Abstract
J
I was on psychiatry that December and had been called up to the fourth floor for a consultation regarding this unfortunate man: his distant history of substance abuse, of major depression, and his most recent diagnosis. As it turned out, the numbness he'd been feeling in his legs, along with a pesky cough and the unshakable malaise that had kept him on the couch for the better part of December, had all arranged themselves into a dark constellation of symptoms. In one day, in an afternoon, they had come to be called metastatic stage IV nonsmall cell lung cancer.
I made my way to his room. Afraid. What if he starts crying when I get in there? How should I introduce myself? I could hear it now, my own chipper, anxious voice breaking the silence in his room, “Hi Jack. My name is Student Doctor L. How are you today?”
I didn't imagine he'd be doing very well.
I stood outside of his room, thinking a 1000 thoughts. I contemplated the 100 or so ways I might make a fool of myself, or of this dying man, as I interrupted his morning to fumble through his fourth H and P of the day and I thought back to a second year clinical skills class—a Breaking the Bad News laboratory we'd done in school. I remembered being expressly told to avoid euphemisms at times like these. That made sense to me. I remembered something about the importance of reflective listening. I practiced saying the word cancer in the hallway outside of Jack's room. Cancer. I practiced my introduction. I took a deep breath and chewed nervously on my lower lip. And then, despite my own practiced efforts of avoidance, of distraction, it hit me. My past swelled up and entangled itself with the present. It left me aching, confused, and stunned like a grade school kid hit unexpectedly in the head by a foul kickball at recess. I fought back tears and struggled there in the hallway with the dissonance of wishing that my own memories of loss could at once be both closer, more vivid, more real, and further away.
When I was a freshman in college, my boyfriend, Tim, died of melanoma. I dropped out of school in the fall, and came home to be his way-too-young-and-hopeful caregiver. I spent the years before he died, wishing and hoping and praying away his disease with all my might until it took him, that lovely green-eyed boy who wanted so much to be alive. It surprised me often how the seemingly mundane quirks and idiosyncrasies that made him mine once could come so quickly rushing back, could pierce so sharply into focus in my mind spurred on by the most unassuming triggers. It took nothing sometimes to recreate the perfect memory of his guitar-string-calloused fingertips gliding across my cheek, of the oddly focused way he stirred a cup of carnation instant breakfast at the kitchen table. These details rose to mind, as unwelcome in the workplace as they were, in razor-sharp perfection, from their places tucked neatly away near the choking-back-tears center of my brain.
When I walked into Jack's room that day, I held a pad of paper, a pen, my stethoscope, a great deal of empathy, and a little bit of experience. Or baggage—depending on your perspective. For better or worse, I carried Tim with me, as I do and have done, to varying degrees, every day since I met him. I sat down with Jack, this new consultation of mine. I fought back the conjured memories of Tim. Jack looked sick and tired. He attempted a smile and I asked how he was holding up.
Jack was a 44-year-old man in flannel pajama pants whose patchy black beard only half-hid the baby face lying beneath it. His chart, much like that dark façade of facial hair, postured a flimsy hardness that quickly gave way and left in its wake a truth about him that was soft and kind and innocent. I performed his fourth admission H and P of the day and just like that, Jack was in my life.
As a medical student I knew that I was afforded the luxury of time and with Jack's name added to my morning rounds list, I took full advantage of my station. I was on psych and in no way in doubt of the benefit inherent in a 30-minute conversation with a lonely man who had nothing much more to do than think, among other things, about his own mortality. So, I got to know Jack. He had two kids and loved them dearly. He was just learning, with some difficulty, to operate the iPhone he'd gotten himself as a Christmas present. He smoked cigarettes and marijuana and was seriously contemplating kicking the former habit—you know, “given the lung cancer,” he'd said. He was starting, in his free time, to read the Bible, which, he reported, made a lot more sense to him now than it had 15 years ago. As we talked about and around his impending death, I caught glimpses of a transformation in him from fear and sadness to acceptance, from angry determination (“I'm gonna beat this”) to quiet peace (“I've had a good life”), then back again. It felt good to sit by his side and I was happy for him when he left—the decision painstakingly made to stop treatment, to die at home. I felt honored to have been his sounding board and hopeful that he'd be ok. Whatever that meant.
I happened to be on palliative care when Jack resurfaced on the hospice inpatient unit. In those few short weeks between my psychiatry rotation and his admission to the inpatient hospice service, Jack had changed dramatically. He was now listless and muscle-weak, his legs were swollen, his posture slumped. His movements and his thoughts were now clumsy and honey paced. And although his words came slow and quiet, if at all, they rose up and perked the ears of those who once may not have noticed. His perspective now, a man so raw and close to death, had become something valuable beyond description.
Jack was surrounded by his family in those days and they cried and laughed beside him. They gave head rubs and went on elaborate food runs. I recognized their vigilance. In the incessant tapping of nervous feet against the linoleum, I recognized their sense that busy hands might counteract the utter powerlessness of their position as they sat with Jack in those last hours.
I've heard it said before that “every man dies alone.” But death takes only a moment. In all the time leading up to death, in all the weeks and hours and seconds before that last breath, man dies surrounded by his fears and memories, by the great joys of his life and, I can only hope, by the ones who have come to love him so dearly in life that they're willing to hold his hand through the journey. Dying, it turns out, and living come to be about the smallest, narrowest problems and their narrow solutions. Heated blankets for a chill, a daily head rub, a well-placed joke, a little lotion on the dry spots, and the battle of the day is won.
If I think about it for a moment, I can feel the distant warmth of the person whose hands I once tossed back and forth in my own. I can relive a hug. I remember Jack's sister sitting next to him, rubbing lotion on his cheeks the day before he died. The greatest, the most precious things are born here in this space. Dying, it seems, isn't always a solitary process. In fact, I've found it can be quite a group effort. And in my life, when we had long since thrown in the towel on dreams of beating Tim's disease, we instead turned toward fighting for and winning every moment we were given. What else was there to do? And I suppose, if we won anything, we won that much.
We learned to live.