In Memorium

I loved him as far as patients go. He was warm, and friendly, and needy. His thick accent always pleasant. Often he spoke in a mix of languages, intertwining one with another. Some I understood...some I didn't. His culture was different from mine. But very respectful. Physicians were held in high esteem.

The diagnosis was horrendous and of course the expected lifespan was short. Often he circled life's drain but usually found away to pull himself back. Long ago he had entered hospice but the truth of the matter was that I never completely accepted it. At least not emotionally.

He had been doing poorly for the last few days. I tried the few tricks that usually worked. Then I got the call this morning that he took his last breath and died..... just like that.

And as per usual I feel a great tinge of sadness and guilt. If I had done something different. Been more aggressive....been less aggressive. Could I have managed things better?

I picked up the phone to call his wife today. She said that she saw him last night. That his stroke induced garbled language cleared for a few minutes and he became very aware. He told her that he was dying and then preceded to give her a series of instructions. Then he said goodbye.

And so he died. And now I sit at my desk and try to discern what I learned from him.....

Maybe as physicians we give ourselves too much credit. That this strange dance of monitoring, measuring, and tweaking is all for naught. That maybe those who are going to live....we help recover faster. And those who are going to die...we help prepare for death.

And sadness, guilt, and blame are all just crutches we use to help maintain the illusion...

that we actually have one iota of control over our lives.