‘I met him when I was still doing my foundation year. He was in his forties and had had a rough life. Born into a dysfunctional family, he was put into foster care, ended up on the fringes of society and eventually became a drug addict. It was then that he contracted hepatitis-C, a viral liver infection, which is how he ended up in my office. There was only one available treatment back then, but it came with serious side effects and in his case proved ineffective. All his hopes were pinned on discovering a cure. I’ve rarely had a patient who pursued a treatment so doggedly. He conducted his own research, and our appointments became almost technical discussions. Whenever I came back from a conference, he would ask: “And? Any news?”
As time went on, I began to understand the burden he carried with him. So many of his old friends, who had led similar lives, had already died of hepatitis. He had seen how cruel the virus could be, and to his best friend especially, whose liver and brain had been utterly ravaged. That can’t happen to me, he said. He was petrified of meeting the same end.
Several years ago, new drugs came onto the market that had successfully contained the virus within a few months. I was so happy to give him the news, but in his case, again, the medication had virtually no effect. After finishing his treatment, the virus returned. When an alternative drug didn’t help either, he was crestfallen. Then a third drug was released last year, which targeted the specific strain of the virus that we knew was in his liver. Initially it seemed to work, but afterwards he displayed new symptoms, so I did an ultrasound. I can still remember the image that appeared on the monitor: his liver was entirely lit up, white and gleaming. I was bowled over. A CT scan confirmed the diagnosis. He had liver cancer.
He was admitted to a hospice five weeks ago. I went to see him; he has a magnificent view of the river. I confessed that while I had travelled alongside him all those years as a companion and navigator, I hadn’t been paying enough attention. I should have done an ultrasound sooner – I usually do with all my patients, but with him I’d overlooked it for some reason. I now see why. The two of us had made a kind of silent pact, to rid him of that infernal virus for good, a virus that had become as much mine as his. I had been so focused on that one goal, convinced that together we could do it, that my obsession had eclipsed all else.
He asked whether doing an ultrasound earlier might have helped. Perhaps not, I said, since he had never even wanted surgery, let alone a liver transplant. Still, his case humbled me. I’ve learned that a broad perspective is always necessary, as well as a certain level of professional distance. And I’ve gained a real respect for diseases, having seen how they can bide their time, like a waiting assassin, before pouncing unexpectedly on their victims.
He once told me of how proud he was to have quit smoking. It was the last of his addictions to go, and it had been a hard road and was supposed to have marked the beginning of a new life for him. But he now faces the very fear that first gripped him all those years ago – soon he’ll be dead, just like all his friends. And I couldn’t protect him. He now wants to stick it out as long as possible. We keep in touch via WhatsApp: “Thanks for your message, Joost,” he wrote recently. “I’m comfortable and happy here, by the river. I think of you sometimes.”’