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A pleural effusion​ , fluid trapped between the linings of the lung, had been identified on the CT scan of a 65-year-old man recently diagnosed with lung cancer. ‘Either it’s nothing,’ I told him, ‘an inflammatory response to the biopsy itself, or it’s from the cancer. If the fluid has cancer cells in it, that would change the prognosis.’ Cancer cells in the fluid, a ‘malignant effusion’, would mean the cancer couldn’t be cured. Expected survival time: less than a year. He didn’t speak for a long minute. While I waited, I looked at the patches on his leather bomber jacket. ‘Agent Orange’, one read. Another: ‘Dioxin Kills.’ Another: ‘Combat Veteran’. ‘Where did you get those patches?’ I asked. He stood up, turning around so I could see even more of them. A large round patch covering nearly the entire back of his jacket said ‘Vietnam Veteran’ in gold letters, framing a silhouette of an undivided Vietnam. ‘My son got them on the internet,’ he said. He pointed to one covering his left bicep. ‘What do you think of this one?’

I wasn’t sure it said what I thought it said. ‘What is that?’ I asked.

‘Shit burners,’ he replied.

The patch was three inches by three inches, and showed a stick figure, with a stick figure shovel, poking what appeared to be a broom into a barrel.

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