longest run of the month, and, during the second hour, when the road was flat and straight, he would look upward and feel as though he were running toward it. It was as if fatigue brought with it not only clarity but magnification, and a slight rise in the road would fill him with the euphoric feeling of liftoff.
The ultrasound did not rule anything out. Rather, Dr. Goodwin’s voice became quiet as he pointed to a ghostly bulge on the screen. You see this, Mr. Griffin? That’s your internal iliac artery. It’s difficult to get a clear view on ultrasound. What I see here concerns me, however – I think there is a possibility that what we’re seeing is an aneurysm. Dr. Goodwin told Larry that he needed a CT scan and a consultation with a vascular surgeon. Larry wasn’t sure what this meant, but when Dr. Goodwin began to tell him where the vascular surgeon’s office was, Larry thought, right now? Things must be serious. The office was on another floor and when Larry arrived they directed him down the hall for the CT scan. Larry lay on the concave carbon fiber table and listened to the tech. The X-ray beam will rotate around your midsection and generate a 3D image. Please remain still. It will only take a few minutes. With a thin hum, the table slid forward until the donut-shaped console that had been at his feet encircled his waist. Larry’s heart palpitated, as if stimulated by the radiation.
He turns his head and looks back at the faint layer of filth that marks his path from his bed to the bathroom. Filth comprised of the accumulated grime that clings to his skin from not showering in weeks. The electric wheelchair that he’d sworn he would not use had stopped working two weeks prior, but he didn’t want to call anyone to come fix it, didn’t want to see anyone at all. He started using it a month ago, when he had grown frightened at otherwise having only a few days left. He remembers telling Dr. Goodwin, I won’t grovel to stay alive. I can at least go out with my dignity intact. The memory of those words almost makes him laugh. Larry imagines calling Dr. Goodwin and apologizing for the spiteful, uncomfortable end to their relationship. Then maybe Dr. Goodwin would tell him that he could be treated after all. There were times when such a thought would have brought him hope and tears. Now he observes the thought, lets it drift past, and resumes his crawl. He can no longer imagine a cure, a life of unlimited steps, a life that ends in an unexpected fashion at an unexpected time.
The journey to the toilet complete, he pulls himself atop it and then listens to the intermittent tinkle of his urine, trying to envision his insides, where the growing aneurysm presses against his bladder like an unwanted child. He does not think of the aneurysm in the possessive sense, does not consider it his like he does other organs and body parts. He thinks of it as the aneurysm, a foreign invader, an unwelcome intruder, an apocalyptic threat.
Dr. Brennig, the vascular surgeon, told him that it was inoperable. Your extensive internal scarring, particularly between your heart, aorta, and iliac artery, eliminates surgery as an option. Larry’s scarring had occurred eight years ago, when he had driven over an improvised explosive device in Afghanistan. He remembered none of it, though Jamey, a laid-back private from Oklahoma City who visited him in the hospital stateside, had told him Dude, you were fileted open like a mackerel. Jamey’s words were in Larry’s mind as he tried to picture himself immediately after the explosion, which is what he was doing while Dr. Brennig was talking. There was mostly blankness there, and, while he always told people that he was thankful that he didn’t remember, the truth was that he ached to fill that gap, that he felt like if he could only remember then things would somehow be better. But the few memories of that day were faint as scents, and his mind wandered between them like a dog off leash, investigating the mysterious and reveling in the familiar, lingering indiscriminately. He pulled himself away from the past and tried to attend to Dr. Brennig.
Sorry. I’m struggling to absorb all this. You can’t fix it. Okay. So what’s next? Is there some drug? Or do these ever just go away?
Well, as for what’s next, Mr. Griffin. I think you’d be best off discussing that with Dr. Goodwin. He can present you with some options as far as hospice care and pain management. As for medication or whether this could resolve itself... Well. I’m not aware of any aneurysms like yours that did not eventually rupture if left untreated. However, there are some medications that we can prescribe to reduce the risk of a clot breaking free and causing an embolism. We can also prescribe blood pressure meds. Lower blood pressure will put less stress on the vessel. That at least could buy you some additional time.
How much time do I have, Doc? Larry said, feeling like he was reading a script in a bad movie.
Dr. Brennig smiled. And, though his round face and white hair and wire-rimmed glasses gave him a sort of grandfatherly benevolence, the smile did not convey warmth. Unfortunately, I can’t really answer that at this point, Larry. Your aneurysm is about nine centimeters. A recent study found internal iliac aneurysms ranging from two centimeters to thirteen centimeters at the time of diagnosis, and, while the point of rupture was similar, sometimes those that were smaller initially progressed faster. It really is unpredictable until we’ve monitored its growth for a period.
He crawls back toward his bed as his leg pulses, a clock that cannot be rewound marking off its final ticks. Though he has stopped going to the doctor, he has continued charting his steps and knows he has less than five thousand left. He is thin now, and his body feels heavy and firmly rooted to the ground. Some days he sits in a chair by his front window and watches life in his neighborhood continue. The elderly on their walks, the mothers pushing strollers, the joggers – all of them seem alien to Larry. Their movement is so free and light, as if gravity affects them differently. Larry realizes that that the world is little more than a backdrop now, and he can step into it about as easily as he can step into his television screen. He wonders if this is a common feeling for the old and decrepit, and he weeps, thinking but I’m only thirty-five.
Larry was skeptical when Dr. Goodwin told him that he had around 100,000 steps left. It took a half dozen visits to arrive at the number. When Dr. Goodwin first said it, Larry rose from the exam table and took two steps forward. Uh-oh, Doc. 99,998 now. Dr. Goodwin didn’t smile. He just pointed again to the CT scans and the graph that plotted his steps against the growth of the aneurysm.
Larry, I know it is hard to believe, but look at this. We can accurately measure the rate of growth of your aneurysm between each of your last six visits. We can compare the growth to the amount of time elapsed and, since you’ve been wearing the pedometer, we can also compare it to the number of steps you took between each visit, okay? Larry nodded. It appears that your aneurysm is worsening with each step. I discussed why that might be with Dr. Brennig, and we think that, because of your internal scarring, the movement of your leg pulls on the aneurysm in such a way that causes more rapid expansion. Look at how much less it worsened during the 48 hours that you spent in bed.
Dr. Goodwin had assigned Larry to bed rest between two of the visits, and the CT scan taken at each showed that the aneurysm did grow more slowly during that period.
Alright, Dr. Goodwin. So what I am supposed to do? Stay in bed until I keel over?
No, Larry, that’s not what I’m advocating. I’m just encouraging you to think about how you use your steps. We know about at what point these aneurysms will rupture, and, projecting the rate of growth that we saw during your bed rest period… Well, I’d guess that you could increase your time left by more than tenfold if you utilize a wheelchair. It will still rupture eventually, but you can delay it, Larry.
Larry ignored the suggestion of the wheelchair and focused on the 100,000 steps.
100,000 steps. I’ve been using, what, 4,000 a day? So you’re saying that in 25 days this thing’ll rupture and that’ll be it. A month. Am I wrong?
Dr. Goodwin bent forward, the wheeled stool beneath him squeaking as he moved. Not 25 days, Larry. 100,000 steps. Sure, if you take 4,000 steps a day you’ll have around twenty-five days. But if you use a wheelchair, you’ll probably live another year. Dr. Goodwin leaned back and folded his hands in his lap, as if he had delivered satisfactory news.
One week later, Larry walked into Dr. Goodwin’s office still wet with sweat, for he had gone for a run just before the appointment. He was angry, knowing that Dr. Goodwin would be pushing him to use a wheelchair. He thought running would prove something. He’d taken off his pedometer and, for a few steps, he felt like he’d traveled back in time. But as his heart rate climbed, a sense of building pressure rose up his thigh and into his belly. The pressure welled up with each contact with the pavement, and he couldn’t help but count. And so, after less than three miles, 5,000 steps, just two laps around his neighborhood, he stopped, knelt on the pavement, and sobbed.
Dr. Goodwin greeted him warmly but became grave as he examined the new CT scan.
Have you been wearing your pedometer? The aneurysm is expanding faster than I would have projected, given the number of steps you recorded.
Larry could see no reason to lie. Doc, I went for a run, he said.
Dr. Goodwin tilted his head and squinted, as if he were confused.
You ran? How far? You must not have worn your pedometer. Dr. Goodwin spoke the last sentence as though he were reassured that his calculations weren’t incorrect, that it was a matter of patient noncompliance. Larry cut him off before he could say anything else.
Look, I needed to run. I mean, this whole thing seems like science fiction. Or it did. But I could feel something on that run, a lot worse than my run from six weeks ago, a lot worse than it feels when I’m walking.
How long was the run, Larry?
Maybe three miles. And yeah, I counted. Around five thousand steps.
Dr. Goodwin jotted something on his pad.
Larry, based on how the aneurysm looks today, I’d guess that each running step actually costs you more than each walking step. Maybe one and a half times. So a 5,000-step run is equivalent to roughly 7,500 steps walking.
Larry nodded and said nothing.
Was it really worth it? Doctor Goodwin asked.
Well, I love running, Doc, Larry said. Maybe that’s silly, but it’s true.
Doctor Goodwin frowned for a moment, then smiled. Surely you love other things as well, though, Larry. Things that aren’t so costly to your health. Family? Friends? Don’t you think they’d appreciate you sticking around a little longer?
Larry was quiet, thinking if I’m not going to pursue a love just because the price is high, what does that say about love? And then he thought about his departed parents, his estranged sister, and his ex-wife. No, Dr. Goodwin, I don’t have a lot of strong social ties. I’m divorced and my parents passed a few years ago… And I’ve thought about the wheelchair thing. I don’t want one. I don’t want to die in a chair. If someone told you that you could live an extra 20 years but that you’d have to live in a chair for the rest of your life to do it, would you, Doc?
Well, Larry, no one has presented me with that option. And while I do see your point, how about I order the chair, and you can try it out? No one will make you sit in it. If you’re concerned about the cost, I’m confident we can establish a service connection, in which case the VA will cover it.
Larry wanted to tell Dr. Goodwin that his mind wasn’t really on cost since he only had a month to live. He wanted to tell Dr. Goodwin to fuck off, to stop trying to force him into a chair. But he didn’t want things to end badly. He liked Dr. Goodwin.
Okay. Order the chair. I’m not saying I’ll use it, though. Also, I was thinking, if I only have a certain number of steps left, I think I’ll end my visits to your office. No offense, but I don’t know if it’s worth a few hundred steps every week if there’s no treatment for me.
Dr. Goodwin seemed surprised. That’s your decision, Larry. I am concerned, though, because we won’t be able to monitor the aneurysm from afar. It might advance slower or faster than we expect. When Larry didn’t respond, Dr. Goodwin continued, seeming mildly perturbed that Larry would choose to go unmonitored. But if that’s what you want, that’s fine. How about I make a house call to check on you in a few weeks? Dr. Goodwin looked at him as though he should be grateful for this offer.
Larry stared back, wondering why Dr. Goodwin couldn’t understand that knowing when the end would come was not necessarily a blessing. Being able to quantify the percent of his life he expended while walking from his bedroom to his kitchen did not feel like something to be thankful for. He thought such knowledge might cause him to go mad before he died. But he decided to agree, reluctantly, though there was one more thing he wanted to know.
A house call would be fine. I have one more question, though.
Go ahead, Larry.
Larry lowered his head and looked at his feet. Seeing his running shoes made him feel even more absurd and pathetic. What’ll it feel like? he said.
Pardon me, Larry?
What’ll it feel like, Doc? You know, at the end.
Dr. Goodwin tried to dodge the question at first, saying that maybe that wasn’t the best thing to focus on. But Larry insisted. Finally, Dr. Goodwin told him that he would probably feel a tearing, a sudden flash of pain followed by lightheadedness. Then, Dr. Goodwin said, you’ll probably pass out. He didn’t say that Larry would not wake up.
It is sometime after one in the morning, and the bathroom floor is cold. Larry tried to keep his nighttime trips to the toilet to a minimum, but he’d drunk three beers around ten o’clock. The transition from warm bed to cold tile jars him to alertness. From his position on the floor, he cannot see the moon, though its pale light casts shadows through his bathroom window. He remembers that it is full, and he suddenly has the urge feel its light shine directly on him, and his breathing becomes shallower and more rapid with excitement. He reaches up and grips the sink, pulling himself to his knees. Then he plants his right foot in front of him, places both hands on his thigh and presses up as he stands, slowly, mechanically, frame by frame. A pop emanates from his right kneecap, unused to bearing his weight. He wavers, distracted by the phantasmal image in the mirror. He hasn’t looked in a mirror in over a month, since before Dr. Goodwin made his house call. The light is not adequate for him to see his own eyes, and he is frightened by his face, by the hollow darkness around his eye sockets. A breeze outside waves a tree limb in front of the moon, and the movement of the shadows disorients him, and he thinks for a moment that he will fall. Then he steadies himself and looks outside, where the world seems bright as day.
The house call only happened once, two weeks after his last appointment. It didn’t go well. He answered the door on his feet, and Dr. Goodwin almost immediately admonished him for not using the wheelchair. Then he tried to persuade Larry that he should try meditation or counseling. Larry remembered his ex-wife telling him after he’d returned from Afghanistan that he should meditate. He tried it a couple times, but his meditations were filled with trauma, not peacefulness. He didn’t tell Dr. Goodwin that. Instead, he said, Thanks, Doc. But I don’t have the patience for meditating and I don’t have the time for counseling. I’ve got to conserve steps, remember? Dr. Goodwin nodded and said that he wanted to talk to him about that. Then he tried to convince Larry to move into a clinic or an assisted living facility. Dr. Goodwin said that they could monitor him and keep him comfortable. Larry told Dr. Goodwin that it was out of the question, that this was his home and he had memories here to accompany him to the end and he wasn’t leaving. He accused Doctor Goodwin of only wanting to help him so that he could publish some sort of case study or capitalize on him in some way. He had no idea as to whether that was true, but he’d heard Dr. Brennig talk about the rarity of these types of aneurysms and how few relevant case studies there were in the literature. Dr. Goodwin avoided the confrontation and left, wishing Larry good luck and telling him to let him know if he had further questions about his condition. Larry did not speak to him again. He did begin to doubt Dr. Goodwin and Dr. Brennig, however, and he requested his medical records and sent them on to two other vascular surgeons with a request for an opinion, explaining in a written note why he didn’t come in person. The other two surgeons gave him the same response: there was nothing they could do for him.
By the time Larry shuffles outside, the moon seems to have reached its peak in the sky, rendering the streetlamps unnecessary. He steps down from his porch onto the sidewalk, and his leg quivers, weak and unsteady. He is barefoot, and the pavement feels rough under his feet. One foot moves forward and then another, and, though his street is flat, he feels like he is moving downhill, an unseen force pulling him forward, his legs just barely keeping up. Momentum accumulates and soon he is airborne for that split second between the striking of the ball of each foot. The mailboxes and the houses seem strange, otherworldly, and watching them rush by nauseates him. He turns his gaze to the ground, thinking about how it feels under his feet and not about how soon he will be beneath it. He zigs and zags back and forth across the street, running through shrubbery and into lawns. Clouds move across the moon, and Larry has the illusion that they are stationary and that he is moving across the landscape so rapidly that it changes their relative position. Then he is on the ground.
Another explosion, Larry thinks, as the blood rushes out from his burst vessel into his body cavity. The sensation is not as painful as he had feared. He is in the middle of the street and the asphalt around him mirrors the sky, dark and uniform, any stars or irregularities drowned out by the moonlight. His blood, which once ran so precisely through his veins and arteries and vessels, begins to pool beneath him, a layer of warm liquid just beneath the skin. Yet he grows colder, and he thinks that he was wrong about the moon, that the moon is actually a hole in the night’s fabric, a point of ventilation through which the day’s heat escapes. He tries to imagine a sky of whiteness as bright as the moon, covered by a shroud, and he thinks that would be a white light, after all. Then he tries to picture what a world beneath such a sky would look like, and the moon seems to move, and he thinks he can feel its gravity. And, finally, his body lies still on the asphalt, all the blood inside him unloosed, free to wash back and forth like the tide.
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