I used to live alone before I knew you

One of my patients is dying. This is not an uncommon occurrence in the realm of Internal Medicine. Internists tend to manage some of the sickest folks in the hospital. In fact, this is not the first patient I have encountered who is not likely to survive his hospitalization.

Yet, this one, I must admit, is getting to me. In medicine, there is an impulse to suppress these feelings, the sadness and frustration and despair that comes with seeing a patient dying. This particular patient is 66 years old, was just recently diagnosed with a bad, untreatable variant of cancer, and was admitted to the hospital because he had an infection in his abdomen. My team was consulted because of the infection, but soon thereafter, his bowel perforated and air started to leak into his abdomen. The surgeons have told him that he is not a good surgical candidate. No one wants to intervene.

So every day, I walk into his room and watch this man slowly lose his dignity and become even less comfortable. And this is a man who is clearly not prone to complaints. A retired police officer, he rode Harleys in his spare time. Every time his family is visiting, he says that his pain is not that bad. Every time I see him in the morning, when he is alone, he tells me that the pain is excruciating and he does not know how much longer he can take it. Because the infection is the least of his worries these days, I spend most of my visits with him asking about his life, the work he did, or the bewilderment he experienced on learning he had cancer less than three months ago.

Yesterday, when I left him room, I said, “it is good seeing you this morning.” It was nothing special, a fairly typical farewell.

He said, “you don’t know how good it is to hear people say that, it really means something.”

I managed to tell him that I really meant it, and then stormed out of the room, knowing I was about to lose my composure. I know all the reasons I was about to lose it. This man is dying, but death is a natural part of life, in my opinion. The problem, for me, is how much he is suffering, and how little medicine can do for him, with all our talk of advances and compassion. And I hate watching patients lose their dignity; it really squeezed the life out of me to watch a stoic, previously strong man lying weakly in bed, not at all ready to die.

And there is something else too, something selfish. You see, you would think that you see things like this, and it changes how you view the world. You would think you see a patient dying, you see the love of his family and the way that people rally around him, and you would learn something from that. You want to learn something from that. You want to conclude that life is short and that you should focus on the important things in life. You want to be enlightened, and have that new knowledge translate into the way you live your life. But it doesn’t work that way. Some of that is due to you, and some of it is due to everyone else in the world. Regardless of the reason, you are stuck knowing that life continues to march on and you’re not applying any of the lessons you are supposed to be learning.