[ WP ] I could see it in their hooded glances and practiced smiles .

The doctor strolled into the room gaily, a spring in his step that was just too even and a smile that creased over his cheeks like a freshly ironed pair of slacks. He took one look at the patient and then, seemingly overwhelmed by the image of a dying man, turned around and grabbed a chart that sat in a small shelf on the wall furthest from the diseased. After briefly reviewing the patient ’ s medical record, the doctor set down the chart and hopped over to the bedside. 
 
 “ Hey there, Nathan! How are things today? ” 
 
 Nathan wanted to scream, but he couldn ’ t. He didn ’ t have the energy for it anymore. He took a couple deep breaths before responding. 
 
 “ About the same, doc. About the same, ” came the raspy, hardly audible reply. The ( lack of ) sound, the ( lack of ) intensity in his voice always gave rise to a great sinking sensation for Nathan. *I was a professional auctioneer*, he wanted to add, to let Dr. Madison know that he was so much more than this crippled husk. *I yelled for a living*. 
 
 “ Well that ’ s good! ” Dr. Madison seemed to perk up at the thought of everything being exactly as despicable as they had been a few days ago and took the opportunity to flash Nathan a bonus peek of his outstanding set of pearly whites. Nathan returned only a cold glare, the coldest his diminished facial muscles were capable of producing. He knew that it was probably not very intimidating, but even still he felt a weak satisfaction in ignoring traditional dead-man etiquette. He could see that the doctor wanted him gone, out of his life to make room for the patient that might actually have a chance. He could see it in his hooded glance and practiced smile. 
 
 
 Dr. Madison was exhausted. His lab coat was pristine, but his drive withered after another 18-hour shift. He had always known that oncology would be a difficult profession, but he could not have accounted for the all-encompassing, constitutive nature of the field. He could not have known that every dead patient would weigh so heavily upon his conscience, every saved patient so little. He could not have guessed that the stress accumulated over the course of the day would drag behind him like a cartoon ball and chain, that he would be unable to check-in the burden at airports like he checked in his socks or a t-shirt during the few times of the year when he could spend extended periods of time with his loved ones. 
 
 “ Your scans show that your tumors have been growing at a decreased rate over the past couple of months, which I assure you is nothing to sniff at, ” he continued. “ However, given the adverse effects of the combined chemotherapy and radiation treatment, I think it ’ s time we start thinking about a different goal with your care. ” He saw Nathan just barely roll his eyes, an expression that must have taken some dedication given the tumor ’ s established impingement of his third cranial nerve. Dr. Madison knew all too well the anxiety and frustration the patient must feel spending his last days attached to 4 IVs and a nurse that knew his routine too well, but there was little that could be done. The patient knew that, too. 
 
 After a few seemingly effortful breaths, Nathan managed to respond. “ Goal? ” 
 
 “ I think it ’ s time, ” Dr. Madison stated quietly, “ to consider palliative care. ” He paused for effect, to allow the words to sink in. “ That means, as I ’ m sure you know, that we terminate your current medication and treatment in favor of providing of you with the best reduction of symptoms to make this time more bearable for you and your family. ” 
 
 Nathan took a long time to respond this time, and not because it would be difficult to make out the words. Eventually, after what seemed like an hour ’ s worth of pin drop silence, he said, “ So that ’ s it? I ’ m done? ” 
 
 “ Well it ’ s just that given the severity of your condition, you might find that you would prefer to spend this time fully cognizant and able to realize whatever you might need to do before… ” Dr. Madison ’ s voice trailed off for a moment. “ Before you no longer can. ” 
 
 This time, Nathan ’ s response was quick. “ So that ’ s it? I ’ m done? ” 
 
 Dr. Madison took Nathan ’ s hand in his own. It was cold and brittle and it reminded him of an ice sculpture he saw at a wedding some years ago. It hit him after a moment - his own wedding, ten years prior. He smiled kindly at Nathan once more. “ I ’ m sorry, but I don ’ t know how much longer we ’ ll be able to fend off this cancer. You may only have a few weeks. ” A knock came at the door, and a nurse dressed in sky blue sporting cherry red lipstick peered into the room. 
 
 “ Dr. Madison, ” she started shyly, “ your patient in room 8 has been waiting for a long time and is feeling restless. ” Dr. Madison waived her away and, after letting the deafening echo of the shut door dissipate, looked down again at Nathan. “ I ’ m sorry, ” he repeated. Nathan smiled softly and beckoned wordlessly for Dr. Madison to go see his other patient. Dr. Madison sighed internally because he knew that that the smile was nothing more than a flexion of the zygomaticus muscle, that beneath the surface Nathan could not stand him because *he* was the one forced to stare blankly at a clock that ticked away his final moments. He could see it in the hooded glance, the practiced smile.
