“I will catch you on the flip side,” I said these words as I planted a kiss on Laura’s clammy forehead. I instinctively knew this would be the last time I spoke with her. I walked around the foot of her hospital bed to Sherry and told her not to get up as I bent over and gave her a big hug, the kind where I buried my face in her sweater. I smelled her laundry detergent, and she cried and shook in my arms. My contorted back hurt in this position, but I stood there and felt her tears drip down the side of my neck. Her earrings jingled as she sobbed.
I had known for days that Laura was in her final chapter. Each day, I added another layer and tried to get the family ready. “I’m worried that these spots on the CT scan—the ones right here—are, in fact, cancer.” I had said this a week ago, which was my unsubtle way of saying that I knew it was cancer and they soon would know it too.
Even before I had the biopsy results, I pushed the conversation forward and took CPR off the menu of possibilities. “Let’s do plenty of things, Laura, and treat your pain, anxiety, trouble breathing—let’s take care of those—but let’s not try CPR, or go to the ICU.” I said this on Monday at the bedside, a conversation which involved a supine Laura and her shell-shocked husband, Chuck, who was bent forward on the edge of his chair. I didn’t pose this as a question, more like I delivered a somber declaration. These words hovered in the silence, and I stared at them until they nodded.
I repeated the words “comfort” and “goals,” and talked about a process, one where I would help and be present. I had always known I would be the narrator in this story, and now they knew too. For fifteen years I had been Laura’s doctor, and she had enough chronic problems that I expected—hoped, really—to be present when her death arrived. There were so many hospitalizations, tears, and disappointments before this day.
Adult children arrived the following day, and I took extra time to answer their questions and previewed the looming cataclysm. I repeated words about comfort and gratitude—for them, their questions, their presence. They looked so surprised, shocked in a way that was both unique and, at the same time, exactly like every other sad family in my hospital. I had once been that family member, and I knew the glazed-over expression, the blank stare, the thoughts and words that never seemed to come.
By the time Hospice staff came to the second floor, Laura’s family had accepted what was coming, which was a huge relief to me. I don’t judge family members in these situations when they protest and grasp for “just one more treatment,” or, “Can’t we try that surgery?” While understandable, could I remember even a single instance when any of those treatments made a difference in the outcome or led to more quality time? I was relieved for Laura that I wouldn’t have to spend precious emotional energy guiding such pointless discussions.
Two days after she left the hospital, Laura died in her home, as she wished. And I felt good about this, knowing that I had honored what she wanted. Like so many other patients, I wished there had been more peaceful days, but I stopped grieving long ago for those lost opportunities, knowing that most of my patients had to get sick to the point of hospitalization before they contemplated end-of-life choices.
I didn’t cry a single tear when Laura was in the hospital, which was the expected result of being fully in the zone and present in the conversations described above. Somewhere during my career, I claimed moral leadership in the painful, sad, and desperate situations of my patients and their families—the ones that required me to slow down, tell the truth, and not cry. When I pushed myself into this frame of mind—no, state of being—I went to a place that is the opposite of the mushy, tender-hearted, cry-in-the-movies man that I, actually, am.
These emotional gymnastics are complex and awkward and, I am sure, I get many things wrong each time I twist myself into this unnatural pose. I know that someday I will cry for Laura, and it will probably be a random Tuesday when I am by myself and no one needs me. Or maybe I will be blind-sided while pumping gas, or some other pedestrian moment. At that time, without armor, I, too, will think of her sweet smile and all the conversations we had about diabetes, rheumatoid arthritis, professional wrestling, and the meaning of life. I too will remember how much I love her.
Ryan McCarthy is an internal medicine physician.
