Query

Leo couldn't say two words without gasping; the last time he was weighed, he was 82 pounds. I came to visit him after being called by his frantic wife, who felt that Leo had given up hope and was willing himself to die. I was struck most by two things, the oxygen and the emaciation, for when I knew Leo he was ambulatory and able, a mere 58 years old and on the upswing from an earlier bout with his illness, an illness that didn't seem capable of killing him.

Figure. Photo by: Anson Liaw

When I arrived, there was a moment of confusion. He mistook me for his son, but after a few moments recognized me and asked me to sit down. It was hard not to think Leo's wife was right. I saw untouched Ensure cans on his bedstand; he told me his doctor had said if he didn't eat he would die. But he just “didn't see the point.” He had seen a psychiatrist the day before — sent, in Leo's phrase, to “shrink his head” and convince him life was worth fighting for. Leo had refused to speak to him. “I'm not crazy,” he said, “just tired.”

Getting all of this information from Leo was obviously tiring him out. I'd never seen him hopeless before; all I had ever known was his unwillingness to be beaten by illness, his good nature in flare-ups of chronic illness, his boasting about coming back from the brink.

Leo was a factory worker; he'd made his way up to foreman and left the company on good terms when his medical problems became too much. He had two sons and a grandchild, who visited Leo briefly and whom, Leo tells me, his wife has been using to push him to fight.

I've dealt with resigned patients before who have given up; I've talked to them, counselled them, held their hands; I've asked psychiatry colleagues to visit, to see if they can find something to treat, some way to restore motivation. But motivation is the trickiest part of medicine, trickier even than insight.

For Leo, I simply listened, as powerless as he felt. I had no privileges there; I wasn't his doctor, just his friend, and one possessed with the feeling that if I could cajole him to drink just one protein shake, that maybe … well, it's silly to say. But maybe he'd come around and make it out of the hospital for his granddaughter's birthday party. Maybe he'd live another day. Maybe he'd make it up to three-word sentences, and from there, four. Take a few steps down the hall. Then to the cafeteria. Such small, achievable goals, I thought. But he had to want them. Was the role of a friend to chastise and browbeat? To tell him it was wrong to just waste away? Leo told me he'd had enough of that from his family. So I simply said how sorry I was to see him feeling this way, and how much being his friend meant to me, and that I would hate to see that end, and that I was sure there were dozens who would say the same thing.

I left it at that. Anything more would have been preaching. And when I was done, we chatted about mutual acquaintances, marital woes, work, kids. It didn't feel like I was talking to Leo; it felt like I was talking to an amiable corpse. I got up to leave when I realized that he was getting sicker before my eyes; I shook his hand, and as I walked out into the summer evening I wondered if he would still be there next week, and if there was anything more I could have done.

— Dr. Ursus