Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I failed to appease pain during her life, so she died terribly

James C. Salwitz, MD
Physician
July 8, 2013
Share
Tweet
Share

Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer had always given Ellen no chance to survive.

Futile, painful, invasive and abusive medical care occurs frequently in the lives of oncologists and intensivists. Often doctors communicate badly or the family has so little experience with dying that they are unable to cope, unable to make decisions and cling to pyrrhic fragments on a yellow brick path of barren hope. However, Ellen’s case is different and reminds us of the ability of the past to intrude on the present and the effect of guilt on decision.

In 1963, Ellen was given in a prearranged marriage; she was 16. She moved to the United States and raised five children, who in turn begat eight grandchildren. She worked hard and had a successful, if relatively simple career, as a checker and then manager in a local market. Instead of happiness and fulfillment, Ellen was cursed for five decades with mental and physical abuse in the hands of a misogynous alcoholic husband, who coped by hurting her. Ellen survived because of love for her children and commitment to their happiness and safety. For Ellen, because of her culture and her responsibility, leaving was never an option. In the words of one of her daughters, “she had a terrible life.”

Last year, “the monster finally did something right, finally helped her … the SOB died.” After half a century, she had a quiet home and family that loved her. At age 66, there was the chance to live in peace and safety. It was at that moment she coughed, and Ellen began to die.

As cancer ripped through her body, this family could not let go. It was so unfair, a cosmic cheat. If ever their god owed a miracle, it was now. But no deliverance came. The disease destroyed Ellen, piece-by-piece, organ-by-organ, moment-by-moment, pain-by-pain. Her kids, always at the bedside, clung to hope born not of ignorance, but of righteous anger built over 50 years of torment. The same way they had gotten by for all those decades, praying and hoping their father would be kind or simply drop dead, they begged now for another chance for Ellen and perhaps for each of them. They hoped for mercy and life; redemption for years of agony.

There was no happy ending. I failed to appease their pain during Ellen’s life, so she died terribly. In the sullen cramped hot funeral home, they stared blank at a sealed casket, trying to fathom what had been lost, guilt made brilliant by the confusion of those last days. Unable to repay the sacrifice of many years, her children found no meaning, her headstone a monument to loss built of suffering. Perhaps, the only gift was all of them, five children who loved Ellen, loved each other and preserved a few precious memories.

Outside, grandchildren played in the snow.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

Prev

It's hard to grasp the experience of being a patient

July 7, 2013 Kevin 11
…
Next

Declining board exam pass rates: Blame millennial doctors?

July 8, 2013 Kevin 21
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
It's hard to grasp the experience of being a patient
Next Post >
Declining board exam pass rates: Blame millennial doctors?

ADVERTISEMENT

More by James C. Salwitz, MD

  • Each line on the radiology list is a patient’s line in the sand

    James C. Salwitz, MD
  • The broader mission for hospice care

    James C. Salwitz, MD
  • Is the medical profession at its end?

    James C. Salwitz, MD

More in Physician

  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • How regulatory overreach is destroying innovation in U.S. health care

    Kayvan Haddadan, MD
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 20 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why point-of-care ultrasound belongs in every emergency department triage [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why PSA levels alone shouldn’t define your prostate cancer risk

      Martina Ambardjieva, MD, PhD | Conditions
    • How to handle chronically late patients in your medical practice

      Neil Baum, MD | Physician
    • Reframing chronic pain and dignity: What a pain clinic teaches us about MAiD and chronic suffering

      Olumuyiwa Bamgbade, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • Why medicine must evolve to support modern physicians

      Ryan Nadelson, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I failed to appease pain during her life, so she died terribly
20 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...