The Meaning of Life, explained at Camp Lejeune

Primary biliary cirrhosis is an immune liver disease of unknown cause. It silently attacks the bile ducts in the liver, causing over time the accumulation of scar tissue, which is cirrhosis, the end point of any chronic liver injury whether from alcohol, viruses, or other disease. We really don't have a cure or even a real treatment; these days we have medicines to mitigate the process, often enough that it makes no difference to the patient's survival. A bad case, even now, means a liver transplant.

Mrs. Jackson had a bad case. Back then, liver transplantation was in its infancy. It was reserved for young, strong patients, and Mrs. Jackson was neither. All there was to do was manage the many complications of cirrhosis: the bleeding, the fluid accumulating in the belly (sometimes over 20 liters), the itching from jaundice, the brain suppression which comes with liver disease, the low blood cell counts with all their systemic effects. I was like a one-armed paper hanger, fixing one problem only to have another pop up.

A colleague said I was playing pinball. To my puzzled look he explained, "You know the ball is going to go down the hole sooner or later, so you're just using tilt and the flippers and... keeping the ball in play. Just keeping the ball in play."

He was completely right. But I kept the ball in play for almost two years, and handed her off to my relief, another young Medical Corps lieutenant, when I rotated out. I saw her weekly, sometimes more often, and I got to know her well enough to judge by the look in her eyes when she was heading for trouble. Her husband was always at every appointment, and when, every six weeks or so, she landed in the ICU, he was there too.

Until one day, he wasn't. Everyone noticed his absence, but no one wanted to ask. I admitted her to the ICU, did my history and physical, and was sitting at the nurses' station writing orders. A young nurse was tucking her in, and she finally popped the question.

"Mrs Jackson," she said, "where is your husband? Why isn't he here?"

"Dear," she answered, "He's golfing today. I came by myself."

"WHAT? How can he play golf when you're so sick?" Mrs. Jackson explained that she'd concealed her symptoms, seen him off to the golf course, and driven herself in. The nurse didn't seem satisfied with that, and said golf was not important enough to let her come alone.

I couldn't see Mrs. Jackson from the nurses' station, but I could see her frail hand reach over the rail and pat the nurse. "Dear, when you've been married for a while you'll understand that men have these... things... silly little things... hat they just have to do. If you never let them, they'll never be right."