Dhukkha

Dhukkha names suffering as both an experience that is difficult to bear and a process that arises through conditions. The novel places this Buddhist account beside the distress of family life, the long labor of cancer care, and Marco Carrera’s final assertion of control over his death; suffering is presented not simply as an affliction to endure, but as something whose origins and possible cessation can be examined.

Definition and Teaching

An underlined note identifies Dhukkha as a Sanskrit term meaning a condition of suffering, with a literal sense of difficulty in bearing it. The text then introduces a teaching delivered by the bhagavā at Sāvatthī to the bhikkhus, asking them to attend carefully to the arising and disappearance of dhukkha.

The account of arising proceeds through dependent stages. Eye and visible objects give rise to ocular consciousness; their meeting produces contact, contact supports feeling, and feeling gives rise to craving. The same sequence is extended beyond sight: sound, smell, and mental objects give rise to their respective forms of consciousness, while contact and sensation lead onward to craving. Suffering thus has a described causal structure rather than appearing as an isolated event.

The account of cessation follows the chain in reverse. When craving ceases completely through the path of the arahat, attachment ceases; with attachment, becoming ceases, and with becoming, rebirth. The teaching concludes that aging, dying, pain, lamentation, bodily pain, mental turmoil, and agony cease with the cessation of this mass of suffering. The emphasis falls on conditionality: the sequence that produces suffering also makes its ending intelligible.

The Teaching within Family Distress

The Buddhist passage appears amid material that moves between personal correspondence and reflections on loss. A letter turns to a book and singles out a poem as especially beautiful and sad, then mentions a small pencilled sentence hidden beneath the flap of a bedcover, placed face down so no one would see it. The teaching on dhukkha gives conceptual form to this surrounding atmosphere of private sorrow and concealment without reducing any individual grief to a doctrinal illustration.

Elsewhere, distress first enters family life through a child’s perception. After Marco Carrera and Marina Molitor move house and change their daughter’s school, the girl is repeatedly found alone and crying. When Marina asks whether her unhappiness concerns the thread, the girl says that it does. The school director calls the belief an evident perceptual disturbance, probably obsessive-hallucinatory, and urges treatment rather than indulgence; the parents begin taking Adele to Dr. Nocetti twice a week. This episode shows suffering being interpreted through competing frames—family judgment, school authority, and psychotherapy—rather than being made legible by one explanation alone.

Illness, Care, and the Limits of Endurance

The later account of Probus Carrera’s cancer treatment gives suffering a long, practical duration. After a rainy Friday diagnosis of adenocarcinoma, the novel describes a medical path of biopsies, consultations, choices between operation and treatment, side effects, and changes of protocol. Probus undergoes intestinal surgery, but metastases subsequently appear in his liver and a lung. Chemotherapy proceeds in a repeating seasonal rhythm: intensive treatment in winter, a spring break, summer rest, and a resumption in autumn.

Marco assumes the work of care from the beginning. He accompanies his father to chemotherapy, monitors side effects and medication, takes him for CT scans, and arranges home blood sampling while also working and caring for Adele. The oncologist holds out the possibility of years of survival with appreciable quality of life if Probus’s body and morale endure. That conditional hope does not remove the burden: Probus’s physical response is initially good and the metastases shrink, while his inner state remains difficult to read because he speaks so little.

As the disease advances and pain treatment fails to quiet Probus’s torment, the language of treatment reaches an ethical limit. In morphine-clouded speech, Probus repeatedly asks Marco to take him away. Marco knows, as a doctor, that he could intervene, and finally gives a dose of morphine sulphate outside the prescribed protocol. Before doing so, he tells his father that this time he will take him away, lies beside him, and asks whether he is ready to move to Marylebone, the London neighborhood Probus had once hoped to make his home. Probus answers yes and murmurs “Goldfinger house” before falling asleep. The scene makes care inseparable from an act that Marco understands as obedience, pity, and a choice made alone.

Suffering and Autonomy

The novel’s later end-of-life scene echoes this conflict over who may act, and with whose consent. Marco tells those present that he is speaking as a doctor of forty years and that what he is about to do is undertaken by him alone, in complete autonomy and full mental clarity. He explains the contents of two bags attached to an IV pole and connected to a vein in his right arm: one contains midazolam and propofol for deep sedation, the other undiluted potassium. He says he can carry out the act himself and that Rodrigo’s role is only to provide twenty or thirty seconds of peace.

Set against the teaching’s account of craving, attachment, and cessation, this declaration does not simply resolve suffering into a doctrine or claim that clinical knowledge can master it. Instead, the contrast sharpens the novel’s question of agency: the Buddhist passage describes release through the cessation of the conditions that sustain suffering, while Marco’s medical knowledge equips him to make a deliberate decision at the end of his life. Across the child’s distress, Probus’s prolonged illness, and Marco’s final insistence on autonomy, dhukkha functions as a framework for seeing suffering as embodied and relational, while leaving its human and ethical costs intact.