Wednesday, March 14, 2012

The Last Four Weeks of Doctor K

Last month, the Wall Street Journal published an article called "Why Doctors Die Differently".  It begins with the story of Charles, a 68-year-old doctor who was diagnosed with cancer.  
But instead of taking the damn-the-torpedoes approach to fight the illness with his knowledge and excellent access to treatment, he chose to forgo all intervention.  He spent his last months with his family.  Charles knew all too well the reality of cancer, the limits of medicine to extend life, and the decreased quality that life would have.

Here is the story of one patient I had met in a hospice where I volunteer, a former convent where terminally ill patients are admitted.  At that time last year, all the patients were elderly and bed-ridden, fading in and out of consciousness on their daily schedule of being fed and cared for by the staff.  While I was at the bedside of one patient, I saw from the corner of my eye someone walk quickly past the doorway.  It was a young-looking woman, healthy, strong, and very alive.  And in a hospital gown.  But no wheelchair, walker, or oxygen tank.  I thought I had seen a ghost.

But it wasn't an apparition, the hospice was not haunted by any former residents hanging around as younger versions of themselves.  This woman was a patient, and she was herself a physician.  I'll call her Dr. K.  

Dr. K had been diagnosed with an aggressive form of cancer which had claimed her sister the year before.  "I don't want to go through what she went through,"  she explained. "I saw it all.  It was beyond pain."  As a physician, she knew her options, she had no false hopes.  So after her diagnosis, she closed her practice, sorted out her affairs, and when the cancer reached its advanced stage, she checked herself in to the hospice.  Her plan was to stop eating and end her suffering in four weeks.  

The hospice staff was gracious beyond belief.  They enjoyed conversing with a fellow medic, listening to her story, and accommodating her every wish. Visitors flowed in and out of her room.  Between her busy visiting dates, I talked to her during the first two weeks.

She was grateful to have all the cleaning, shopping, and personal care done for her; all the more time for her to spend with loved ones.  She talked to me about her career and her family.  But, with a level head and sharp intelligence, she also talked to me about the morbid subject of starving one's self to death.  Namely, she had not been sticking strictly to her plan of only drinking ice water with a teaspoon.  She had been eating occasionally; the human need to stay alive was too strong.  In fact, she said that to do it "properly", one had to take a strong dose of valium, close the door, and lie in bed all day, every day.

I don't know how much of her decline was due to refusing food or the inevitable progression of her cancer.  The third week came and I stopped by her room.  She was no longer in any condition to talk, drastically thin and visibly weak.  I pulled up a chair to sit with her in silence.  She turned her head to me, opening her eyes halfway.  "I recognize you," she whispered, placing her boney hand on my arm.  "I'm sorry, I'm very tired.  I can't talk right now."  

It never fails to impress me that people maintain their decency and politeness at the end of life. I told her there she didn't have to apologize, we didn't have to talk.  Her eyes slowly shut and she drifted into a reverie.  But I also knew that in a hospice, there is no coming back.

The following week, I went up to her room and saw that it was vacant.  The bed was made and Dr. K's belongings had been cleaned out.  I was amazed, she had carried out her plan on time.  She had done things her own way, calmly, serenely, and with no open ends.