She plants both feet on the floor, blinks rapidly.

“Are you sure? I don’t think . . . he quit smoking a long time ago,” she says in an attempt to redeem him. “How many years has it been?”

“Not every cancer is caused by smoking,” I reply. I am usually warmer with patients. I don’t like that I’m a different doctor right now, but there is so much more happening in this room. “Mr. Nabi, you’ll need surgery. I can remove most of the tumor.”

I review the details, half of which they will forget. Words like “chemotherapy” and “radiation” sound more and more like “nuclear” and “apocalypse” in a room like this. I list the risks and benefits of treatment, which is like sitting two elephants on opposite ends of a seesaw.

“You can take time to think about this, but I wouldn’t wait too long to decide. The sooner we act the better the results will be.”

“You do the surgery?” he asks me.

“Yes,” I say, though I’ve already decided I won’t. Once I’ve had a real conversation with him, I will refer him to one of my colleagues.

Shair uses the palm of his hand to brush his hair to the side. He clears his throat.

“If I don’t do this surgery,” he says calmly, “what is happening?”

“Boba!” His daughter’s eyes brim with tears. Her voice is a hoarse whisper as she makes a single plea to her father—please.

“It is a fair question. If you choose not to have surgery, the cancer will continue to spread. It will become more difficult for you to eat. You will continue to lose weight and become weaker. And it will continue to spread.”

His daughter’s eyes fill with tears. A small whimper escapes her lips.

“How much time? With surgery and without surgery?”

“It’s hard to say. Without surgery, maybe three months. With surgery, perhaps a year or two. It really depends on how the tumor responds to chemotherapy and radiation as well.”

His breathing fills the silence.

“What are you most worried about?” I ask automatically. I have not forgotten who I was when I first met Shair, nor can I forget who I am standing before him now. And I want to know everything about him, including the fears he harbors.

“I don’t want,” he says, then shakes his head and points to his open mouth, his stomach, the insides of his elbows. “I don’t want tube, tube, tube, and machine.”

His daughter mumbles something under her breath.

“I have pain,” he admits. “Too much.”

“I understand,” I say. “We have several medications that can treat the kind of pain you have. Looks like you have a good understanding of what you want for treatment. Tell me, what kind of work did you do before you came to this country?”