Mark vs Cancer

Wednesday, June 25, 2008

Waiting for the End

I have a very pleasant patient who is slowly dying of end-stage emphysema. He is on very high levels of oxygen and a number of medicines, but there is no cure for his condition, no remedy that he is willing to consider. He will continue to experience a slow decline until he finally succumbs and dies.

I've been caring for him for the past twelve months, when I inherited him from one of my partners. Yesterday, he came to see me again, feeling generally miserable, short of breath, and utterly fatigued. We discussed his specific symptoms, which all revolved around his incurable underlying condition. Finally, his well-meaning, relatively healthy, and somewhat frazzled wife cut to the chase.

"Doctor," she asked, "how much longer is this going to last?"

"You mean until he feels better?," I asked.

"No," he answered for her, "she means how much longer until I'm going to die." He spoke this final word with impatience.

I paused for a bit, collected my thoughts, then said as honestly and compassionately as I could, "I don't know. It is very difficult to tell in these cases." They looked at me expectantly. "Based on where you are today, I would say probably six months to a year." I waited for a response.

"Six months?" His wife gave an exasperated little half-chortle. "That's what they told us two years ago!"

We all laughed at that for a bit, at the absurdity of living a life in suffering with the sole purpose of waiting around until one day you finally die. This sort of situation invariably raises the spectre, in my mind at least, of physician assisted suicide. First of all, it's illegal. But that doesn't mean necessarily that the idea is wrong. In fact, in specific cases such as this one, it is very hard to argue against it from a medical ethics point of view. (That may come as a surprise to some, but medical ethics is full of shades of gray, and because in our western medical-legal paradigm the principal of autonomy typically trumps all others, it is hard to build an argument that would preclude a rational patient with an incurable, agonizing disease to voluntarily take their own life.)

But this encounter did not devolve into an esoteric discussion of medical ethics. Rather, this was pragmatic, a patient suffering who wanted some sort of reassurance or comfort. I felt compelled to morph into Missionary Mark, to share in a non-denominational way some of my personal religious convictions, as I will sometimes do when religous patients come to me for comfort, and medicine has nothing else to offer.

I suggested to him that God appoints our times and seasons, when we live and when we die, and that the fact that he's still alive must mean that God still has some purpose for him. I encouraged him to try and view each day as a gift and to find meaning in it, even if that was only holding his wife's hand or writing a letter to a grandchild or appreciating a flower.

Then I raised my hands to the heavens, shouted "Hallelujah!" and asked him for an alms.

Not really. But I did feel some sort of spiritual inspiration, and my patient and his wife were noticably moved.

He will still suffer physically and emotionally, will likely die within the year, and I'm under no false pretense that my one minute sermon will dramatically affect his end-of-life care. But I did have a feeling of satisfaction that, rather than offering lethal doses of morphine, I was able to offer my terminally ill patient words of comfort and perspective.


Kristen said...

I am sure they really appreciated what you said. I can't imagine how that would be. Good job missionary Mark.

Tankfos said...

That is an all around tough situation. It makes me think of the Phenomenon when the doctor is asking him if he can operate on John Travolta's brain and John says something like, "I just might have something to say with my last breath."

Angie said...

Wow. That's tough. Way to go for thinking of the right thing to say just when your patient needed it. I'm sure it really did help when nothing else would have. You're a great doc.

Angie said...
This comment has been removed by the author.
Jeff said...

I think I might have met this patient. Thanks for you thoughts

princess jen said...

I'm glad you were able to offer some sort of reassurance to your patient. However, I wanted to comment more on physician assisted suicide. I think the physican should have the option of prescribing lethal doses that the patient can then choose to use or not to use. I believe in death with dignity. After working at a skilled nursing facility (pc for nursing home) for a year or so, I saw too many patients with no quality of life whatsover, just trapped in bodies that have let them down.

JOYce said...

Your comments left ME comforted. I am another one of your patients. I live with pain every day, every hour. During the more difficult days, I have asked the Lord just to take me home, PLEASE. No one else can know or fully understand (unless they live with pain, too) how very difficult it is to live with pain all the time. And, it isn't just the pain. My church community knows I have pain. I really am at a loss for words when folks ask me "how are you doing?" I don't think they really want to hear (every time)..."Oh, I am hurting, as usual". Each day I try not to let my pain rule my day. Most of the time I succeed. I try to get my mind off myself and tho' I still know the pain is there and limiting me, I FOCUS on doing something for someone else. That helps me as well as them. I appreciate your thoughts and discussion on medical ethics. I agree with Missionary Mark, that God will call me home when HE has planned and that any days I have left until that time, are meant for me as a gift and for me to reflect HIS glory.