“Doctor, I am ready to die.”

I knew her from a few years back. This patient of mine.

I am a hospitalist and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different.  I saw her once many years ago when she was gravely ill, and we managed to pull her through and she survived. Because of that we never forgot her, and she remembers me. At that time, we found a cancerous lesion in the lung but she did OK and was discharged home.

When she came back years later to the hospital, the cancer has spread this time, and she is sicker. She was proud though, because she did make it this far even though her oncologist told her she only had six months to live. It’s been two years and a half. And yet, the cancer ravaged on.

Now she is dying.

I came to her room. From afar, you could tell she is short of breath. I told her how the cancer has spread and caused fluid in her lungs to accumulate making it hard to breath. I explained our options ranging from doing invasive procedures to non-invasive care including comfort measures and letting nature takes its course. She waited patiently for me to finish. Then she smiled and said:

“Doctor, I am ready to die.”

I said, “Are you sure?”

“Yes.”

I proceeded to explain to her what we can do to help the transition go painlessly and smoothly, to allow death as comfortably as we can. She listened attentively, nodding her head in agreement. She asked that I not tell her husband. “At least not yet,” she said. “He does not have the strength to hear those news.” I acquiesced and promised to honor her request.

Later that day, I came back to see her because I knew the husband was coming to visit her and would ask for me. I explained to her husband as best as I could what the plan would be for the next few days. I did not mention the words “death” or “dying” but used words like “comfort measures” and “supportive care.”

As I kept explaining to the husband the plan, I kept looking back at my patient. In my patient’s eyes, I saw courage, and fear too. And yet, I saw more of courage. I felt her uneasiness as I was talking to her husband, fearing that I might slip my tongue and break my promise. But I did as she asked.

I stooped down to her and hugged her as tight as I could, knowing that it probably is the last one I will ever give her. I planted a soft kiss on her cheek. She knew. She could tell that I was ready to break into tears but was just holding out. She kept smiling. Her eyes were telling me that it’s going to be OK. I said goodbye.

On my way out the door, I told her that I will be off the next day and won’t be back till next week. I explained that someone will take over tomorrow and carry out the plan we discussed.

My last words to her were “I will see you again.” I lied. I won’t. Not in this physical life. She understood. She smiled.

I left the room and went straight to the bathroom to be alone. I cried unabashedly. I barely knew this woman, but I cried like someone close to me just died.

I do not know why though. I am not sure why.

I never even discussed with her what she believed about death and dying. Most of us physicians do not even venture to ask patients what they believe — let alone discuss our own beliefs — on what happens after we die. We swore to preserve life, and we are the superheroes who save patients from the throes of death. And yet, we cannot even discuss death with our patients. With ourselves. Death who is our sworn nemesis. The enemy we do not even understand.

What is death? Is it just an illusion or a metaphorical doorway, and we actually continue on living afterwards as what most religions of the world say? Does consciousness persist without the body, or does it cease to exist ones the body dies?

I was religious in my early years but outgrew it. Nowadays, my system of beliefs and understanding about life (and death) is based on experiential knowledge that to me is subjective, but at the same time very personal. I would rather have that than believe in truths that others believe just because they were told to do so. When it comes to death, however, how does one experience it and live to tell the tale? Wouldn’t that be the ultimate experiential knowledge on death? One agnostic neurosurgeon, Dr. Eben Alexander III, heroically published his near-death experiences in a book entitled Proof of Heaven and seems to have been lucky enough to have had some personal experience on the matter. Not all of us are that fortunate.

So why was I crying? I still do not know.

Is it my humanity showing through in this materialistic and dualistic world that knows life and yet sees death as nothing but an end? Is it a lack of conviction about life beyond death? For if we know with certainty that we exist beyond dying, what is there to fear? What is there to lose? Did I cry because I was so conditioned that death and dying is a bad thing, when in reality it is not? Or am I just projecting onto the situation some underlying fear or loss that needs to surface?  Did I cry because here in front of me was a brave woman, afraid of the unknown, and yet ready to face it alone with calmness and great courage.  Or did she awaken my inner compassion, the one that makes us human?

I stopped thinking and just kept letting the tears flow. And they flowed till I was empty.

The author is an anonymous physician.