The Sickness Read online

  Table of Contents

  Praise

  Title Page

  Introduction

  I

  II

  Copyright Page

  Praise for The Sickness

  “Driven by an urgent narrative pulse and a great fluency of style . . . [The Sickness] will touch the heart of many readers for its sensitive and balanced exposition of the fundamental problems of the human condition.”

  —ANGEL BASANTA , El Mundo

  “Tyszka is a perceptive, original writer. He has brought an unusually sophisticated understanding to a wonderfully intense, little novel. No sentimentality, no polemic, just emotion at its most resonant.”

  —EILEEN BATTERSBY, Irish Times

  “A delicate piece of craftsmanship . . . A small great work.”

  —JUAN CARLOS PALMA, Mercurio

  “This is a short, tersely written novel that distances and invades us at the same time. Powerful themes and powerful writing [that do] not let you off or let you down.”

  —SUSAN HILL, author of The Woman in Black

  Introduction

  I was afraid to read this book.

  My father died after a course of illness very similar to Javier Miranda’s when I was just finishing my training as a pediatrician. It was an experience that I am reluctant to relive, if I can help it. The premise of The Sickness is made quite obvious on the back cover, and you don’t have to read more than a page or two to realize that Alberto Barrera Tyszka writes powerfully affecting prose and is unlikely to pull any punches, either by design or accident, as he escorts his reader through the nightmare emotional and physical landscapes inhabited by very sick people and the people who love them. This is a great book by a great writer, I thought after only a few pages. But I wanted to put it in a lead box and forget about it.

  I did set it aside for a long time, but I could not forget about it, and I spirited it away from its containment more and more frequently, for longer and longer stretches, feeling somehow as if I were peeking through my fingers at the words. Eventually, I dropped my hands from my mind’s eye, gave myself over to Tyszka, and finished the novel. Then I read it again in a single sitting.

  I could not resist this story or avoid it for the same reasons I have never been able to fully resist or avoid the story of my father’s illness: the fundamental gravities of guilt and regret and grief are inescapable while we are alive. They lock us into orbits that can look a lot like our old lives—the ones we lived before the sickness or the accident, before the death—but aren’t the same. Much more importantly, I could not resist this story because it illustrates—perhaps it’s more accurate to say it contains—a set of energies that work in opposition to guilt, regret, and grief. That is to say, I thought this was going to be one of the most depressing books I have ever read, but it was exactly the opposite.

  That’s not to say it isn’t a sad book, or a brutal one—it’s both. But it travels into dark, sad, brutal places and brings back the report that life is very much worth living because people are very much worth loving. This is the news that sickness itself sometimes brings, to the sick person, to his or her lovers and families and caretakers, often in a way that feels too late: the sick and dying person discovers or remembers too late whom they loved or who loved them. The Sickness reminds us that it is both always and never too late to discover or remember such things: if health is rendered into a state of waiting for sickness to manifest, then we all, sick and healthy alike, are given a mandate to grasp at everything and everyone precious in life. That’s why this book is the very opposite of depressing. Depression maintains very convincingly that everything—every person and every experience—is worthless and without meaning. Its opposite convinces you that everything and everyone matters—that you matter, that your life and the people in it matter.

  I am a congenitally dispirited person. When trying to describe my usual spiritual and emotional torpor, I’ll sometimes ask people to imagine a cruel experiment in which Christopher Robin’s dysthymic donkey friend Eeyore is forced to watch twelve consecutive episodes of Law and Order: SVU and then made to eat a quaalude. I tell you this now to try to make you understand that I am not a person ordinarily susceptible to attempts—by priests, poets, therapists, or social workers, by movies or music or books, by Smurfs or unicorns or drag queens—to convince me that everything is actually all right, that life is good, that people are worth the various risks of knowing and loving them.

  But this book convinced me of all those things—the goodness of life, the worthiness of people, the ultimate value of communication—without even appearing to try. If it had appeared to try to make such an argument, to say directly such things as Other people can help you in your suffering or You can help them in theirs, I would have balked. But then, we all should probably resist when such things are merely said. These are just platitudes, empty forms that can inspire rage and resentment in the suffering or doubtful person to whom they’re addressed. You cannot say such things to me, I think, in a way that is barely articulated or acknowledged but very powerfully felt, whenever I hear someone state that people suffer for a reason, that illness and grief make us stronger, or—worst of all—that it’s all part of some plan, that our own and others’ suffering is a thing we’ll understand one day as having been necessary. You can’t say such things to me, I think, because I am a congenitally dispirited person genetically protected from sunny platitudes, or because I am a pediatric oncologist, or because Eeyore is my mascot. But really you can’t say these things to me for the same reason that you can’t say them to anyone: I’m a human being, and I know better.

  The Sickness does not offer up platitudes. It destroys them. Yet it provides a reassurance that is believable and real, and it is believable and real because it is not spoken but shown, because we are invited and compelled to live it within the story. We may very well suffer for no reason, and gain no strength from our troubles except the final invulnerability of oblivion; the best we may ever do one day to understand our suffering is to try to forget about it; there may be no plans to our lives except for retroactive fictions—The Sickness does not deny any of this. It may even insist upon it all. But in writing so honestly about illness and suffering, Tyszka throws a light on everything that is not sickness or suffering—the sickness illuminates its own remedy, which has nothing necessarily to do with modern medicine. This is a book that is ultimately about whether or not we are all alone—in our lives, in our suffering, in this world. And it is a book that ultimately makes us less alone, something for which we should all be very grateful to the author. You should read this book if you are congenitally dispirited, like me. But you should also read this book if you are congenitally full of good spirits, if you have never been sick or felt afflicted by the universe, if you have never loved someone who was ill, who suffered, who died. Even if bouncy Tigger is your mascot and spirit guide, you should read it, because one day we are all going to need to have heard its message, and to try to remember it.

  —CHRIS ADRIAN

  I

  “Are the results in yet?”

  No sooner are the words out of his mouth than he regrets having spoken them. Andrés Miranda wishes he could catch the question in midair and send it back where it came from, hide it away again beneath a silence. But he can’t, it’s too late. Now all Andrés has is the chief radiologist’s face, his lips a knot in the middle of his mouth, his dark eyes like two stains, as he offers Andrés a smile of strained sympathy and hands him a large brown envelope. The radiologist says nothing, but his very expression is a judgment: multiple lesions suggestive of a metastatic disease, for example. That, more or less, is what the knotted lips are saying. Medical people rarely use adjectives. They don’t need to.

&nb
sp; “Are the results of the CT scan in as well?”

  The radiologist shakes his head and shifts his gaze to the corridor.

  “I was told they were being sent direct to you.”

  Andrés feels strangely embarrassed, as if both of them were making a tremendous effort not to upset the fragile balance of the moment. He thanks his colleague and makes his way back to his office. No one has told him as much, he hasn’t even seen the X-rays, he hasn’t been shown the results, and yet he knows that his father has cancer.

  Why do we find it so hard to accept that life is pure chance? That is the question Miguel always asks before any operation. There they all are wearing green gowns, gloves, and surgical masks; the white light of the operating room seems to float on the cold air-conditioned air. And then Miguel picks up a scalpel, looks at Andrés, and asks: “Why do we find it so hard to accept that life is pure chance?” Some of the nurses dislike this as a prelude to an operation. Perhaps they realize that it’s not exactly a good way to start, almost a prior justification in case anything should go wrong. Andrés is sure this isn’t so, for he knows Miguel well; they’ve been friends since they were students. There’s no cynicism in that question. It seems, rather, an expression of self-compassion, a kindly prayer; a way of recognizing the limits of medicine in the face of nature’s infinite power or, which comes to the same thing, the limits of medicine in the face of illness’s infinite power.

  As soon as he goes into his office, as soon as he closes the door, he begins to tremble. He feels as if, suddenly, his body were breathing differently, making different sounds and movements, as if he bore inside him some helpless, stumbling creature, as if he were giving birth to a disaster. He hurriedly makes his way over to the chair behind the desk and sits down. He’s still holding the envelope. Inside are two chest X-rays. Bluish photos, harsh, sharp transparencies. His father’s body transformed into a blurred drawing in which, however, death is all too cruelly clear. Andrés feels afraid, even though this isn’t a new fear: it’s been there for years, stalking him. It must be the same fear which, for no reason and yet so often, leaps out at him from his own shadow. It’s the anxiety that weighs on his chest some nights, preventing him from sleeping. We’re probably all born with such a fear, which is as vague as it is overwhelming. It wanders about inside us, not knowing where to go, but never leaving us. It prepares itself, trains itself, waiting for the right moment to appear. It’s an omen, a voice that doesn’t quite know yet what it has to tell us. But it’s there, an indecipherable, incomprehensible sound, an insistent drip-drip, an alarm call. He’s been hearing it for years, running away from it, trying to frighten it off, but never succeeding. Now, that anxiety has taken on a shape: the face of the radiologist, with its evasive, resigned expression. Andrés has seen it too many times before. He himself must have worn the same expression on more than one occasion. It’s the illustration that accompanies a bad diagnosis, the first installment of an expression of condolence. Is he ready for this? He’s not sure.

  The phone rings. It’s Karina, his secretary. She tells him his father is on the line again, asking if he can speak to him.

  “Am I so ill that you don’t even want to talk to me?”

  This is his father’s opening line. Delivered in a jokey tone, of course. Andrés recognizes the nervousness that lies behind. It’s a classic strategy. Many patients opt to use it, positioning themselves on a thin line where everything is simultaneously half jest and half serious; they try to act normally, when, in fact, they’re terrified and haven’t stopped thinking, not even for a second, about the possible result of their tests. They’ve spent hours pursued by the fear of mortal illnesses; they’ve felt an odd twinge in every movement they make; they’ve seen suspicious blotches where before they saw only skin. Then they go to the doctor, trying to look strangely natural: they smile, but appear to be on the verge of tears. They ask questions like the one his father has just asked.

  “I didn’t phone you earlier because I’ve only just seen the results of your tests,” Andrés says.

  “And?”

  “In principle, everything’s fine,” he says, touching the sealed edge of the envelope.

  “In principle? What the hell does that mean, Andrés?”

  “Calm down, Dad. I’m telling you that you’re fine.’

  “You’re telling me that, in principle, I’m fine: that’s rather different.”

  Andrés is perfectly familiar with this stage too. Generally speaking, patients need to squeeze every word, wringing out its most precise meaning, with every nuance washed away. They want to clear up any doubts, even about punctuation. A patient always suspects that he’s not being told the truth or at least not the whole truth, that some information is being withheld. That’s why they insist on delving desperately into everything, even language. In this case, though, his father is right. Andrés said “in principle” because he hasn’t yet looked at the X-rays. Why doesn’t he take them out now, why doesn’t he open the envelope and study them? What is stopping him from looking at those results?

  The radiologist’s face hangs like a balloon in his office. Hospital corridors tend to be full of such balloons. They drift slowly through the air, identical, tenuous bits of plastic on which are painted frowning brows, grave mouths, sober looks: all the outward signs of helpless resignation. It’s a ceremony, a clinical protocol. Hospitals are places through which one passes: temples to farewells, monuments to partings.

  “I said ‘in principle’ because I still don’t have all the results. The ones I’ve just been given are fine.”

  “Which means that . . .”

  “That there’s nothing to worry about, Dad,” Andrés says, interrupting him, already embarrassed. He can’t stand lying for any length of time. “Go out for a walk, have a coffee somewhere with your friends. Everything’s fine, really.”

  “Are you sure?”

  “Yes, I’m sure.”

  There is a brief silence. A tense, unbearable pause. Andrés wants to hang up. He can sense that his father is still uncertain, still in doubt. He can imagine him in his apartment, sitting on the arm of the green sofa beside the phone, gripping the receiver, thinking. Suddenly, Andrés feels as if he were poised above a chasm of nothingness, a precipitous drop. They’re suspended for a moment not in silence, but in the void, until:

  “You wouldn’t lie to me, would you?” His father is speaking from his very bones, in the harsh but intimate voice with which all bones speak. “Andrés,” he goes on, “if there was something seriously wrong with me, you wouldn’t ever hide it from me, would you?”

  Andrés has a hedgehog on his tongue. His throat fills with pineapple rind. Despite himself, his eyes well up with tears. He’s afraid his voice might fail him. He makes a huge effort to speak.

  “I would never deceive you, Dad,” he says at last, with as much conviction as he can manage.

  “That’s all I wanted to hear. Thank you.”

  Dear Dr. Miranda,

  I trust you will remember me. It wasn’t easy to get hold of your e-mail address. If you knew what I’ve been through to find it! But that’s another story. What matters is that I’m here now, writing to you. Not that I like the fact. I’ve never felt com fortable writing. It’s not me, it doesn’t feel right, I don’t know where to put the words or what to say. But in a way, circumstances are forcing me to write. I have no other option.

  I need to see you urgently, Doctor. I’m desperate. For three months now, something very strange and mysterious has been going on. When I call your office, I’m told you’re not in or can’t come to the phone. If I ask to make an appointment, the person at the other end says “No,” she can’t do that. And she won’t explain why either. I’m sure you know nothing about this situation, nothing at all. You would never treat me like that, but if that’s the case, who is responsible for all this? And why?

  This is the reason for my letter, Doctor. It’s the only way I have now of asking you for an appointment. My situation re
mains the same, with my health deteriorating by the day. Reply directly to this address. Please, trust no one else. I need to see you as soon as possible.

  Thank you for your attention and, as I say, I’m here, waiting for your reply.

  Ernesto Durán

  Blood is a terrible gossip, it tells everyone everything, as any laboratory technician knows. Hidden inside that dark fluid, stored away in little tubes, lie murky melodramas, characters brought low, or sordid stories on the run from the law. When his father fainted, Andrés insisted on him having a whole battery of blood tests. His father protested. He tried to make light of the matter. He preferred the term “dizzy spell” to “fainting fit,” and insisted on this almost to the point of absurdity.

  “It was just a dizzy spell,” he kept repeating, blaming it on the humidity, the summer heat.

  It was, according to him, the fault of the climate rather than an indication of some physical ailment. But the truth of the matter is, he had collapsed on the floor like a sack of potatoes in front of the woman who lived in apartment 3B. They’d been talking about something or other—neither of them could remember what—when suddenly his father collapsed, and the neighbor started screaming hysterically.

  “I thought he’d died. He was so pale! Almost blue! I didn’t want to touch him because I was afraid he might already be cold! I didn’t know what to do! That’s why I started screaming!” says the neighbor.

  A few seconds later, his father, once he’d recovered consciousness, had tried to calm her down and reassure her that everything was fine, that nothing very grave had happened. Perhaps he had told her, too, that it was just a dizzy spell. Nevertheless, that same afternoon, the neighbor phoned Andrés to let him know what had happened.