The Ghost Print

He tells everyone in the room to leave except you. The others on your team--the attending, your cointern, and two medical students--all file out quickly. The heavy door closes behind them. The bolt clicks. It's your third month on medicine, your eleventh hour on call. He sits at the edge of the hospital bed with his back to you. His torso is wrapped in a thick spiral of bandages discolored by blood in various stages of drying. "If you want to take a look," he says to you, his voice remote, "you'll have to cut them off yourself." You start cutting the bandages away from his chest. His wife sits in the corner of the room. She wears large, dark sunglasses that obscure much of her bony face. She says nothing. When you're done cutting, ribbons of bandages pile on the bed next to him. You step back to take in the whole picture. Of what has happened. Of what he's done to himself. For the last several years, week after week, he's been injecting his chest with mineral oil to slowly and incrementally develop breasts. Rather than forming deposits at the sites of injection, as the blogger who counseled him had promised, the mineral oil seeped and spread, then hardened. This has resulted in his organs becoming encased in rigid wax, like a cast made from the inside. He's in excruciating pain. All of the skin on his chest is now breaking down, raw and red and oozing. He was admitted because he was unable to eat; the hardened mineral oil--which you later find out is referred to as a parrafinoma--puts pressure on his esophagus. The parrafinoma then induced a granulomatous disease and as a result, his calcium was markedly elevated, and ... blah blah blah. His medical course has nothing to do with why you remember him all these years later, or why you find it so hard to tell his story now. He wasn't allowed to keep his secret. You remember thinking this when you examined him that first day--how unfair it was that he had to tell it to a total stranger. His voice always seemed far away. You can't remember what his wife's voice sounded like. Because of the sunglasses, it was often hard to figure out what she was looking at. He could tell from your stuttering and your continually shifting stance that you hesitated to speak in front of her. "Don't worry," he told you. "She knows everything." They both looked worn down and poured empty. You were too intimidated to ask him about what led to the injections, afraid that it might be misconstrued as disrespectful. As a doctor, you're constantly negotiating how much to bring to the surface, how much to leave dormant. In print-making, a ghost print is a secondary print that one makes from the initial plate, using whatever ink is left over from the original. It's often murky and blurred. Haunting. This patient is a ghost print, his mark lingering on you. You keep struggling to imagine the pieces of the picture that remain out of focus. You are drawn to the parts of his story that happened before he came to the hospital. Like the part about him being in his late sixties when he started this, a man of means with a high-profile job. Like the part about his wife asking him night after night about what was going on with his chest, and night after night, him telling her that it was just a thyroid problem, and that it was being taken care of. Like the part about him waiting for her to fall asleep so that he could tiptoe down to the basement and inject himself. You imagine what that first injection must have felt like for him, a man who had never used a needle before. The agony of it. The hope. A literature search at the time brought up a single case report written in Thai. Textbooks weren't much help, either. There was no protocol to follow, no discernible endpoint to work toward. This was his sixth hospitalization in as many months for the same problem. …