I wrote this piece ten years ago, but I can see the hospital room as if it were yesterday…
My patient is dying. I have a patient, and he is dying. There is a man I take care of every day, and soon he will be dead. No matter how I rephrase that, whether I use the terms “dying”, “passing away”, “end-of-life”, “palliative”, or “terminal”, it’s all the same thing. It might be easier if he had lived a full life, saw the faces of his children, or would go in a peaceful manner. Would it be easier? Would it be less harsh, less unfair, if he had months to say goodbye instead of days or weeks? Today, he almost had hours…
I have a patient, and he is dying. He came to us with pain, just some pain, a nagging, aching, annoying pain deep inside where you know pain can’t be good. We didn’t know what to make of it at first, when we saw his scans, but the disease inside him soon became clear. The reports, though only providing this thing with a name, told us all so much more as we read the literature on this rare monster – incurable, six months to a year at best, no real hope to provide to the family or the patient himself.
My patient is dying. Yesterday I took him on a trip downstairs for a procedure – I stayed with him and his family for over an hour, relaxing them, trying to keep him in a calm state and make sure his pain was controlled. We did well yesterday. There was hope at least for comfort, if nothing else. Then today – his wife catching me in the hall, saying “he’s in so much pain, he can’t take it anymore!” – finding him writhing in bed like I’ve never seen. Examining him, knowing that something really really wrong was going on inside, and knowing exactly what it was the second I touched him. Running to find my senior residents, not exaggerating as I stated the emergency before me. Then – I took them on another trip, the patient and his family, back downstairs to the same floor, the same wing. I took them for another procedure, and this time it was so different. So much pain, so much heartache, the tears in his wife’s eyes held back by her strength and solidity of being. He, so much wanting to let go for all the pain, me, hand on his arm, soft words to calm him, urging relaxation techniques that he had learnt previously. Using the healing arts in direct conjunction with the surgical procedure, all at once, feeling like the blood running into his arm from the transfusion paralleled the strength I tried to give him as we worked through that hour together. And when it was all done – he was so much better, he could breathe again, his pain was so much less.
But my patient is still dying.
No matter what comfort I can offer, no matter how much all the hospital teams try to keep him from experiencing the gnawing creature inside him, my patient is going to die soon. But each day he teaches me; his trust teaches me responsibility, his strength teaches me strength. His body teaches me to trust my intuition, my clinical skills, my judgment; his soul teaches me to stay longer when the day ends, go back to the room and check before I leave, respond when I’m asked to, no matter the time of day or night.
Because we’re doctors – and our patients die.
But before they do, an exchange happens: we give of ourselves, and we take for ourselves. My patient is dying, but he won’t go without leaving something of himself with me; our process together will change my practice forever.
Yet even saying that, trying to end with hope, keep my positive outlook, I know that when he goes it will be his wife’s eyes I see. Because more than all of what I just wrote, what this patient and his wife have taught me is the importance of love. The fleeting nature of life, that scary knowledge as a physician that it can all go in seconds – this, my patient is teaching me. Love, the glory of it and the utter vulnerability of it; a fear, a dread, knowing that love can mean loss, heartbreak, inability to be whole again – he shows me this. But it’s a beautiful thing to witness, in all of it’s fragility, evidencing such power.
Life, death, struggle, love, beauty, faith, trust, hope; this is the world I wander through in witness each day I don my long white resident’s coat and take the title “Doctor”.