Two Days

He called me in late October and told me he was done. The treatments weren't working. The pain was unbearable. His kidneys were starting to fail and he refused to go through dialysis. Maybe one day I'll forgive myself for my selfish response when I begged him to keep trying and asked him how he could give up on us so easily. I still hate that I used those words. I hate that I even suggested that any of this was easy for him. I had been instinctively optimistic, struggling to instill in him the hope I had programmed myself to feel. As a future physician I felt responsible for offering that hope and possibility of recovery. Yet, at that moment all I could feel was fear and anger. I was terrified that his weakness would cause me the worst pain imaginable. I felt that he thought I wasn't worth fighting for, and that stung me to the core. I berated him with all of these emotions. That I will always regret. But I've learned that in times like these, our feelings tend to get the best of us. I think he knows that too.

Things happened so quickly after that terrible conversation. Within a few days, I got an even more horrific call saying to come home quickly. This is when it finally hit me that my father was dying. I was on a plane the next day and while I was about to board the connecting flight, my phone rang again. My stomach dropped to my feet. All I could think was of the worst. I was too late. In a way, I was. It was my stepmother telling me the doctors wanted our approval to send him to palliative care where he had a prearranged room waiting. She said, “I need you to tell me it's okay. I need to hear it from you that it's the right thing to do.” Looking back now, I guess I didn't have much of a choice, but at the time it felt like I was making the hardest decision of my life.

When I finally got to him four long hours later, he was sleeping. I had expected to see him propped up with a newspaper open to the local property transfers. I thought he would welcome me with the usual “Oh I didn't know the so-and-so's moved across town!” On the contrary, I was told he hadn't opened his eyes or responded to much all day. I longed for the days when he lit up the room with his animated stories and infectious laugh. His thick black hair had been replaced by a pale bald scalp. His cheeks were sunken. He didn't look like my dad at all. He was so small and frail, and he had a big bandage on his neck from his two dialysis treatments. I felt guilty about that hole in his neck. I knew he had decided to go through with dialysis after our phone call. He had done it for me. When I told him I was there, he opened his eyes. He gave me a weak hug and teased, “I put in my own catheter.” He was always trying to impress me with his medical knowledge, aiming to make the future doctor proud. I had thought I was about to have the dreaded “goodbye” conversation, but instead he chose to keep the moment light. I laughed until I cried, and I cried, and then I cried some more.

The nephrologist told us it would be two days before his kidneys failed, and that would ultimately shut down the rest of his body. We had just two more days with him, which was not enough. We wanted more time to say goodbye. More time to tell him how much we loved him. We wanted more time … until day two. I never knew how exhausting it is to wait for someone to die. All of my thoughts were conflicting. I was constantly on edge. His breaths got further and further apart, and many times we jerked forward because we thought he had passed. But then he took another gulp of air and we would fall back again on the couch. I worried that I was wasting precious time with him when I stepped out, but when I was sitting with him we really weren't spending time “together,” were we? What was the difference in having him there physically with no response, as opposed to him being gone? I couldn't imagine the thought of losing him, but in a way I already had. I refused to read the infamous “blue book” of dying, because I couldn't bear to know what would happen next. I was at the crossroads of wanting to know everything while also wanting to know nothing. I wanted to hold onto him forever, but I found myself hoping it would just end so I could be done with this.

I remembered what my father had told me a few months back, when he said that we were praying for different things. While I had been praying for a cure, he was praying for it to be over. At the time, it had made me so angry that he would say that, but now I finally understood. Now I was accepting that it's all right to pray for death when medicine clearly held no answers. I learned that the needs of the patient come first. A doctor's goal can't be just to see how long you can delay the passing. That becomes meaningless if you can't even ask how the patient feels if all the pain medications have left him virtually lifeless.

Although the subject of death is taboo to most, a doctor must discuss it with a cancer patient and his family. While it is important to instill a sense of hope and optimism, we must make sure that death goes right when healing goes wrong. Every physician wants to be there for the success stories, but we must also be there to ask the questions that everyone else is too afraid to address. Patients and their families hang on to the possibilities offered by the oncologist. We need to be prepared for the moment when those possibilities run out. We cannot overlook the significance of palliative care. If death does win the battle over life, it has to be managed in a way that makes the patient comfortable.

I watched my father die right before my eyes. I know what it is like to witness a life ending, to see the decline to that final breath. I would give anything to have my dad here, teaching me more old family recipes and watching National Lampoon's Christmas Vacation on repeat. I long for his lectures about always keeping my spare tire inflated and turning the lights off when I leave a room; the constant boasting of his perfectly mowed green grass and pristine garage. I miss everything about him. I wish he could be here to watch me fulfill my dream of becoming a physician. I would be lying if I said I understood why he had to leave so soon. But the ending of life isn't a complete tragedy. Death can end suffering. My father taught me that. And I know that realization will shape me into the physician he would be proud to call his daughter.