Friday, August 3, 2012
Like A Moth To The Flame
Bob's on a PCA pump. His bone marrow transplant failed.
I gulped. Patient controlled anesthesia? In the nursing home? She continued to deliver the bad news.
A percutaneous gastrostomy tube was placed yesterday. He's a full code. His next chemo is scheduled for a few weeks.
I marveled that such a patient could be transferred to the nursing home without a courtesy phone call from the discharging physician. Even a thorough review of the medical records would not convey the nuances of dealing with this amplitude of complexity. Before entering Bob's room, I tried to connect with his oncologist. The nurse kindly informed me that he was out of town and unreachable.
It took only moment's to realize that Bob was dying. His young frame was battered by the ravages of cancer and multiple unsuccessful medical treatments. The only evidence of his youth remained in the sparkle of his eyes. I pulled a chair close to his bed and we talked.
We talked of his hopes and dreams. We discussed futility and the risks of over treatment. We lamented that he had no family members to comfort him. I told Bob, in no uncertain terms, that he was dying, and that the price of prolongation of life would be quality. I said these things as I had done so often before. My voice was strong and unwavering. I watched the emotions pass across his face. They were a mix of anger, sadness, and acceptance.
By the time I left, Bob had signed a DNR form and agreed to avoid hospitalization. The hospice team would see him soon. I titrated his narcotic dose generously.
Bob died a few days later. His passing was peaceful and quiet.
Sometimes I wonder why I don't turn away from the sadness like so many other physicians. I have never been adept and building such walls. Instead, I watch as the flames engulf my defenseless skin and leave gaping welts.
There are weeks like these when I feel I have become an angel of death. But in my heart,
I hope I'm more like an angel of mercy.
Posted by Jordan Grumet at 9:41 PM