Will Atlas Shrug?

"You know you could die tonight if you don't go to the hospital," I tell him.

He lies on his messy bed, smelling of feces and vodka. A plastic bucket sits beside the bed as an ersatz spittoon. He misses more often than not, gobs of chewed tobacco caking the dirty wooden floor. I notice that the toilet seat is caked with feces. There are more than 20 empty vodka bottles piled behind his bed. He stares at the TV tuned to Spanish soap operas.

"I won't go to the hospital. I won't go." He stares intently at the TV.

"Look," I respond in Spanish. "Your blood pressure was more than 200/120 yesterday and today I can't even hear it. You have no pulse in your wrists, and I'm afraid your pressure may be dangerously low."

"I'll stay here in bed and take my medicine. I'm not going anywhere, and that's that."

He tells me he fell a few hours ago on his way to the bathroom. He was very dizzy.

I call the primary doctor. She advises me to write a letter for him to sign, stating that he understands he is going against medical advice by refusing to go to the hospital. She also says he shouldn't take any more meds until I can recheck his pressure and pulse. He readily signs the paper with his shaky signature.

"Are you sure you won't change your mind? I'll feel bad if you die, but that's not important. Your health is most important. Do you care that you could die?"

"I don't care. I'm staying here."

I leave messages on his brother's cell phone and land-line, saying that his life may be in danger but he refuses to go to the hospital. I know his brother is at his wits' end and doesn't know what else to do. This man, the oldest of six, is a helpless and hapless alcoholic, pouring vodka down his throat like gasoline on a fire. His end is written all over his face in pure and deep pain which I will never understand. I hide his medications in a kitchen cabinet so he won't take them by accident. I offer again to call an ambulance but he waves me away like a pesky fly.

I walk down the four flights of the fire escape, feeling somewhat dejected. It's cold. The wind whips through the sorry city. He could die tonight. Does he really not care? Is he that far gone? What about the others who can't pay attention long enough to take their AIDS meds? And the smokers with COPD and asthma? And the other alcoholics with cirrhosis? And what about the diabetics who gorge on sweets and leave their pancreas abandoned on its own road to self- destruction?

My shoulders hurt. Am I carrying the weight of the world? If I was Atlas, I'd probably shrug it off and take a long winter's nap.