Without Cause

Larry Glines


“You mean no known cause, I’m sure,” I said. A bit smug to the person who would eventually tell me I was going to die.

                        “I know what I said,” Dr Maya replied, peering over her rimless glasses. “Your disease has no cause.”

                        My clipboard is cradled in her right arm, on it all my info from my uneventful birth, middling age, and average height, to the faded scars of slipped knife, door slammed on foot, mountain biking accident, divorce, estranged kid.

                        “I don’t understand. I came in here for a cough. I know you’re the doctor, but I’m pretty sure the cause is germs. Mystery solved.” I was anxious to get back to work; I was already stretching the limits of my lunch break for this appointment.

                        She shook her head. “I’m not talking about the cough. You’ve never had a splenectomy, have you, Mr March?”

                        “I don’t have time for this. You have my chart, don’t you?”

                        She continued, her patience enviable. “Your chart says no. The lack of trauma in the area says no. But. Your blood work from last week is consistent with someone who’s recently had their spleen removed. Memory cell count down, platelet count up. [I hope I’m remembering this correctly.] We’ll do a CT scan just to be sure, of course.”

                        “I really don’t have time, I need to get back to work.”

                        She allowed herself a small scoff. “There’s no way we could do it right now. You’ll have to schedule it with the radiology department.”

                         “And what about the cough? You know? The thing I came in here for?”

                        “The spleen,” Dr Maya continued, “is an important part of the immune system, filtering your blood of infection. Luckily it seems that you just got a cold this time, but we’ll need to schedule you to get a few vaccines to prevent that cough from turning into anything worse. I would take it easy, Mr March.”

                        I got back to work, the vaccinations scheduled for the next day, the CT for the week after.

                        “Took you a while, huh?” my boss asked, genial as always. “Everything alright?”

                        “Oh it’s, uh, it’s just a cough,” I said, my small hesitation immediately noticed by both him and myself.

                        “Just a cough?”

                        “Well yeah. But no. I’m missing my spleen.”

                        His eyebrows raised, his brow furrowing, blood pooling into the hillocks he formed.

                        “It’s just not there.”

                        “You know it’s audit season right? We need you here, I can’t have you—” he dropped his voice, leaning into me. “I can’t have you cracking under the pressure.”

                        “That’s just what the doctor said. My spleen’s gone.”

                        I was fully prepared for him to press me on it, responses lined up in my head, but he dropped it. “Well, Amina says there’s some issues with the P&L report for last quarter. Why don’t you go help her out with that?”

                        And I did, the spleen gone from my mind as much as it was from my body.


I decided I like the smell of hospitals. I think it reminds me of the fabuloso my ex used (quite liberally) to clean the linoleum of our apartment when we were together. But maybe I’m just prone to falling for the simple deception that the smell presents, choosing to ignore the underlying decay and humanity it’s trying to erase. Or something. I think I’m still half-dreaming.

                        In any case, I have a lot more time to write now. I’ve even had time to spruce up what I worked on a couple of days ago.

                        I missed the appointment for the vaccinations, the P&L issue turning out to be much worse than Amina let on, possibly even fraudulent. We ended up having to work into the night on it, only stopping because she noticed how pale I was.

                        “How about you go home? I got this. This isn’t my first rodeo,” she said, despite it really only being her second rodeo. I was going to decline, but a cough erupted from my lungs, so sputative and violent that it left my diaphragm sore.

                        “You’re right. It’ll be easier to get this done from home anyway,” I replied, trying to stay casual, picking up my laptop. I wasn’t able to get any work done, though, my cough only getting worse. I couldn’t sleep it off and could feel the febrile heat radiating from my eyeballs and through my eyelids. In the liminality of feverish half-sleep, I could feel the hole where my spleen should be, a deep well I had somehow fallen into, the rest of the world far away from me.

                        As soon as I woke up—although I’m not quite sure if that’s the right word for it. More like, as soon as I got out of bed—I sent a quick email off to work.


Hey team,

Don’t wait up for me. Feeling super sick. I’m really sorry, but I have to go to the doctor today. Pneumonia? I’ll keep you updated



Among a few well-wishes from them, including a very earnest “get better soon!!!” from Amina, my boss replied.


Hey man you know how important it is that ur in right? Audit season is here. No one else has ur experience ur like everyones big brother. ARe u sure you can’t come in?


Sent from my iPhone


After I replied no, first to that email and then to an image of an admittedly adorable cat begging “pweeeeeasse,” he asked me to at least bring my laptop with me.

                        I feel I should mention that I’m lying in an adjustable bed now, surrounded by thin curtains and the clean smell of erasure I mentioned before. The only things that mark it as my own are my laptop and a shiny novel on the bedside table. An IV is sticking out of the back of my right hand, which I can feel shift under my skin as I type. I’ve skipped the boring waiting and stern admonishments I endured when I came in, acting as if it were nothing, despite my paper skin bursting into pain (already sore from contact with my clothes) as soon as I sat on the stainless steel stool in the waiting room where they took my vitals, despite the fever being so bad I could feel it in my teeth gums tongue, making it difficult to respond to the nurse’s, and later Dr Maya’s, questions.

                        “Do you realize how serious meningococcal pneumonia is, Mr March? Do you realize how close you were—and still are—to dying, Mr March?” etc. etc. etc.

                        Going into the CT scanner was fun, though. I drank something that tasted like a chalk smoothie and got wheeled through the halls by two high schoolers wearing masks, gloves, and scrubs, a brother and sister from what I could tell. They told me that they were volunteering, that they got fired from the HR department of the hospital, and that I smelled like death before I went through the giant donut that dominated the room. The sister slapped a strawberry scratch-n-sniff on my chest before wheeling me back. I didn’t catch their names.

                        “The good news, Mr March, is that we were able to do a full-body scan. The radiologist identified what are called pulmonary infiltrates in your lungs, confirming your pneumonia diagnosis. Luckily, they haven’t infiltrated too much, and your prognosis is good. The bad news is that we also confirmed that you no longer have a spleen.”

                        Dr Maya’s words washed over me without quite reaching my brain. I was still feverish, after all. Still deep in the well left by the missing organ. It didn’t help that I was preoccupied with the P&L issue, my laptop open on my lap. At least thirty spreadsheets open, numbers not reconciling, auditors asking questions, my boss in a panic.

                        “Additionally,” she continued, “your app—could you put your computer away, please? Thank you, Mr March. Your appendix is gone, as well.”

                        I’m only just now realizing the gravity of what she said typing it out.


“Did you save the sticker?” the sister asked.

                        I pointed to the back of my laptop, the hot pink cartoon strawberry standing in sharp relief to the matte black of the laptop.

                        “Good thing you saved it. I don’t have anymore and you really need it,” she said before leaving the room.

                        I’ve been going to the CT scanner more frequently now. About twice a week now for the past three weeks. Dr Maya assured me that the risk the radiation poses is small enough that I shouldn’t worry, though I wasn’t worried until she mentioned it. Despite this, I still haven’t caught the brother’s and sister’s names, and at this point I feel it would be embarrassing to ask.

                        The sister reminds me of my daughter, headstrong and a bit rude, but always in a joking way. Sometimes slipping up and showing how much she cares. I haven’t talked to her in years now, too proud to reach out. She sided with my ex husband, with her dad. It hurts to write this out.

                        I’m going to sleep.


The CT scans turned out to be unnecessary to find the next piece of me that was erased.

                        The second bone of my left index finger was and is gone. I woke up thinking that my finger had somehow fallen asleep, not responding to any commands I sent it. It reminded me a bit of roadkill when I finally looked at it, the middle horribly flat and squashy.

                        The nurse—Mitch, maybe? Or Reggie? Something like that—seemed excited for me as he placed a latex glove with its index finger cut off like mine would be soon (“for sterileness”).

                        “The surgeon won’t have to cut through any, y’know bone or anything. Honestly, this’ll probably be a pretty easy surgery for you. I heard you had your spleen and appendix or whatever cut out in like a week. This will be nothing for you. You won’t even have to go under.”

                        Truth is, I’ve never gone under, my wisdom teeth still ensconced in my skull as far I know, but I think I would’ve been okay with this being my first time. I could hear everything as they cut through the limp skin where the bone was missing.

                        The phantom finger is still reaching for Rs and Ts while I type. The middle finger of my left hand is picking up the slack, like how Amina is picking up the slack for me at work. I had my doubts, I told her that I was the one who wrote the tangled web of formulas and references in the sheets and that even I’m baffled, but she seems to be making good progress.

                        (I feel that, as my body is unraveling, my mind is constantly finding new connections and parallels between different points of my life. As if I could stitch myself together this way.)

                        I feel, also, that it’s disingenuous of me to leave out how much I screamed when I discovered my fingerbone—Dr Maya informed me that the technical term is the intermediate phalanx of the first finger—was gone, spirited away to wherever my spleen and appendix and who knows what else are hidden. There was an interminable moment where my vocal cords refused to produce sound. My scream was its most intense when it was silent, until my breath, still recovering from pneumonia, broke through harshly and alerted the nurse—I think his name is Curt, actually—that he needed to come and check on me.

                        But I’m still here. For now at least. Writing this all down seems more pressing all of a sudden.


My boss took some time to email me today:


Hi hey, have you been able to figure out what’s going on? Ive had to pay Amina overitem the last 2 mths. U realize she’s hrly right?? What have u been doing? Ur really lucky that its just a quarterly audit this time otherwise we would be sued or fiend or w/e


Sent from my iPhone


I didn’t respond. I learned that a rib was missing earlier this evening after touching my toes for the first time in thirty years. It didn’t hurt.

                        For some reason that seems worse: that it doesn’t hurt each time I lose a piece of me, the possibility I’ve lost more than I’ve realized as a result.

 But maybe I’d be saying the exact opposite if it did hurt each time. Like missing the cold when it’s summer, only to miss the heat when it’s winter. Or missing the seasons while trapped on three sides by thin, clinical curtains; on one side by a thin, clinical wall. Trapped inside by a thin, clinical body. Trapped on all sides by thin, clinical air.


I can tell the nurse is a little frustrated that I haven’t remembered his name. He’s told me at least seven times (I’ve counted), but I still can’t quite hold on to it.

                        I used to be really good with names. But now all the people around me have slipped into anonymity. There are more nurses than just Mitch-Curt-Reggie, but since I can’t remember their names, I’ve left them out of this. The brother and sister are the most embarrassing. I see their nametags dangling over my face whenever they’re transporting me, but they’re still only “brother and sister” to me.

                        Is this just a consequence of my age? Or have I lost the part of me that’s supposed to be in charge of this info?


I lost my right testicle.

                        I half-joked about my fears of testicular cancer with my ex (it seems juvenile to call him this, but I can’t quite bring myself to use his name), a possibility that never precipitated. And now never will. In the right one, at least.

I want to tell him.


I’ve compiled a list of all the possible causes of my causeless disease that I can think of:

  1. My body is eating itself.
    1. Unlikely. Would probably be more painful, and the Dr would notice.
  2. I am being smited for some reason.
    1. Possibly. I haven’t been a perfect person, especially to the ex and the kid.
  3. The world has forgotten me, and I’m being erased as a result.
    1. This one seems more and more likely. No one really calls me by my first name anymore. Only the boss and Amina talk to me, but even then it’s only to get the work thing figured out.
  4. I’m in some sort of novel or story and the disease is a metaphor or something.
    1. No. My death hasn’t been very interesting and I’m not even sure what it could symbolize.
  5. A me in a parallel universe (or universes) needs the organs more, and they’re being plucked out of me for some sort of interuniversal surgery.
    1. As unlikely as this one is, I like it the most. It makes me feel like there’s some sort of meaning to my falling apart. And at least I would be helping someone out.
  6. There is no cause and life is truly meaningless and terrible.
    1. I hope not.


My wisdom teeth disappeared next. They didn’t fall out, they just weren’t there. My tongue is constantly tripping over their slick absence.

Both the brother and the sister sympathized with me as best they could. The brother told me how he could only eat cold mashed potatoes for a week after his were taken out (although his sister said that was really only two meals before he went back to his normal diet). They both not-so-subtly boasted about how they didn’t need the percocet the orthodontic surgeon provided them.

                        I miss my finger. Its ghost is getting itchy, and I wonder if something similar will happen with the missing teeth.


“hey pops didn’t know you were in the hospital”

                        So reads the text from my daughter. I reached out to her after Dr Maya informed me that I would no longer need CT scans, their cost growing prohibitive compared to their dwindling utility. The doctor misinterpreted my downcast expression, telling me that I had nothing to worry about and that she would continue doing everything she could to mitigate my symptoms, but I was actually saddened by the thought that the brother and sister would no longer be taking me to the radiology department.

                        I felt a strange sense of loss in learning that I wouldn’t be seeing them anymore; I felt compelled to bridge the gap between me and my daughter.

She still hasn’t responded to my response (“Yeah. Don’t know when I’ll be out, but would you be able to see me for lunch after? My treat.” I’ll let her know that I probably wouldn’t be getting out at all another time).


I woke up to a subdued world.

The dingy mint green of the curtains was transformed into a dingier beige this morning. Maybe they replaced them? I thought at first. But the floors and bedspread were also different. As I woke up more I realized that everything was the slightly wrong color.

I had become color blind.

Either some portion of my cones were erased between yesterday and today, or the part of my brain that distinguishes the difference between red and green did. The doctor had no idea either.


Amina solved the issue: a hidden cell in a hidden sheet in the P&L report had a mistyped constant in it that had never been used before, and so numbers were being multiplied by 105 instead of 10.5. It made it seem like the company was trying to overemphasize the P in P&L and defraud the investors of etc. etc. etc.

                        Incidentally, I no longer work for the company. I don’t quite know if my boss had fired me or if I quit, but I’m not sending the laptop back. There’s no way I could take the sticker off without it losing its stickiness, and figuring out some way to ship the machine seems like too much hassle.

My boss, thoughtfully, sent me one last email:


 At least we wont have to pay for ur effin health insurence anymore


Sent from my iPhone



“How are we doing today, Mr March?” Dr Maya asked, her finger tapping her bouncing knee in some sort of complex rhythm.

                        I closed my laptop. On it was a spreadsheet with a ranking of which part of my body I’d be most okay with losing next, leaving off obvious losers like heart and brain. I would’ve color-coded it, but it seemed useless. Hair is easily at the top of the list. I’m missing most of it as it is, might as well get it over with. At the bottom of the ranking, cells that would normally be colored red, are femur, stomach, and kidney.

                        “We’re doing great today, Dr Maya,” I replied.

                        Her finger-tapping got faster. “We think it will be best if you either move into hospice care or even find someone to care for you at home.”                      

                        I noticed for the first time that she wore a thin yellow bracelet around her left wrist. Or maybe red. Or green. I’m still not entirely settled into my colorless life.

                        “Your disease—if it can be called that—seems to be accelerating, and, with no cause, we have no way to treat the root of it. You know, as well, that you no longer have any way of paying for this.”

                        “What if it’s contagious, though?”

                        “Without a cause we also have no way to know how it spreads or if it does. We believe the risk is very small that it will spread. I am still all here, aren’t I?” she said, giving me a thin, clinical smile. “I wish there was more I could do to help,” she added.

                        At least now I’m in my own bed in my own pajamas with my own thoughts, truly alone. My apartment is not as immune to the smells of death as the hospital was. I wish I had a few more scratch-n-sniff stickers or at least some fabuloso.


I lost my tongue last night.

                        I noticed it as soon as I woke up, the new hollowness of my mouth obvious and strange and horrifying.

                        For the first time since the divorce I wept, the stinging salinity of my tears untasted until they hit the back of my throat. I’ve been afraid to eat, afraid to drink. I’m lucky I haven’t had much of an appetite lately.


“Hi, Pops,” she said.

                        She didn’t say anything else before walking in. I hobbled behind her, my left foot not working quite right anymore. No more doctor to tell me whether I lost muscle, bone, ligament.

                        “I can’t talk,” I typed (I just added the quotation marks now). “No tongue.”

                        “I know,” she typed back. The alacrity that she typed with was impressive, especially compared to my my nine-point-five-fingered plod.  “I got your text.”

                        “You don’t have to type with me. You still have your tongue.”

                        She smiled before walking away into the kitchen, coming back with a strange-looking smoothie after a couple of minutes. I was reminded of the chalky drink I had to drink every time before going into the CT scanner.

                        “The yogurt in your fridge is about to expire,” she typed.

                        “Thanks for letting me know.” I took a few sips of the smoothie—based on the smell I was lucky I no longer had a tongue—before continuing. “I’m glad you could come today.”

                        She took a few moments to compose herself before typing on the line under mine. “I don’t know if I’m ready to forgive you yet pops. But I’m here for you. I’ll be here to help you.”

                        “Thanks kiddo. That means a lot.”

                        We sat for a while without talking while I finished the smoothie she made.

                        “I read one of your books by the way,” I typed, pulling it out from the drawer of the end table. “It’s what inspired me to write out what’s been happening to me. Maybe you can read what I wrote and give me some notes when it’s done.”

                        She started to speak before catching herself, typing out: “You should’ve let me know, pops,  I would’ve sent you one for free.”

                        “It’s not a big deal. I wanted to support you, even if only a little. My daughter, the novelist. But why the name?”

                        A crease appeared between her eyebrows, forming a rift between them, before she realized what I was actually asking about. “Oh, the editor felt April Schumacher wouldn’t look as good on these covers.”

                        “I guess I can see that.”

                        She took the empty cup from my hand to wash it. I listened to the rising pitch of the cup as it filled with water, the hollow splashing of water in stainless steel sink, the clattering of the rack as she placed the cup to dry. I wanted to tell her—or type out I suppose—that she was using too much water, but I reconsidered.

                        She walked towards the door, but reconsidered as well. She turned around and took the laptop from my lap. I stared at the scratch-n-sniff strawberry as she typed.

                        “Dad said he’s thinking of flying out to see you next week,” the screen said.

“See you, Pops,” she said before walking out the door.

I’m looking forward to the meeting, even if it ends up being painful. Or maybe because I anticipate it will be. Hopefully I won’t lose anything too vital between now and then.




Larry Glines was born and raised in Las Vegas, NV. He moved to Gainesville, FL to study Physics at University of Florida. He currently lives in Denver with his wife and their bratty dog, Poncho. Larry has a black belt in jiu-jitsu.