Having no intention of being involved in this case besides my signature on the chart, I listened to the Physician Assistant as she described the patient. He was old. He had prostate cancer with metastases to his liver and his brain. He was sent from the nursing home because he was now seizing. His wife was at the bedside. She wanted everything done.
The only questioned I asked, “Is he a full code?”
“Of course,” was the PAs response.
“Great, another life saved,” I cynically remarked as I instructed her to “do everything” which we both knew only meant prolonging his inevitable death.
But then the overhead page went out moments later, “Doctor to room 9, stat!”
He had to start convulsing again before we could get him loaded with the anti-seizure medication.
Walking slowly into the room, I already knew what I would find. There laid this shell of a man, flopping from side to side. He was swinging his arms and legs wildly, foam poured from his mouth as he bit his tongue while shitting and pissing himself. His wife kept begging for someone to make it stop.
And I did. That was the easy part. I had plenty of drugs for that so I gave them judiciously.
Tears streamed down her face as she rubbed, cried, prayed and sobbed to him that she loved him so. And then she would wildly pace the room looking for answers that no one could give.
Cowardly I did exactly what she asked. I never questioned her motives. How could I? She was grasping, hoping beyond hope that I could fix her husband. I knew there was no remedy but I didn’t bother explaining this to her. She was in no state to take in any words. It was too much for her lonely soul to bear. Or so I assumed.
The drugs succeeded. He stopped. She calmed.
I left the room disgusted by what I had done. But it was the end f my shift. I was in no mood to really talk to her. And why should I bother? She was in no state to hear the truth. I didn’t need an x-ray or blood work to tell me what I already knew…the swelling on his brain from the cancer was now causing seizures.
He was toast, done, time was up and he was being called home. I could keep him in his body for a while longer with all my fancy medications. But at what cost? Is this what he really wanted. He was in no state to be asked so I relied on her.
Until I just happened to overhear the phone call.
The PA had just hung up the phone with the actual power of attorney. I was taken aback when she explained that in fact, it was the son he had willed his decision making to if he became incapacitated. She was astute enough to have him send the documents immediately.
The sheets of paper were still warm from the heat of the printer as I read his words. They were clearer than anything I had ever seen.
They were written in eloquent doctor lawyer language that I luckily could decipher.
“Leave me the fuck alone if I ever get to this point!”
There was a message from the son on the front of the fax to please call him for any medical decisions. I did just that.
After I introduced myself as the emergency physician, his voice quickly displayed pure gratitude for the call.
“Thank you for getting in touch. I live so far away that I couldn’t get there. Please don’t do anything to my father except make him comfortable. Hospice is coming tomorrow to help him die. His wife does not have the capacity to understand.”
This man who could no longer speak for himself had left the only one he could trust in such a dire time to speak for him. His son was a physician. In fact, he was a neurologist. He knew more about the brain than I did. But most importantly he knew his father’s wishes and he was determined to honor them.
After assuring him that his father would be made comfortable without any further poking, prodding or testing, I realized I had one last obligation. I had to have a real conversation with the wife.
Walking again back into the room, this time I sat down.
I pulled up the stool right next to his body and I looked into her frightened eyes.
“What have the doctors told you about his condition?”
She easily replied, “He has spots on his liver and brain from his cancer.”
“Yes, but what does that mean to you?”
She just looked at me. There was silence. His heavy breathing from all the remedies that I had administered was the only sound in the room.
“Do you understand that he is now at the end of his life? Do you understand that no matter what I do for him he is going to die?”
She just sat there looking at her husband.
“Do you understand that he has a living will and he does not want any of this. I’ve spoken to his son.”
That’s when she left her daze, “He won’t go against me. He won’t. I’m his wife.”
Then I asked her to do something. I had never done this before.
I asked her to close her eyes and imagine her body contracted, convulsing, in pain and unable to speak.
“I’m sorry but this is not about you no matter how much you are suffering. It’s about him and I know from his own words on the paper that he signed that he does not want to suffer any longer. It’s not about going against you. It’s about honoring him.”
Something happened that I see so infrequently. Her body relaxed. She started listening to me. We talked about hospice. We talked about helping him die. In peace, without pain, surrounded by love.
And that’s when I felt her. There was Cathy. Of course!
It was the beginning of May. It was brain cancer awareness month. It was also the month that my friend died of a brain cancer three years prior. And every year since her death she always sent me a brain cancer patient at the beginning of May. And here he was and I almost missed it because I was tired and overworked.
And then I got to take a breath and share Cathy’s story with this beautiful, scared woman. I got to tell her how Cathy lived life to the fullest every day. She fought for life every day. She inspired people. She inspired me. And when her day came, her husband held her in his arms as she took her last breath.
She died loving and living life.
I wish that for all beings on this earth. I also encourage you to make your wishes known whatever they may be. And choose an advocate who has the strength to carry them out even when it is difficult and not what they want.
It is the most selfless thing I have ever witnessed as a physician. We all deserve that in the end.
Namaste.
