The Final Sentence, by Rich Paschall, Sunday Night Blog

In a cold and sterile room, Ernie sat on the end of a table. He waited in brutal silence for someone to enter.  He studied the floor intently through his boredom.  The light-colored tile was clean.  He could find no dust in the corners, although he examined the areas closely.  One small window that could not be opened allowed a little sunlight to fall to the floor.  The counter along the wall was clear.  The cabinets were labeled with the contents.  And a small chair awaited an occupant.

Ernie did not feel well.  He had not felt well for months.  Perhaps it was longer.  He had been somewhat in denial until recently.  His body could no longer ignore what his brain had tried hard to conceal.  The persistent aches and acute pains had become a fact of life.  Now there was this, the reason for his waiting.  His vital signs had been taken, and he was made to sit on the end of a rather hard surface, trying not to think of what was to come.

Suddenly, there was a knock on the door.  The person on the other side announced himself and then came in.  He was a man in his mid 50’s according to Ernie’s way of thinking.  He was as official as official could look.  He sat in the small chair, put a file folder on the counter and began.

“Hello Ernie.  How are you doing today?” the businesslike gentleman asked.  He studied Ernie’s face for his response.

“Hello Dr. North.  I am doing OK, I guess,” Ernie lied in a tone that was not at all convincing.

“Really?” The doctor responded.  He had been treating Ernie’s ailments for over 15 years, so he knew all too well what were the complaints and attitudes that went with Ernie’s comments.

“Well, I guess it is not that good,” Ernie confessed.  “My neck and lower back are almost always in pain.  My right leg and arm sometimes get numb.  If I sit too long, it is hard to get up.”

This admission of his problems was a hard thing for Ernie.  He was only 61 and ardently believed that he should still be leading an active life.  He wanted to do everything he had done in his thirties.  As a bit of an adventurer, he wished to be off to foreign lands in search of new and exciting things to do.  He wished to climb mountains and paddle canoes down rivers.  He wanted to fish and to swim.  He wanted to ride a bike through small towns and villages of Europe.  In other words, he did not want life to change.  His hopes for the future could only be achieved with a time machine, however, and he did not have one of those.

The doctor proceeded to make a quick exam of Ernie.  He focused mainly on his coordination, flexibility and strength.  He was not pleased with the result.  He did not have to say that.  It was written all over his face.  Ernie knew it.  He was a good reader. Doctor North sat back down in the little chair and made notes in his folder.  Then he wrote a prescription and wrote down some phone numbers for Ernie.  He began with a voice that could only be described as sad.

“Ernie, I am sorry to say that your strength and flexibility are not what they used to be.  Some of this should be expected as we age.”

Ernie sat motionless and expressionless as Dr. North went on.

“The MRI you had last week revealed acute cervical spine disease.”

His patient did not react, so the good doctor continued.

“You have degenerative discs.  That is to say your spine is in bad shape.  That is why you have these pains and the occasional numbness.  We will treat that with some prescriptions now.  Here is Prednisone.  And you should see a specialist for this.  These are my recommendations.  This is what we can do in the short-term.”  At that, the doctor handed Ernie some papers.

“And in the long-term, doctor.   What about that?”

Dr. North looked down to avert his eyes.  He thought a moment and spoke without looking up.  “It’s not good.  This is something we can not make very much better.  It will get worse in time. I want you to get all of your treatment options from a specialist.  He maybe able to relieve the pain for a while.”

“I see,” Ernie responded.  “I guess I know how Hemingway felt.”


“Ernest Hemingway.  I understand the end of his life now.”

The doctor was not exactly sure what Ernie meant.  He was not a student of American classics and their authors.  Ernie was and he just understood something he could not grasp from high school until now.

“Fill the prescriptions and make an appointment with the specialist today,” Dr. North advised.  “Call and let us know when you have an appointment and we will send records to the rehab specialist.  Make an appointment to come back here in two months. And Ernie, I think you should stop driving.  Get someone to take you to these appointments.”

The doctor left the room and Ernie got up slowly.  As he stood his right arm and leg began to tingle.  It was as if he had slept on them and cut off circulation.  He carefully left the exam room and walked to the reception desk.  He handed the doctor’s charges and appointment instructions to the receptionist and began to walk away.  She called after him.

“Oh, Ernie.  The doctor has you down for an appointment in two months.  Would you like to schedule that now?”

Ernie responded with an odd grin and a simple reply, “No, thanks.”

At that, Ernie carefully walked to the door, opened it and went out into the quiet hallway.  He was never heard from again.

Categories: #Health, Fiction, Getting old, Rich Paschall

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12 replies

  1. Reblogged this on rjptalk and commented:

    This is a short story of a man who thought, perhaps incorrectly, that he was out of options. Click View original post at the post to follow over to SERENDIPITY for the rest of the story.


  2. We are struggling with end of life issues in Canada. I think in Quebec you can have a doctor assisted suicide, but the conditions for doing so, are complicated. Of course this is very disturbing for most doctors with their oath – to do no harm. I can understand why Hemingway did what he did. Pain can be very debilitating. That was a choice that he made. I don’t think I would choose that for myself.

    Liked by 1 person

  3. Northwestern Medicine Spine Center is ranked nine, nationally. They take United Health.

    Howard S. An, MD (Midwest Orthopaedics at Rush, Chicago). Dr. An is the director of spine surgery and the spine fellowship program at Rush University Medical Center in Chicago and has held the inaugural Morton International Endowed Chair position since 1997. He has published more than 140 articles, 80 chapters and 15 books on spinal surgery and instrumentation. Prior to joining Rush, Dr. An served as director of spine surgery for eight years at the Medical College of Wisconsin in Milwaukee. He received his medical degree and completed his internship and residency in orthopedic surgery at the Medical College of Ohio in Toledo. He completed a spine surgery fellowship at Rothman Institute-Pennsylvania Hospital and Jefferson Medical College in Philadelphia. Dr. An is a recipient of the 1990 North American Traveling Fellowship from the American Orthopaedic Association and the 1995 Scoliosis Research Society Traveling Fellowship. He is currently involved in research in the fields of spinal biomechanics and tissue engineering with funding from the National Institutes of Health, companies in the medical industry and foundations.

    Gunnar Andersson, MD, PhD (Midwest Orthopaedics at Rush, Chicago). Dr. Andersson is the chairman emeritus and The Ronald L. DeWald, MD, Chair in Spinal Deformities at Rush University Medical Center. He is author and co-author of more than 250 academic papers and more than 150 books and book chapters mostly related to back pain and back injuries and has been at the forefront of spine surgery research and education for more than 30 years. Dr. Andersson started his career as an orthopedic surgeon at Sahlgren Hospital at the University of Goteborg, Sweden, and is credited with designing the seat in Volvo automobiles. He came to the United States in 1976 as a visiting professor.

    Liked by 1 person

    • My neighbor had his surgery at Northwestern. It is not that far from me. Rush is a little farther away, but still in the city. Either would be fine. I will check for appointments at both and take the soonest.


  4. I have had degenerative disc disease for my entire adult life. It is painful, but it is certainly not so debilitating as to make life not worth living. I worked like this for more than 30 years and I’m still living with it today.

    AND please — NO competent doctor would give you Prednisone for more than a week or two. That WOULD probably kill you. Prednisone is safe in small doses and controlled conditions. Long-term use of it has long been shown as seriously harmful. If you are going to a doctor who gives you a long-running therapy of it, run, do not walk, to a better doctor. The degenerative disc disease won’t kill you, but Prednisone will.

    There are many medications … as well as controlled exercise … that can and will help you deal with this. It’s not rare. It is often genetic. But it is not the kind of pain that makes life unlivable, no matter what Hemingway may have thought.

    You CAN live with it. I DO live with it and so do many, many people. It isn’t the end of your world.

    Liked by 2 people

    • I never understood the end of Hemingway, if it happened as most believe. The main point, I think, for Hemingway was that he suffered from physical deterioration and was no longer able to do some of the things that he liked. The great adventures for which he is well known were over. He could have carried on, but he chose not to do so.
      In the story the doctor would likely give a prescription for Prednisone in one of those packets that have decreasing amounts and are done in short time (5 days?). It is a short term fix as you know. That is all the doctor is offering. My doctor did the same. In the story, there is no telling what actually happened to Ernie, but he is clearly disturbed that life has changed. By the way, my own doctor was also over dramatic and did advise me to stop driving. I am still driving and do live with it. There is a choice to live with certain forms of deterioration. We know what Hemingway chose.

      Liked by 2 people

      • He had cirrhosis of the liver. That’s LETHAL deterioration. Fix it or die and in those days, there was nothing that could fix it. We hadn’t invented transplants yet. So Hemingway WAS dying and there was no reprieve, just a lot more pain.

        This is something else. Especially if you’ve got a bad piece of cervical spine — which Garry had — the fix is pretty simple. You just need a good, experienced, surgeon and nothing fancy. Garry had his herniated disk resting right on the nerve, so he needed to have it removed. Once it was done, it took a few weeks of healing (and Garry was very happy to get some time off from work, so I think he stayed out at least a month extra), but after that, he’s been OK.

        As for me, I went online to the best spine hospital in Boston (Baptist Hospital — they do the Red Sox and the Celtics and the Patriots, always a good sign) and then I looked up resumes of all the top surgeons. In this case, though, I specifically went to the top guy — M. Eric J. Woodard. I did I lot of asking around. The FIRST thing he said was “don’t let anyone cut you.” I was there a couple of years ago again and asked if there was anything he could do for me and he said “No.” And that was that. he said i could deal with it. Get some exercise and don’t spend all my time sitting.

        Liked by 2 people

        • Hemingway was clearly at the beginning of mental deterioration as well and knew it. He suffered from hemochromatosis. He was also famously (infamously?) a heavy drinker. The mental problems may have been the bigger contributor to his death. He had difficulty working.

          I have checked online reviews for the several spine surgeon recommendations I was given, and picked the best looking one. He is associated with North Shore University Health. I have already been advised I could have the disc removed and replaced with another in a surgery that is rather common.

          Liked by 1 person

      • A prescription for Valium. A complimentary bottle of Scotch. A pre-paid, sawed off shotgun, loaded.

        Ernie, we value you as a patient.

        Liked by 4 people


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