While some might see nothing but a piece of cardboard , Ernie wallows in the horrifying truth that years of innefective chemotherapy has left Bert so frail and weak that he is indistinguishable from thick card stock . Knowing Bert is no longer capable of coherent communication , Bernie wonders if his brother resents him for his miserable state , trapped here , infirm and unable to interact with the world . Not for the first time Bernie , seeing Bert struggle simply to move his eyes and to breathe , doubts he made the right choice . 