Sketch of a Sicilian
The subject, a 40-year-old first-generation Italian-American, visited the ER of the hospital, assisted by his wife. He complained of dizzy spells and of stumbling, while walking. He feared an approaching stroke. Despite profuse apologies for any trouble he might cause, he was admitted. The wife was apprised of the immediate condition, entrusted with a prescription, and ordered to drive them both home. They were further instructed to return in the morning.
The resident medical team planned the subject's treatment in the meantime and, in the morning, subject was informed more fully of his condition. An X-ray of the front of his head showed an obvious anomaly. A large, white (therefore opaque to X-rays) blob appeared to fill most of one side of the subject's cranium. It was a tumor, comparable in size to a fist. Further complicating his condition, it had forced most of the cortex on the tumor side to the opposite hemisphere of the cranium.
It was a perilous squeeze. The subject was given six months to live—without surgery. The operation was considered so risky, by the attending doctor, that he advised the subject to return home once more—before returning for the operation—where he was to "get his things together." It was a physician's tactful intimation to a patient that the patient should finalize his Last Will and Testament. He might, additionally, bring a few personal items back to the hospital for a brief stay.
The subject was, by nature, a man of irrepressible good spirits. He was ecstatic (in his own words), that the prognosis was good enough to merit so short a stay at the hospital. The doctor, by contrast, was by nature a pessimist. Art is long, life is short, and the medical learning curve is steep. As a professional, he could not be more aware of the risk—both to a man's life, and to his professional reputation.
The surgeon tried to impress upon the subject the gravity of the situation. It is a maxim of doctors that the patient heals himself—doctors merely assist. If there was to be any hope of a successful operation, they—doctor and patient—must come to an understanding. Upon meeting for the first time, the subject was struck by the doctor's Italian accent. Indeed, he had an Italian name. Assuming Italian heritage, the subject sought to guide the conversation towards a congenial topic.
"Where are you from?"
"Sicily"
"What a coincidence! My father was Sicilian. My mother was from Rome, and my grandmother was from Reggio, Calabria. I learned a little Italian as a child."
"Do you know where you are?"
The subject was not a fool. As a child—an altar boy—he had memorized the Latin Mass. The Latin language has an effect of organizing the cortical development of the youthful mind along Roman principles. Historians inform us that Roman philosophy aligned along two flanks. On one side were the proponents of Stoicism and, on the other, were the Epicureans. As a practical matter, intelligent Romans were both—depending on circumstances. The time for tact had ended. The surgeon probed more deeply:
"I have never seen a brain tumor this large."
The comment was a feint, a mock retreat from frank disclosure of present danger, avoidance of over-reaction. For his part, the subject's instinct for self-preservation had been touched—like a nervous reflex. Pausing for reflection, it occurred to the subject that what the doctor was saying was that he had never seen a tumor of its size on a living patient. While he must take it for granted that the doctor was an experienced surgeon, and had performed the operation successfully before, was the doctor less confident of success in his case?
“What are my chances, doc-, fifty-fifty? —twenty-five per cent? —ten, or less?
“It makes no difference—unless you consent to have the operation.”
The subject gave consent—under one condition; that the operation wait until after Christmas, which was imminent. He had a young daughter, and he fretted about ruining Christmas for her in the future by his own, inopportune, death. As a follow-up, the subject survived—although clinically brain-dead for the duration of the operation—and is now raising his second child.
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