Dear Mrs. J,

I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together in the nursing home, and she would reach out to hold my hand. She was a gift, your mother. A gift that I in no way deserved.

I’m sorry she got cancer. As a physician, there is no word worse than the word “metastases.” It not only creates fear in the hearts of our patients but cleaves a chunk out of our souls. We are never as hapless in our calling as when we admit that we are mere unarmed foot soldiers in the face of this raving beast. We are not helpless. We can comfort and palliate. Cure, however, becomes an ever-increasing implausibility.

I’m sorry that your mom experienced pain at the end. Lying in bed in the nursing home, she somehow mustered a smile through the groans as the nurses and I passed through the room. She told me that she didn’t see the point anymore. We discussed the risks and benefits of morphine, and I dutifully wrote all the orders.

Most of all, I’m sorry that YOU stormed into the room that morning and ordered the nurse to stop. That YOU somehow convinced your mother — in the last hours of life — that she would get addicted to morphine. That YOU screamed at her for not participating in physical therapy the day before because she was far too exhausted. And I’m sorry that she saw you and I arguing in those last precious moments when you should have been sitting at her bedside, holding her hands, and sobbing.

Your mom is now at peace. She will suffer no longer.

I know that you meant well. I am all too aware that the next few years will be excruciatingly hard as you try to work through loss and maybe even come to terms with the fact that you willfully denied your mom a peaceful death. There was probably much sadness, denial and guilt that led you to make such decisions.

I am no longer angry.

But I’m sorry that I will not be able to be by your side during this arduous journey. Because above being a doctor, I am an imperfect human being and far from above it all. I am right there in the muck with you.

I cannot help you at this time.

Frankly, I’m still too disgusted.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of I Am Your Doctor: and This Is My Humble Opinion.

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