He has lost his temper with the doctor's secretary twice this month, just because she said 'God Bless' to him on his way out the door. 'Fuck God' he said, the second time, snarling like his wife's Jack Russell. That was after the first chemotherapy treatment. They took a biopsy from a lump on his left testicle in the hospital last month. The results are on his doctor's file. The secretary knew before he did: Malignant. He almost punched Dr Lynch when she gave him the news. 'I'm only 41, ' he kept saying, as if he believed that information would make her retract her words, but she just nodded, patiently, and he knew she was used to this. No, he decided, as he heard her calm, positive-butrealistic talk, delivered with expert communication skills. No. I refuse to be drawn into your world, your practised language, your training for tragedy, your favoured specialists, your brand new drugs, your mouthing about Going Forward. Going Forward to what?

"I haven't been to a doctor in 10 years, " he said, glaring at her clear eyes in her youthful, and irritatingly composed face. "I don't get sick. I never get sick." He knew he sounded ridiculous. He supposed she was used to this too.

He is in today with an infection.

He talks agitatedly to his wife, while she quietly tidies the magazines and newspapers on the waiting-room table, a habit she has acquired from almost 13 years of working in a city centre library.

The chemotherapy has weakened his immune system. His wife tries to calm him. She is afraid he will kill himself with his own rage. She believes that with the help of God she will keep him up. If he lets her, that is. She knows he is afraid of dying. She believes he should talk to God.

"You believe in fucking everything, " he tells her, regularly.

His wife is so full of hope she practically glows, like the tiny silver crucifix she wears on her neck. To some of the others waiting, there is something vivid about her. Something pure. It is in the gloss of her hair, the open face, always looking up or straight ahead, never downwards. She has perfect little feet and tiny hands.

Childlike. She captures the eye like a pretty child sitting there in her turquoise tee-shirt, her small brown feet in her red sandals with the narrow snakeskin straps, and her small brown hand with the large jade stone on her finger, resting on his big square knee. He is a heavy, solid man. Only the centre of him is supported by the chair, his thighs spread either side of it. He is too big for the chair. He is too big for the room. His presence makes people uncomfortable. It makes the doctor uncomfortable. But that's because she knows he is sick.

Seriously sick. She tells her colleagues he makes her go cold inside. She says he is one of those people who have lost hope, who wants to die. She has seen his type before. She believes that some people can make themselves ill.

They can kill themselves with their own minds, without pills, or knives, or ropes.

His wife turns the pages of an old Cosmopolitan slowly. She does everything slowly. This is what he first noticed about her, her serenity, her lissom, languid body, radiating calmness. His own body language betrays him. He acts cool, but he is nauseated by even the smallest injection. He fidgets beside his wife, his face is flushed, his muscles tense like a bad liar. In work, he acts cool, and on the odd occasion he socialises he puts others at ease, but he always leans on something for support, though he is not sure exactly why: a worktop, a bar-stool, a table, a wall, the boot of his car. On escalators and stairs he always uses the handrail.

He had a chair pulled from underneath him in school once and he cracked his coccyx in the fall. Sometimes he wonders if the experience made him lose faith in his ability to stay standing up.

"It's like Mc Donald's around here, " he mutters to his wife. They can both hear the woman in the expensive trouser suit who got up suddenly to complain at the reception desk about waiting so long for a doctor, compared to the GP on her own street. "Does she not know sick people don't have a choice. Someone should tell her it doesn't make any difference . . .

here, or the doctor on her street.

Once the health goes, we all go down the same roadf" His wife attempts to distract him.

"Did you see the corridor?" she says. "The walls are lined with photographs of new babies. And they must have got an artist in to paint those two huge storks with that logo 'our little friends' underneath them".

"Am I supposed to be pleased?"

he says, raising his eyebrows, and staring aggressively at her.

She doesn't reply. She was always mad about kids herself, but it wasn't to be. He insisted she stayed on the pill. Just for now, he would say. Just for now. She counts her blessings instead. 'Oh, how that irritates him', she tells her closest friends. 'But I'm damned if he'll bring me down'.

Christ, she thinks, how long can they go on pretending that everything is just fine. She wants to tell people that he is ill, but he refuses. People's perception of you changes, he tells her, when they find out you are ill. She tells him that their friends would be only too happy to help.

He gets up and walks over to the notice-board, looks at the adds for mothers' and toddlers' groups, breast feeding phone-lines, baby vaccination advice. He never had any interest in babies, but now they are everywhere. He even resents his own potential babies, lying in wait in freezing phials in the fertility unit, whether he lives or dies. His ability to jerk off successfully into a plastic jar with his name on it, in that white, bright room, in the clinic, still surprises him . . . his grim determination on that humid summer morning to leave his progeny behind. Will he ever be called by the doctor?

There are no diversions here. The newspapers are out of date, the magazines are torn, or mauled by toddlers' sticky fingers. There was a woman here just now with her toddler. The nursery rhyme she was reading still rings in his ears:

Solomon Grundy, Born on Monday, Christened on Tuesday, Married on Wednesday, Took ill on Thursday, Worse on Friday, Died on Saturday, Buried on Sunday, This is the end of Solomon Grundy.

Lucky for Grundy, he thinks. A quick exit. If only he could have a quick exit. He feels the pressure of his wife's hand on his.

On good days, he feels like Samson, restored to his former self. He can allow her warmth to seep into him, without feeling his stomach clench. He can look at his pale, almost bald reflection in the mirror, and feel as if his strength is returning with the slow re-growth of his hair. He can meet his own eyes, set deep underneath his eyebrows, which have grown back thicker and blacker, like two badges-of-honour to mark his ordeal. He can soap his skin in the shower without recoiling from intimacy with a body that has betrayed his trust. He can walk upright, without bracing himself against a horrible disease.

On bad days, he shrinks from her touch, and presses himself against the cold wall on his side of the bed, sweating from one of his fevers. His bloodshot eyes in the mirror frighten him by telling him what he knows only too well. It could return, they tell him. It could return. He dresses without glancing at his once ruddy skin, like the old nun who taught him religion advised, when he was a boy . . . the custody of the eyes. He wonders if it was a particular sin, or an accumulated total, during his 41 years, which deserves the punishment of death. He wonders why, after 20 years of teaching science, he believes that God is punishing him, why when lying in the foetal-position for hours in the night, or day, he screams for his dead mother, or God, to help him?

He bargains with God. Dear God.

Please God. Fuck you God. He wonders how his class are getting on with the substitute teacher. He wonders are Matt and Daniel acting up. He wonders why vacant Myra, with acne and limbs like tree trunks, has a more efficient body than his own.

They took the train for a short visit to his father last week.

If looks could kill.

"Is it yourself?" his father said, whispering, looking at him as if he was already dead. In the train, he forced himself to keep looking out the window, though the Midlands landscape was dull. Dirty grey outhouses, dull-red corrugated roofs, gaudy mansions with pillars at their entrances. Thistles, yellow fields, modern bungalows. He counted sheep with blue-branded wool, long meadows, telegraph poles. He saw storm-ripped trees, endless stone walls, rusty tin barns. He counted circular bales of hay in tight plastic wrap, watched crows circling massive oaks, like vultures, waiting. He remembered the rectangular steel baler attached to the Massey Ferguson, and thought how little else had changed, apart from the disappearance of ancient Ford Prefects, Austin Sevens, and redundant rust-orange tractors, from back-fields whose fences were now repaired. His own father had to show an interest now, clean up his act, if he wanted to avail of the Grant Scheme from the Department of Agriculture.

There was endless marshy bog, like the tract his father rented, where, in July, he and his mother stacked the heavy, wet, sods into tepees propped in sunlight until dry, and light and scratchy on the skin, when they tossed handfuls onto the donkey's cart. There were some forested areas, like the plantation near their farm which he used to be able to see from his window, and which seemed to swallow his father into its depths, as he watched his father disappear from the boundary of the field into the shadows, with his chainsaw under his arm for chopping logs, along with the other men, resting shovels stoically on their shoulders, carrying paper bags of fresh pork chops, to cook later on the shovels laid over open fires, burning trimmings from trunks felled earlier by the foresters. He used to think Brownie, his favourite dog, would be swallowed too, in the swallow-holes of the bog, 'swalley holes' the older men called them.

"Those eejits, " his mother, the school teacher would say, laughing at them.

"Tuppence ha'penny looking down on tuppence, " he would say, imitating his father's jibe, and they would both laugh. He remembered those deep trenches where the dogs would be thrown, for a swim, and where he would stand, mouth open, marvelling at the dogs' ability to grip onto bits of vegetation and grimly scramble their way up, and out, where they would stand, shuddering, spraying him with brown water. He always thought of those dogs, as an adult, whenever people said 'clutching at straws' about somebody, and more recently, about his unvoiced reactions to his consultant's statistics. There seemed to be dozens of small graveyards, he spotted them all, and each crumbling ruin, once occupied, and the remains of a solitary castle.

All this concentration was because of the man who sat opposite him, with his radio headphones in, smiling and nodding to the music. He looked at his wife instead, but she was absorbed in a book. Something about spirituality. New Age Bullshit, he wanted to say, but that would only cause another argument. He wanted to throw her book out the window. He wanted to wrench the headphones from the man's ears. He wanted to say (quietly, and confidentially). 'Don't smile. We have to talk. I'm afraid it's not good news.' Would the man's smile vanish? Would his face crumple? Would he pale? Would the man punch him in the face, like he had wanted to, when the doctor spoke those words to him? The man was beginning to do a crossword from his newspaper now, carefully unclipping an expensive looking pen. He wanted to grab the black fountain pen and stab the man in the neck. He wanted to draw blood. He wanted to inflict terror, and pain.

Sometimes, walking down Grafton Street, at lunchtime, he wanted to hurt a stranger. He wanted to see wounds, crutches, people in pain.

People wiping tears from their eyes. People wracked with sobs.

People with surprising scars.

People with frightened faces. But all he saw were smiles, people greeting each other, people hurrying, chatting, living as if there were no end to it. Why? Why should they escape the pain of too much knowledge?

In the car-park, he sits staring through his windscreen. He is waiting for his wife, who has gone to the chemist next door to the surgery. Antibiotics today, along with all the other drugs he has to take. He felt the old swell of love for her, while he watched her walk away from the car, her shoulders well back, her open face, her ready-for-anything posture that sometimes turned people's heads, and used to make him feel proud to walk alongside her. Now he punishes her for the fearlessness that attracted him to her, he sees that despite her patience and her endless care, there are times when she is waiting for it to be over; so he can only feel for her now, when he watches her walking away from him, as if he is the one who is letting her go. Part of him knows that if he told her this, she would tell him that he was out of his mind, and then she would hold his head against her breasts, and this would make him bawl like a child, so instead he says nothing.

Rain begins to tap lightly on the windscreen and then, heavily, as a sudden shower rattles on the car roof. He notices two pregnant women in the downpour, rushing to embrace each other. They make no attempt to seek shelter, even though the surgery is only yards away. They hold onto each other for what seems like ages, to him.

Then they pull away, and their faces, one pretty, one plain, are animated. They touch each other's arms as they speak: Old friends, meeting unexpectedly, comparing each other's bumps. The tall woman's light blue sweatshirt is visibly darkening, as the rain dampens it. The smaller woman's long brown hair becomes dark, and heavy with wet. Five minutes pass, and they are still there, talking. Finally, they both turn their faces and hands upwards, and laugh, heartily, and the man looking through the windscreen marvels at their acceptance of the elements; their complete surrender to rain.

Valerie Sirr, a graduate of TCD, has worked in international banking, computer programming, property development, and as a psychologist at the Institute of Psychiatry in London.

She has been twice short-listed for a Hennessy New Irish Writing Award.