Alaska

When I first met Mr. W, I understood only vaguely that his heart was no longer working well and that there was no medicine that could repair it. I was told Mr. W was alone in the hospital, having severed ties with family decades ago over disagreements about his substance abuse. The staff was worried about him having nobody to talk to—could a volunteer come by and sit with him for the afternoon?

Other than the regular beeping of monitors, Mr. W's room was silent. There were no visitors; there were no flowers or cards arranged at the bedside. Mr. W lay propped up on pillows, his gaze directed at the single tree visible outside his window.

I introduced myself as one of the hospital volunteers and asked whether he wanted any company.

“Have you been to Alaska?” he said, by way of answering. The shape of his mouth hardly changed at all while he spoke, as if any extraneous movement would have been impossible.

I responded that I had not.

“It was wonderful over there.” His words were slow and deliberate.

I learned that Alaska was a place where time had been plentiful, and life untroubled. Alaska was before the drinking, before the addiction, before the arguments and the fighting. Mr. W spent six years there, moving every few months to follow work in the mines. Though each job was temporary, he loved the independence it gave him.

“I'm trapped now,” he said, stopping mid-sentence to catch his breath. He gestured to his frayed gown, an unnaturally vivid blue against the pallor of his skin.

Mr. W became a different person in the evenings. One night, his eyes darted frantically around the room, fixating on fleeting, unseen shapes. He pointed to the angels hovering above the bedside. The following morning, after the confusion had cleared, he said the dreaded words for the first time—“I'm dying.” It came out as a soft, unsteady whisper.

I almost responded with “it's going to be okay,” but stopped myself. The phrase seemed trite and dishonest. What did I know about dying, to make such a promise?

“We're here for you,” I replied, sitting down beside him.

He looked at me. “Yes.”

And after a short pause: “Can you stay?”

Over the subsequent days, Mr. W ate less and talked less. Soon, he was too weak to use words altogether, and there were never enough warm blankets to bring the color back to his face. Mr. W was constantly asking for ice chips, which were the only thing that seemed to provide him any comfort. His breathing became erratic and disordered, and there were moments in which he seemed to stop altogether. He grew disoriented, his clarity waxing and waning until confusion irreversibly predominated.

There in that isolated room at the very end of the hospital ward, I met mortality for the first time, watching as it quietly unfolded before my eyes, strength yielding to vulnerability with each passing day. Now that there was little to be done that could restore Mr. W's former health, the energy previously directed toward seeking cures was now redirected to thoughtfully selecting therapies that would ease discomfort and minimize suffering during this time. And throughout this process, the presence of a reassuring voice and the simplicity of the human touch became the most powerful adjuncts to calm and comfort.

A few years later, in my medical school physiology classes, I learned enough to put Mr. W's story together. I learned the natural history of heart failure, the enfeebled heart causing unwanted fluid to flood the lungs. I learned that delirium strikes precisely when patients are at their most vulnerable—at nighttime, when they are alone and afraid. I even learned that Mr. W's unusual breathing had a medical term—Cheyne–Stokes, an elegant name for the slow-fast, slow-fast respirations appearing ominously at the end of life.

As I enter my last year of medical school, I realize that my most valuable lessons on doctoring came before I ever learned to use a stethoscope, before I ever learned how to diagnose symptoms or treat disease. Years before I understood the pathophysiology of Mr. W's suffering, I had the privilege of accompanying him on a journey where I witnessed the tremendous richness of the art of healing where algorithmic diagnosis and cure are no longer enough. Instead of fearing mortality as medicine's enemy, I learned that to heal in mortality's presence required the best of scientific and humanistic practice that medicine has to offer, a practice that acknowledges the fragility of human existence and ensures the dignity of a life fully lived.

Three days after he told me he was dying, Mr. W passed in his sleep. I imagine him escaping the four walls of his hospital room, fleeing toward the radiance of the Denali sunrise.