Death is inevitable, but few people are ready. Even patients with terminal disease often find it hard to deal with their mortality. When I think about preparing for the end my thoughts return to a patient I lost a few years ago. My attempt to help him deal with his illness failed miserably.
He had been my patient for 15 years. He had a combination of high blood pressure and high cholesterol and he came in at least twice a year. Routine follow up appointments and the occasional illness visit led to a total of over 50 meetings over the years, so I knew him rather well. He worked in hotel security for a large hotel in Irvine. He did not earn much, only about $11 an hour. In spite of the relatively low pay he took great pride in his work. He often shared work stories, most of them concerned his efforts to protect the guests and provide a safe environment in a hotel with a limited security budget.
I developed profound respect for his character. He seemed to me to be a valuable employee, someone who always did his best. sadly it was one thing he never did that proved to be his downfall. He never quit smoking. He was diagnosed with esophageal cancer, a deadly form for which there was no cure. He fought hard but the disease eventually got the best of him.
I saw him frequently in the last few years of his life, on one occasion even driving him home when he needed a ride. I was on vacation in Florida when the phone call came that told me the end was near. He had been experiencing shortness of breath and X-rays revealed a fluid build up around his lungs. The fluid was drained and sent for testing which was positive for cancer cells, which meant that the cancer had dramatically advanced. So severe was the spread that the fluid needed to be drained every few days. There was no longer any chance that he would live much longer.
I called him on the phone and told him that the news was not good and that he was a very sick man. I asked him to come and see me as soon as I returned from vacation to discuss what this meant long term. He made an appointment for my first day back in the office and I told him the bad news. “This is bad,” I said, “there is nothing more we can do.”
He replied, “I am not ready to die.”
“I understand. But you will need to prepare for it because it is coming.”
“I refuse to accept it.”
“There is nothing more anyone can do. There is no treatment left. It is hard to accept, but you will have to.”
He got angry. More than angry. He was furious with me that I would dare to take away his hope. Convinced that I was uncaring and insensitive he left my office and went to the emergency room. He was admitted to the hospital. He died there less than two weeks later.
It was hard not to take his anger personally as I thought my genuine fondness, respect and concern were well established. Saddened that I had failed to connect as I had hoped, I took comfort in knowing that I had done my best.
As I reflect back on our final conversation I am reminded of how difficult it is to discuss death. I am also reminded of how important these discussions are.
Years ago I heard the President of the American Academy of Family Physicians speak on death. His observation that, “In spite of all of the advances in modern medicine the death rate has remained constant. It is still one per person,” speaks to the reality that we will all need to be ready someday.
For people of faith it seems that being ready is less difficult, perhaps because of the assurance that there is more life to come. Something to think about!
-Bart
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