One of my favorite patients died last week.
My reaction to this was not quite what you would think: I smiled. No, I didn\’t smile because of his death; I smiled because of his life. I smiled because I got to be a part of that life. His death wasn\’t his tragic end, it was the exclamation point to his life.
I am around a lot of death – it\’s one of the things that makes being a doctor different from other jobs. My goal with all of my patients is to keep them healthy, to relieve their pain, and to do my best to keep them alive. Ultimately, though, it\’s a losing battle; 100% of them will eventually die. That\’s why I don\’t like statistics about how many people who die due to inadequate doctoring. Our job is to resist an irresistible force. We are standing up to the hurricane, the avalanche, the flood.
If you only measure a story by its ending, we all live a tragedy. Even a belief in life after death doesn\’t remove the loss death represents. (I often have to remind my Christian patients that even Jesus wept because of death). But being around death has also taught me that even seemingly tragic deaths aren\’t always tragedies. Sometimes being in the presence of the dying isn\’t sad, it\’s inspiring. Sometimes I consider myself lucky to be with them. Sometimes it\’s an honor to be their doctor. We don\’t always stand against death, sometimes we get to stand with the dying.
My relationship with this patient started without distinction. He was a few years younger than me, worked with his hands, and was generally healthy. What made him different was his ever-present smirk. He was subtle and soft-spoken. It took me a few sentences\’ delay for me to catch a joke he had slipped in without drawing attention. I\’d stop, smile, and his smirk would grow.
Then things started happening. He came to me with unusual symptoms, and after running tests I still was without an answer. I sent him to specialists, and they couldn\’t explain his symptoms either. His symptoms worsened, and he started missing work.
Eventually his picture clarified, and the news was not good: his condition was progressive and untreatable. It was also rare – the kind of disease that happens in people three decades older than him. It\’s not supposed to happen in young, healthy men.
It was a tragedy: a man in his prime with a family is stricken with a disease he \”shouldn\’t\” get. I added him to my list of people I am going to ask God about. Why does this kind of thing happen? He should be living a long and healthy life, but that choice wasn\’t given to him. He just kept getting sicker and sicker from a disease he shouldn\’t have had. As time went on and as the disease progressed, the situation became clear: he was dying.
Standing helplessly while someone you like dies is usually hard. The visits are uncomfortable and quiet, and I get a sinking feeling when I see them on my schedule. But he was different; it was as if nothing had changed. I never saw him sulk, I never heard the word \”unfair,\” and I still had to listen carefully for the subtle jokes. When many would have been angry, frustrated, or depressed; he just smirked.
His attitude was infectious. His wife never complained either. I was always happier after his visits, and so was my staff. Eventually he came to the office with a skilled nurse, and they were always smiling.
His death was not a surprise when it finally came. But what did surprise me was my response. I will miss him and his smirks and subtle jokes. I do wish he had lived out a long and healthy life. But he is no longer on my list for God. He lived better while dying than anyone I have seen. He inspired me, my staff, and anyone else fortunate enough to cross his path. It was the fact that he was dying that made his life so remarkable and how he faced that fact that leaves me richer.
Perhaps we shouldn\’t ignore death. We are all dying, yet we always seems surprised when it happens. Maybe we need to follow my patient\’s lead and die well. He didn\’t ignore the obvious, complain about what\’s normal, or bemoan his bad luck; he faced his end as he faced the rest of his life: with a smirk.
That was great!
I had a BIL that was the same, minus the smirk. He had cancer and initially treatments were going great. But he started getting worse about a year into his battle. I think one of the greatest things he did was hide how bad he felt until the day after his youngest child left for college in another town. I think he was afraid she would want to stay if she knew the truth.
He taught me a lot about dying, with dignity. He & I sometimes talked about his dying and him not being scared. I'm not sure anyone else talked about it, his immediate family was sure, until the very end, that he would beat it.
I even found that initially I was not sad that he died. That did change as I missed him a lot.
Thank you for that post-I loved your comment that “We don’t always stand against death, sometimes we get to stand with the dying.” I once had that priviledge. A certain young man I knew was mentally challenged-he seemed to know about 6 weeks before that something was going to happen because he would pack up all his belongings several times a week & tell his caregivers to “take them to the goodwill-I don't need them anymore.” They would patiently unpack them & put them away again. Then the big day came-I was called to the hospital where he had already been taken. He was calm & chattering away in his usual cheery way about all his favorite things in spite of the pain. When I went to get him some more pain meds, he grabbed my hand & told me, “Don't leave me-I'm going to die today” I reassured him, & he kept insisting he was going to die today. There was no fear-just a strong conviction that today was the day. Sure enough, about 8 hours later, I was standing by his bed with other family members & friends-we sang all his favorite hymns & Bible choruses to him as he went home to be with Jesus-as confidently as he had lived for Him. It was a precious night I will never forget, & death will never again hold fear for me because of this unique young man. I'm glad I had the priviledge of calling him my son for 21 years.
That was a beautiful tribute to your patient. He did die well. he must've been a strong person too.
It must be so hard when you have to deliver the news, but your patients are fortunate to have you because you are sensitive to their situations and genuinely care. they can feel that and it is reassurance through the storm.
You were obviously blessed by this man too.
Death is a surprise. we all know about it..but I guess because we're never ready ..not really to die or lose someone.
Test post. I got nothing on this, but I'm suddenly being described as a “guest”. Maybe this will sort itself out, but it also means I'm having problems reading comments on old postings.
Ok, registering with DISQUS seems to have got some of that, but I've had to change my posting name from KenO because they already had one
Sorry to do that. I am impressed by the options that Disqus gives, but I do see that the old comments are not showing up. I am going to try to fix that.
Thanks Dr. Rob. This is the one year ann. of the end of life celebration. You are my kind of doctor and so is your staff. Thanks for caring about us before, during and after death of loved one.
Good perspective. Working as a nurse, I don't have the opportunity to get to know the patients at the level the primary care provider does. I know my doc rather well, as I was the ED charge nurse on midnights when he was a med student. I waited a few years (my doc of 30 years died while I watched his heart on the ICU monitor system while working in the ICU), and went for a visit. We get along extremely well, and he is able to remember personal details that add to the office visits…frequently we get off topic! He has the unusual double specialty of family practice and sports medicine…that works just fine for me. It's a good relationship for both of us, I think.
Thank you, Sandie, for the way you told of your son's death. I was privileged to be a part of his life as his adopted aunt and was also privileged to be there when we sang him into Heaven. The way you wrote his story was wonderful. Thank you for sharing with all those who see this page that death doesn't have to be feared for those who know the Lord Jesus Christ as their personal Savior. Your son was not afraid because he was ready. As some would say, “Your son and Jesus Christ were very tight.” My life is different because of your son's life; just as Dr. Rob's life is different because of the life of his patient. I thank the Lord for people like you and your son who have had a positive impact in my life–even in the face of death! –mh
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This is EXACTLY what I have been trying to say! On July 3, 2009, I sat at the bedside as a dear friend passed away. I've always said to anyone who will listen that being present when someone passes into whatever comes next is one of the most powerful events you can ever be witness to/part of. My friend's death was gradual and in the end not pretty. When I think of my friend I am able to smile from the lessons he taught me, even while he was dying. Life is 100% fatal and death doesn't have to be tragic. Death is my life!
This is EXACTLY what I have been trying to say! On July 3, 2009, I sat at the bedside as a dear friend passed away. I've always said to anyone who will listen that being present when someone passes into whatever comes next is one of the most powerful events you can ever be witness to/part of. My friend's death was gradual and in the end not pretty. When I think of my friend I am able to smile from the lessons he taught me, even while he was dying. Life is 100% fatal and death doesn't have to be tragic. Death is my life!