Helen climbed the staircase, counting the steps to the door out of habit. Thirty-six. Thirty-seven. A few years before, struggling with their boxes and furniture on moving day, she and Sam had briefly cursed their choice of the small house on the hill with its stone staircase winding up from the sidewalk.

“We’ll do this only twice,” they said, gritting their teeth, reminding each other they planned to spend the next thirty or forty years at this new address. Otherwise, the house was perfect. Surely worth the hassle of one day.

“Hell,” Sam had finally said, hefting a box onto his shoulder and smiling, “if we ever do want to move, we’ll sell the thing furnished.”

Thirty-eight. Thirty-nine. She turned her key in the lock and the door opened without a sound. Sam was there, of course. In his chair, with his slippers poking out from under a thin blanket that hung down from his lap. He was looking out at the garden and the back yard and like every evening, he hadn’t heard her.

She waited at the door, assembling what was left of her cheerfulness after a day litigating property disputes. “Hi,” she called out, marching forward into the hall and hearing the clack of her heels along the wood floor project an energy she did not feel.

He looked up at her. Blinked. He leaned his head up to accept her quick kiss. She turned away to remove her coat. Restrained her gag at the sour, metallic taste of him.

“I’m thinking pasta. You hungry?”

Sam shook his head and turned back to the window.

From the kitchen she conducted a one-sided conversation for ten minutes. Eye on the clock, she pushed herself for an extra two. Twelve minutes of sound, she thought, that has to count for something. Sam acknowledged her chatter with small grunts and sighs. When she exaggerated a scolding she’d had to give an ornery client, he chuckled. She froze, refrigerator door in hand. What did his laughter look like anymore? But then she realized he’d probably just coughed.

She turned on the radio. Classical music. Something with emotion and crashing cymbals. She kept it on low, but she liked the idea of such resonance in the small house again. Competing voices and melodic discourse from a rowdy gathering of instruments. In the harmonies she could almost hear the echo of the dinner parties they had thrown after moving in. She wondered if she turned the radio as high as it could go, would the windows shake with the beating of the drums?

Otherwise, Helen knew that from the time she left in the morning until the time she came home, the sturdy brick walls of their house encased a nearly perfect silence. Some days she accepted this with a philosophical frame of mind. Sam was engaging in a creative act of mute agony; how could she not admire this? Other days she felt the fear in his silence even while at work, felt it reaching across town and down into her throat. She would get out from behind her desk and find someone to talk to. A colleague, a client, the receptionist…anyone who would respond to her spontaneous questions, anyone who could give her the uncomplicated bliss of a phrase like, “Oh, I loved it, great film!”

Dinner was ready. Before carrying it out to the table, she washed and dried all she had used to prepare their meal. She wiped the counters with bleach water and quickly checked the dates of the food in the fridge. Then she ran the hot water and leaned her face over the sink to let the steam redden her cheeks with the suggestion of good cheer.

Sam was already at the table. The same thin blanket over his knees, his fingers resting lightly on the glass tabletop. Helen did not ask him about his day nor did she remind him about his doctor’s appointment tomorrow. She knew he was aware of his schedule, knew he would be ready to go when she gathered her keys and her purse and leaned over to give him her arm.

Helen cut her food into small pieces to keep herself from finishing too quickly. Sam didn’t eat much, but it took him ages. Each small piece chewed to mush and swallowed with a mouthful of water. Chew. Repeat. Chew. Repeat. Like every evening, she found herself resorting to a newscast to fight back the silence of the dining room: the weather, bits of international news she picked up on the radio, comments on a book she was reading. Sam nodded. Attentive. Silent. She imagined slapping him. Would he shout at her?

They finished their food and moved to the living room. Helen made sure Sam was comfortable, then turned on the television and put her bare feet up on the ottoman. Deep breath. Until 11 pm the television would maintain her. For 180 minutes she let what was happening inside Sam’s bones occur without comment or combat. She laughed at the jokes on the screen, felt falsely anxious during a police drama, and relished in the bright, aseptic commercials.

She touched Sam’s hand from time to time, even if most often he was dozing. She never took her eyes from the TV screen and in this way she could almost pretend that she was touching the same person who had been sitting beside her two years ago, three years ago. Six years ago. Her Sam.

The new Sam kissed her goodnight after she had installed him in the hospital bed they had set up in the old family room. She sat in the armchair beside him, a magazine across her lap that she did not read, and waited until he fell asleep.

Upstairs, in the bed Sam had carried in four pieces by himself up the steep hill, she sat awake, mind no longer numb, frantically retying the threads of their struggle into perfect little knots. She would not give up. She would work harder to get him to eat. She would call another specialist. She would say yes to experimental therapies. Only when her string of knots was sufficiently long enough could she lean back and close her eyes, secure for now with the thought of each problem properly tied and fastened.

When Helen came down in the morning, Sam was waiting for her in his chair. His back was to her and she could see a few blue veins branching upward from the base of his neck across his bare skull. A sound caught in her throat but she held it back, turned it into a low whistle.

“Good morning!”

Sam jerked, then winced at his sudden movement. She apologized for surprising him, but he waved her off. He stood, ready to let her help him into his coat. There were bruises forming on the backs of his hands but Helen said nothing. What small task had he tried to do on his own? Take out the trash? Remove something from a high shelf? She stopped herself from looking around the room. Took care to avoid his hands as they closed the door and began their descent down the stairs outside.

Sam leaned on Helen as they made their way down to the sidewalk. Going down wasn’t as difficult for him as going up, but it still took them a long time. She didn’t speak, finding pleasure in the sound of his ragged breathing. Something just beneath the rattle of his breath was like his voice. She closed her eyes. Listened to it hum.

Only one of Sam’s doctors bothered to address himself to Sam anymore. The other two and all the nurses turned themselves immediately to Helen. They sought her automatically, instinctively, rejecting his silence. She answered them easily for all routine questions about diet and sleep and medicines. But there were always a few moments during each visit when new questions would come up, questions for which only Sam had the answers. For these, Helen had discovered a new way to hear him. Despite his apparent quiet, Sam was still speaking.

“Pain, Sam,” she said. “We need to tell them about your pain.”

He was staring at his hands, running a thumb over the purple-brown boundary of his new bruise. He shrugged. Helen waited. Patient. They were both patient, she reminded herself. She was the adjective and he was the noun. This made them the same and had taught her where to find his stifled voice.

She settled herself, looking for him. Finding a way to be alone with him amidst the machines and the people. She slowed her own breathing, searched for where he had hidden himself inside his own hush. There, she had it. In the twitch of his cheek, the rapid inward breath. The way he was not breathing as deep as he should. She understood.

“The pain is different,” she answered. “But he isn’t worried about it. Not yet.”

“He has more pain?” the nurse asked.

Sam was staring at Helen now, hands on his thighs, the answer close to the surface. “No, not more pain. His legs are the same.”

Sam reached for her hand and started to squeeze. Helen spoke again, “He’s having trouble breathing. There’s a kind of pain there now.”

Sam dropped her fingers.

The appointment ended with the usual flurry of prescription refills and next appointment dates. Helen filled her planner with this easy information. Sam shook Dr. Weston’s hand when it was time to leave.

“I’d like to talk to Helen for a minute.”

Sam nodded, accepting this as he accepted everything now, but Helen almost refused. Before she could move, the nurse guided Sam slowly out toward the waiting room, closing the door behind her as they left. The examination room was suddenly small and dingy. Shabby. How had she never seen this before? Maybe they should look for a new doctor, a newer hospital.

Dr. Weston was already speaking but Helen couldn’t hear him. She was still with Sam, still too intent on locating his voice. What was the last thing he’d said to her? Almost eight months ago now. She’d held onto it for some time, but now it was gone. Something about the house, or her hair, or his weekly running club. She tried to picture Sam lacing up his running shoes and a twisted cackle rose up and then choked at the back of her throat.

Dr. Weston was staring at her. She excused herself, put a hand in front of her mouth and asked him to repeat the question.

“This is hard for you, Helen.”

“Sam is feeling really defeated right now.”

Dr. Weston paused, then handed her a piece of paper with a phone number written in small, neat numbers. “Take this. Dr. Ullman comes highly recommended.”

“He’s a specialist? Will he do anything new?”

“No,” Dr. Weston sighed. “Something tried and true.” Helen looked at the paper as the doctor told her that this Dr. Ullman was a psychologist. “Both of you are going to need help. This is never easy.”

Helen turned the card over in her hand. Slipped it into her coat pocket. Slipped it out again. Dr. Weston was frowning at her and she knew if she didn’t say something soon, agree to make an appointment, ask an unrelated question, say anything, he would repeat his request, or worse, he might ask her, kindly of course, to go over the details of Sam’s timeline.

She thanked him for his concern and went into the hallway before he could stop her. The waiting room was busy and this was the first time she was looking at it without Sam to guide through the chairs and low tables. It was filled with people. She blinked. Cancer patients are not an inspiring lot. Helen looked from Sam to an older man to a middle-aged woman to a couple in their sixties. Then back to Sam.

He was reading a magazine, his blued hands nearly hidden beneath the glossy pages, his thin body concealed by his now-overlarge clothing. She watched him take a deep breath, saw him tense with the pain of it. No, they had no more knots to tie. She was pretty sure they didn’t even have any more string.

In the car she handed Sam the paper Dr. Weston had given her.

“He’s right, of course,” she said. “I’m surprised they didn’t make us go sooner.”

Sam dropped the card onto the floor. A sudden long exhalation took all his breath and he started to cough. Here was something Helen didn’t understand. Why did every part of his body have to turn traitor? Why couldn’t he keep one part of himself as it was before? The tumors were now in both his legs, along his spine and on his left shoulder, but why couldn’t he die with strong lungs and a healthy appetite? One resilient thing to hold up against the rest, to make it impossible for her to believe he’d been completely beaten in the end.

“It’s probably for the best,” she said, pulling up to the curb in front of the house and stopping the car. The first stair step waited for them across the sidewalk. She envisioned the next hour and how tired Sam would be when he got to the top. She got out of the car and went around to open Sam’s door. His lips were blue. He was breathing too hard.

“You’re angry,” she said.

“Me too,” she said, expelling a tired breath. She wasn’t angry.

He gripped her shoulder. Helen removed his hand gently, placed her arm around his waist and turned him toward the steps. She said, “You don’t think this Dr. Ullman can help.”

“I don’t know, Sam, it can’t hurt, right?”

His arm trembled where it rested on her shoulder. Down the street a car alarm turned on. A jackhammer pounded next door where the neighbor’s were remodeling their driveway. Helen took Sam’s weight against her own and listened to him.

“You want me to go with you,” she said.

“Of course,” she said. “Of course I’ll go.”

But no, thought Helen, unlacing her arm from his back and letting Sam take that first step up the stone stairway by himself. She would not go. It wouldn’t work, she thought, picturing Dr. Ullman’s office and a pair of leather armchairs. There would be a desk. Dr. Ullman would sit behind it waiting for Sam to speak. Maybe he would wait and wait, and push and push. It wouldn’t matter. Sam was not going to say a word. Eventually, Dr. Ullman would turn to her. But she wouldn’t do it, she decided, watching Sam grip the old metal handrail as he placed one foot slowly in front of the other. She would not be the one to relay Sam’s responses to questions about how it would all end and what they had planned. She did not want to know if Sam was ready or not. Even if somewhere in his silent new language Sam was harboring the words to answer this kind of question, she did not understand them. She was just a beginner, still memorizing vocabulary. She needed more time.