“The Last Appointment”
I arrived at the clinic before dawn, the way I always did. The small town still slept under a veil of mist that clung to the empty streets like breath on a windowpane. The sign outside my clinic flickered faintly—half the bulbs were gone, and the other half hummed, producing a faint buzzing sound that had become part of my mornings.
The building was old, once a bakery before being turned into a medical center by the town council decades ago. The scent of yeast had long since vanished, replaced by that faint mixture of antiseptic and damp walls.
I switched on the lights, unlocked my office, and waited for the day to begin. Mornings in this town were predictable—flu, fevers, the occasional minor injury. But there was always that one patient who broke the pattern, the one who stayed on your mind long after you locked the door at night.
That day, he arrived just before noon.
He walked in slowly, his shoulders drooped, his face pale and swollen, eyes rimmed red. He must’ve been in his early forties, though the lines on his face made him look older. His breath carried a faint smell of alcohol that lingered in the air as he sat down, trying to steady his shaking hands.
“Doctor,” he began, his voice soft but heavy, “I’ve been feeling tired… real tired. My stomach feels heavy, like it’s full of stones.”
I nodded, gesturing for him to lie down on the examination bed. His abdomen was distended—firm, almost like a drum. The veins around it stood out like faint blue rivers under pale skin.
“How long have you been drinking?” I asked gently.
He looked away. “Since I was a teenager. But it’s worse now. Helps me sleep.”
I took a breath. “How much?”
He hesitated. “Half a bottle… sometimes a full one. Depends on the day.”
There was shame in his tone, but also resignation—the kind that comes from years of trying and failing to change.
I drew his blood and ordered a few tests. Liver function, ultrasound, the basics. His eyes followed me quietly as I wrote in his file, as though he was searching for something behind my face—perhaps hope.
Before he left, he turned back at the door. “Doc… this isn’t serious, is it?”
I looked at him. The truth hovered on my tongue, but I softened it. “Let’s wait for the results. We’ll take care of you.”
He smiled faintly, but it didn’t reach his eyes.
Two days later, the results came.
AST and ALT were both sky-high. GGT was worse. The ultrasound showed fatty infiltration of the liver—Grade II bordering on III. The words “early fibrosis cannot be excluded” stared back at me like a quiet warning.
He came in later that afternoon, smelling faintly of cheap cologne—trying, perhaps, to hide the alcohol.
“It’s alcoholic fatty liver disease,” I told him. “Your liver is inflamed. It’s still reversible if you stop drinking completely.”
He swallowed hard, looking down at his hands. “And if I don’t?”
“Then it gets worse. It can turn into cirrhosis. Once that happens, we can’t turn it back.”
He nodded, quiet. “I’ll try.”
I’d heard those words before—from miners, farmers, laborers, men whose lives were hard and whose nights were long. “Try” often meant “I want to, but I won’t.”
Still, I gave him the usual advice—quit alcohol, eat better, rest. I prescribed vitamins, some supportive medication. I told him I’d see him in two weeks.
When he left, I noticed he was walking a little slower, one hand pressed against his side.
Suspense begins here — around 500 words in.
The two weeks passed, and he didn’t return.
I tried calling, but the number he’d given was disconnected. In a small town, though, people talk. I’d hear snippets—he was seen at the bar by the river, drinking late into the night. Someone said he’d collapsed once but refused to go to the hospital.
Then, one evening, just as I was locking up, the nurse ran in. “Doctor, there’s a man outside—he’s vomiting blood.”
My heart sank even before I saw him.
He was slumped against the clinic’s front gate, his face ghost-white, shirt stained with dark maroon streaks. His breathing was shallow. His hands trembled as he reached for me.
“Doc…” he whispered, voice barely audible.
We rushed him inside. The nurse started an IV; I checked his vitals. His pulse was rapid but weak. His eyes were sunken, skin yellowish.
It was a variceal bleed—I knew that look too well. The kind of internal rupture that comes when a liver has given up.
“We need to transfer you to the city hospital,” I told him quickly. “You’ll need an endoscopy, maybe a transfusion.”
He shook his head weakly. “No… can’t afford it.”
“You’ll die if you stay here,” I said, my voice cracking.
He gave a faint, broken smile. “Maybe it’s time.”
We worked through the night. I did what I could—fluids, medications to reduce portal pressure, bandages for comfort—but I knew it was like trying to stop a storm with an umbrella.
Around midnight, he looked at me again. “Doc, do you believe people can start over?”
I paused. “Yes… but sometimes the body doesn’t wait for the soul to catch up.”
He closed his eyes. “Then I guess I waited too long.”
He fell asleep shortly after, his breathing uneven but steady. I stayed beside him until dawn, listening to the rhythmic hum of the IV pump, the soft creak of the clinic walls as wind brushed against them.
The next morning, I checked on him. His eyes opened slowly. “It’s strange,” he murmured, “how quiet mornings are when you’re sober.”
I smiled faintly. “Maybe that’s how they should be.”
He nodded. “If I make it through this, I’ll stop. For real this time.”
He didn’t.
A sudden convulsion hit him mid-sentence, his body jerking violently as the IV line tore free. The nurse and I rushed in, but within minutes, his heart flatlined.
The silence afterward was deafening.
We called for help, but by the time the ambulance arrived to take him to the district morgue, the mist had returned outside—thicker than before, as though the world itself wanted to hide what had happened.
I filled out the paperwork, my hand trembling slightly as I wrote cause of death: hepatic failure due to alcoholic liver disease.
That night, I couldn’t bring myself to go home. I sat in the clinic, staring at the empty bed. I’d seen death before, plenty of times. But this one stayed with me—not because it was unique, but because it wasn’t.
In small towns like ours, the disease wasn’t just in the liver. It was in the silence that followed lost jobs, in the loneliness that filled empty rooms, in the bottles that became friends.
And for every patient who promised to quit, there were ten more waiting quietly, drinking their pain away one glass at a time.
Weeks passed. His file remained on my desk, untouched.
Then one evening, just as I was about to close, a young woman came in carrying a small envelope. Her eyes were swollen from crying.
“You were his doctor?” she asked softly.
I nodded.
She handed me the envelope. “He asked me to give this to you. Said it was for the doctor who tried.”
I opened it after she left. Inside was a small folded note, written shakily in blue ink.
Doc,
If you’re reading this, it means I didn’t make it. I don’t blame you. You did your best.
I just want you to know that you were the first person who ever talked to me like I still had a future. That meant something. Maybe it’s too late for me, but not for others.
Keep trying—for them.
There was a small stain on the bottom corner—perhaps from his drink, perhaps from his tears.
I kept that note in my drawer, under the prescription pad. Every time I felt the weight of futility pressing down—the endless cycle of advice, relapse, regret—I would read it again.
Months later, another man came in, early fifties, same weary look, same yellow tinge to the eyes. He said, “Doc, I drink a bit, but not much.”
I looked at him and saw the same story starting again. But this time, I spoke differently. I didn’t warn him; I told him a story. About someone I once treated. About how the liver can whisper before it screams.
He listened quietly.
A week later, he came back—sober, trembling, holding a notebook where he had written the number of days since his last drink.
“Three,” he said. “It’s not much, but it’s a start.”
And in that moment, I realized that maybe my patient hadn’t really died in vain.
He had become a story I could tell—one that might save others.
But still, on quiet nights when the clinic was empty and the world outside was silent except for the distant howl of dogs, I’d find myself looking at that empty bed.
Sometimes I’d imagine him sitting there again, smiling faintly, asking, “Doc, this isn’t serious, is it?”
And I’d wish I could go back and tell him the truth, not the softened version. I’d tell him yes, it’s serious—but so are you. Your life is worth saving.
Because sometimes, kindness can sound like permission to keep falling.
A year later, the town built a small memorial near the river—nothing grand, just a bench with a plaque that read “For those who left too soon.” I knew who one of them was meant to be.
I still walk there sometimes, especially at dusk when the water reflects the orange of the dying sun. It reminds me that even the quietest places can hold echoes of pain.
Every patient since then, every case of early liver damage, I treat not just with medicine but with memory. I tell them the story of the man who tried too late, the one who taught me that healing isn’t always about recovery—it’s about recognition.
Recognition that beneath the medical charts and test results are people trying to fill empty spaces in their lives with something—sometimes love, sometimes alcohol, sometimes just silence.
Last winter, I had a dream.
In it, I was standing in the clinic again. The lights were dim, the air still. The front door creaked open, and he walked in—not sick, not pale, just calm. He smiled, placed his hat on the counter, and said, “Doc, I kept my promise. I stopped.”
Then he faded away with the morning light.
When I woke, the sun was rising over the hills, and for the first time in months, the mist outside looked less like grief and more like forgiveness.
I know now that medicine isn’t just about saving lives—it’s about bearing witness to the ones you can’t.
And in a small town like ours, where every loss echoes through the narrow streets, that’s enough reason to keep the lights on, even when the world feels heavy.
So every evening, when I lock up and the sign above the clinic flickers weakly in the dusk, I whisper a quiet promise to the ghosts that linger in the waiting room:
“I’m still trying.”
