When we first met in the emergency room you said you liked jazz, so I played a few Herbie Hancock tracks on my iPhone while I examined you. There was a bloodstain in the corner of your left eye; at the time I did not know it was a harbinger of things to come, that you had already started to bleed internally a special, sinister type of bleeding, where the blood literally begins to curdle and that within days, you would be unconscious in the intensive care unit, on mechanical ventilation, with a grid of electrodes covering your bald head like a helmet. Typically this sort of bleeding has a trigger, you see, but despite consulting with four different specialists and subjecting you to numerous tests, we could not find one. During one of my twenty-eight hour shifts, I watched helplessly as you grew sicker and sicker, and when I arrived home, I sat alone in my bedroom thinking of you, the mocking daylight filtering through the blinds; when I finally did get to sleep, my dreams were suffused with numbers (your labs) and nonsensical thoughts related to your condition. I awoke, tired, to a night sky. Unsure of whether to eat breakfast or dinner, I decided to start by heating up the teakettle, and as it warmed to life, I tried to imagine what fills the space between knowledge and truth: undiscovered molecules moving purposefully through our tissues; elaborate pathways whose structures contains deep secrets of oncogenesis, autoimmunity, and longevity; and beneath it all, a seething quantum foam. I drank a cup of tea, but before long, I was back at the hospital sitting around an oval conference table with your family I had come to "answer questions." Your brother asked: Are you saying you cannot save him? Or that he cannot be saved? and I had to pause to consider the difference. 

When you died, I was relieved your family requested an autopsy. They were not the only ones who needed closure. When your body was ready, our team rode the elevator down to the morgue  a quick pitstop before lunch  and met up with the pathologist, who peeled away a green cloth to reveal your organs, sliced thin and splayed open like books on a table, just two weeks after we listened to Herbie Hancock together in the emergency room. The pathologist had not found the answer either, but he used the opportunity to review some basic anatomy: here was the tube of your esophagus, the ridges of your stomach, the trampoline valves of your heart; here was your dense, jaundiced liver. And there were your lungs. I touched one gently with a gloved finger. It felt spongy, full of air.

This post was written by Emily Silverman, MD