“Do you have any more tissues? These are about used up.” I held wadded, bloody paper. No trash can was in sight. More blood flowed. I tossed the tissues under a chair. Red filled Maxwell’s ears and a small red tide matted his hair and dribbled from there onto carpet. His shirt collar was stained, and my tie, as far as I could tell, was wet around the neck and probably ruined. Was there any point in untying it and slipping it off Max? Perhaps. It could be dry-cleaned. I know a dependable cleaner who often has success with difficult stains. I suggested to Bertram that it might be prudent to remove the tie from Maxwell; then I reached in and got to work. This tie is fashioned from a superior, floral-print silk that achieves an especially fine, compact knot. If you hitch it tight, it’ll stay tight and it’ll look good, no matter what. The knot around Max was remarkably firm. I tried getting a purchase on a fold of loose silk, but had no luck and so tried easing the intact knot down the tie’s slender length—to slide it down Maxwell’s shirtfront and in this way open and enlarge the “noose.” This did not work either. The knot would not yield. I was smearing my brother’s blood on my hands, and the stethoscope was rocking and pitching over Maxwell’s face, and I felt oppressed by the stupidity and smallness of life. Bertram said, “What’s bugging you tonight, Doug?”

“This is my tie. It’s my favorite tie. He took it without asking and now it’s ruined.”

Bertram leaned close to inspect the bloody tie and said, “It’s got a lot of maroon in it already, and it’s pretty dark overall. Plus, it’s not glossy. The weave will conceal discoloration. These earth tones might even be enhanced. One thing you can do is, when you’re putting it on, you can fiddle with the knot, to hide the stains. I had a tie with water spots on it once, and I found that if I tied it just so, all the water spots would be out of sight.”

Need I say it hurt me to think of my weary, middle-aged brother standing before a fogged-up bathroom mirror, carefully, deliberately, obsessively tugging at soiled neckwear? I had a vision of him with uncombed hair and a misbuttoned shirt, his crummy tie flapping, and with bloody tissues stuffed up his nose, as he readied himself for a horrible new day.