Problem: a small mass on his butt.
The emergency room doctor feels like there's a big infection and decides to keep him in the hospital. The young patient gets a surgery for his back, and a huge 30-cm cancer is found stuck to his muscles and bones.
Further tests show that this is an aggressive cancer that has spread to his liver and lungs as well.
Tom has been in the hospital for 3 months now, and had a major surgery to remove the tumor in hope of prolonging his life a few more months. He now has a very large scar on his buttocks and thighs. He hasn't walked or even sat in his bed in three months.
He is 36, but now looks double his age.
I have seen many depressed people. I've met some people who tried to kill themselves because of depression. I had a patient who once tried to slash his wrists inside the hospital. But I've never met a person with this kind of depression that this guy has.
Tom stopped talking. He barely says anything now. His brain, vocal cords, mouth and tongue are (still) working, but he's not talking. I asked him how was his day going, did he have any pain, did he feel like crap, and he kept silent.
I've never seen anyone so depressed, so defeated, and so broken like him.
Eventually, we told him there was no chance for him to be cured, and we'd prefer him to receive comfort care at home where he can be pain-free and more comfortable. He said a few words, "I don't want to". He wanted to stay in the hospital and live the illusion that one day he might get better, but the end is very close and we all know it. I know that he'll die in pain, and that he'll die silent, very very silent.
Silence was his language. It was his voice and his way of communication. It could have been the source of his strength or the expression of his defeat, or maybe both. I would never know, and I would never ask him because he'd answer me with a long pause that will make me ashamed of myself.
I've just learned that silence can be the most powerful scream.