Entry the ninth.
Since last I wrote, I was called upon to assist in the treatment of lingering lung-fever, age-related cognitive decline, commotion caused by shaking of the brain, and a minor leg break. All of these cases have had in them their lessons for me — but, for certain, the one we are most concerned with at present is that of the consumptive, Master George.
What I have learned of his history goes thusly: he has been suffering from lung complaints for about a year, though he could not say when a preceding cold ended and this more serious ailment began. He has since been afflicted by fevers and disturbance of sleep, severe enough he has some trouble sorting out true memories of the past year from the nightmares. The wasting is severe; he is so thin that, though he is a bearded youth, he has like been reduced to the weight of a child, and his nails are deformed. And there is, of course, the severe and bloody cough and the red cheeks.
From what I have read, there are a number of other conditions that share these signs. Simple lung-fever is unlikely given the length of George's illness. A tumor upon the lung is a more likely alternative, but it would be unusual given his young age, and I am not sure how it could be confirmed before death. Consumption therefore seems a likely, though gloomy, guess.
Before this spring I knew next to nothing of the illnesses of Men, so nearly all my understanding comes from the books you, sir, have supplied me. But consumption is so well-known that I have long known its name, even living in the Mountain; from reading and from word from Dale, I know there are few killers of Men like it. From what I understand, there is for it no cure; for some patients, there is a sort of recovering, where the severity fades for a time and the patient is almost-well again, but it always recurs, and the final decline is inexorable, painful, and fatal.
It may be our charge to provide this mere boy with no more than palliative care, which makes me very sad.
I understand, therefore, his friends' desire to seek out some avenue of hope, even if only a fool's hope. I did speak with the Elf, as I mentioned in my note, and I do not think we should fault her too much for implanting it; she does not know George and did no more than speak once casually with his friends many weeks ago, making no promises. She did make clear to them that she knows of no cure even among the Elves, and as accomplished as the healers of the House of Elrond may be, there is no guarantee they could provide anything better than we could. And I believe that George understands this; it is not so much that he himself hopes for a cure, but that his friends cannot bear to see him give up.
[The quill here briefly hesitates.]
But George has been preparing himself for death.
I now make here a confession.
If George were in somewhat better condition, fit at least to ride, I would have been inclined — if I were sure that he understood the slimness of his chances at healing and that he made the choice knowing that death on the road was likely and death in the Elves' refuge almost certain — to offer him a place in my company departing for Rivendell next week. I am sure you will be displeased to read this, but I will say that I would not do it out of naive faith in the Elves' magical powers.
My reason would be this: I believe that, when we have the opportunity, is it laudable to assist the dying with the choice of their end. With illness and decline come a loss of autonomy and control over one's own fate and even body, and to be gradually boxed into one's house, one's room, and finally one's bed by well-meaning healers and relatives, pressed into a smaller and smaller and smaller cage, is to some worse than the actual pain of death. Granted, sometimes it is "for their own good" — sometimes a healer must take away self-destructive choices in order to help the patient be well.
But if there is no chance of being well again, I feel the least that one can offer is the choice of end. For some, their dignity is to accept that end peacefully — to put their affairs in order and surround themselves with friends and family, to take medicines only for the pain and so drift gently into the long sleep. But for others, it must be a fight to the last, bitter breath, with every effort expended clawing at slim hopes. That way is less comfortable, but it also has its dignity, the dignity of never once surrendering to the dark. And I do not think anyone can say which dignity is higher for another; we must all choose for ourselves, at the end.
If, knowing all the facts, George chose for himself that sort of dignity, I would be inclined to help him. I would not do it secretly; I would discuss it with you and, I hope, persuade you to support the patient's choice. And he would, at least, not die alone in the Trollshaws; there would be at least one healer and friend at his side.
But, realistically, George is too ill to even seek that noble death on the road. I have counseled him to seek treatment from you and Master Maddoct. If he wishes, he can attempt to hang on in hopes of a remission and use that opportunity to journey east in hopes of a cure. Or he can choose a gentle sleep here in the sweet and familiar summer of Bree-land. I will support the patient's choice, as long as it is fully informed and freely made.
I make ready now to go and learn what I can of the Elves' secret arts. My heart is heavy.
