WILLIAM E. BYRD, MD, Roanoke Rapids, North Carolina

Loneliness is not the sickness unto death. No, but can it be cured except by death? And does it not become the harder to bear the closer one comes to death?

Markings, 1966

Two weeks after I entered private practice, I met a man whose quick and unlamented departure from this world would create a lasting impression on my mind.

At 7 PM on Thanksgiving evening, I was called to the emergency department to see a 63-year-old man who had sustained a massive anterior myocardial infarction. Mr Evans, an unemployed plumber, developed severe chest pain after leaving a local Mexican restaurant. A rescue squad was quickly summoned, and he was transported to our hospital emergency department, where he was found to be hypotensive and in complete heart block. After thrombolytic therapy was initiated and a temporary pacemaker inserted by the cardiologist on call, he was then transferred to the coronary care unit. As soon as nurses had adjusted the oxygen and intravenous fluids, I introduced myself and began to take his history. Despite his precarious state, Mr Evans was pleasant and courteous, continually thanking the physicians and nurses for their care.

He was slender, muscular, 5’9″ tall, and weighed about 68 kg (150 lb). He was clean-shaven and appeared to be somewhat younger than his stated age. A brief history revealed that he was a widower of 20 years and had a son and daughter living in a neighboring state. At his request, the nurse removed a worn calling card, “Bob’s Plumbing and Air Conditioning,” from his wallet. On the back were scrawled two names—Sandra and Mark—with corresponding telephone numbers.
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Looking at me, he said, “You can call my children, if you like.”

“I’ll be happy to,” I responded. By this time, Mr Evans was experiencing more chest pain, requiring both intravenous nitroglycerin and morphine sulfate. His blood pressure was barely holding at 90 mm Hg systolic, despite a dopamine hydrochloride drip. His electrocardiogram revealed diffuse ST elevation in the anterior and precordial leads, all compatible with an anterior myocardial infarction with extension. With the patient in impending cardiogenic shock, I realized I needed to notify the children immediately to give them sufficient time to arrive before their father’s condition deteriorated further.

I decided to call the son first. The phone was picked up on the second ring. The background was filled with laughter and the clinking of glasses.
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“May I speak with Mark Evans, please?” I asked.

“I’m your man, buddy,” a jovial voice responded.

I introduced myself and told him of his father’s critical condition. After I finished, there was a long silence. I thought I had been disconnected.

“Hello, Mr Evans? Hello?” I repeated.

“I hear you,” Mark Evans replied, speaking without emotion.

I continued, “Your father may die within the next 24 hours, so I thought you might wish to get down and see him if you can.”

There was another minute of complete silence, and then, “He was no father to me.”
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“I see,” I said, taken aback. “Then, what do you want me to tell him?”

“I really don’t give a damn what you tell him, Doc,” Mark Evaris replied, the decibels of his voice increasing severalfold.

Collecting myself, I said, “If he should die in the next few hours, do you wish me to call you?”

“Not particularly,” he said. “Don’t they have ways of disposing of bodies that no one claims?” I then began breathing deeply, feeling chilled all over. I had never encountered such a situation either in residency or fellow¬ship training. I was trying to think how best to respond.
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Speaking slowly, I said, “I believe the coroner can cremate an unclaimed body.”

“Then cremate the son-of-a-bitch!” he screamed. With that, he hung up.

With the phone quivering in my hand, I clenched my teeth for a moment, waiting for the ringing in my ears to stop. Shaking my head several times, I then dialed the daughter’s number. The phone was immediately


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