Calling

“Can’t you just give me something to end it all? If I were a dog, you wouldn’t make me suffer like this.”

It was hard to walk into the room and know Jack would ask for something to end his life. I remember my days as a medical student: history, physical, differential diagnosis, tests, treatment and then home. I became a physician to help people with their pain and suffering. All we did was treat diseases. Dying patients were put “nonteaching.” We never had to deal with this. I felt helpless, but at the same time I was glad I couldn’t act upon his wish.

From my third year of medical school, I struggled with what it meant to be a doctor. When my kids were five and three, I left medicine to be a full-time mom. During this time, I took a course on the history and philosophy of science. I finally understood my discomfort. Western medicine is based on a materialistic world view. It was unspoken. We never talked about healing. My world view was different.

When I returned to medicine eight years later, I had the opportunity to complete a year of training in palliative care. It was a very challenging year. By the end, I had compassion fatigue. I completed a qualitative research course in the fall of that year. I spoke with Dr. David Gregory who taught the course. I needed to look back at my year and see what happened. He agreed to help me write an article. It would be a part of my training program and my own healing journey.1 I remember telling him “I think I am in the wrong profession.” He laughed and pointed out how I helped facilitate healing for my patients and their families. Had I finally found a place in medicine that resonated with my world view? I returned to work nine months later.

Image courtesy of mkistryn/iStock

Jack appeared comfortable sitting up in his bed. Under his blue gown, his clavicles protruded beneath his pale skin. His facial bones were discernable. His eyes told a different story.

“I don’t enjoy anything anymore. I don’t understand why you can’t give me something.” There were tears in his eyes.

“I could give you some antidepressants to see if that would help.”

“No, you can keep your pills. I just want this to be over!” (Silence.)

“How did you deal with your Crohn disease?” I asked.

“I took it one day at a time. I had no choice.”

“Did you ever feel like giving up?”

“Sure. But I am still here.”

“Did you have someone to support you? Did you ever get married?”

“No, I didn’t want to burden anyone else. Now I am dying with cancer and just want this to be over.”

“Jack, I know you really want something to end your life. You know I can’t do that. Would you be willing to share with me what this journey is like for you?”

He hesitated for a few moments.

“Sure … but I don’t know where to start. I have never done this before.”

“Why don’t you tell me what it was like when you were a kid?”

“I am the second of four boys. My oldest brother George and I were very close in age. We would try and lose our younger brothers all the time. Sometimes I guess we were pretty mean to them. (Chuckle.) I remember the time we stole some apples from our neighbours’ tree. I really wasn’t a troublemaker. The guilt was awful. I never did that again.” Slowly he started to talk about his illness.

“I developed Crohn disease when I was 17. It was around the same time George left to go to university.” A light bulb seemed to go off, followed by a look of pain. Suddenly, he looked very tired. We sat quietly for a few minutes.

“I think we should just leave it at that for today? What do you think?”

“Yeah, I think you are right.” He gave me a small smile and then closed his eyes.

I returned two days later. The nurses said he was waiting for my visit.

“How was our first conversation?”

“It was hard, but at the same time was very worthwhile. I realized something during our conversation.” He was unable to put it into words. Reflection and talking about his life were new experiences.

“Would you like to continue?”

“Yes.”

“How often would you like to meet?

“Twice a week.”

His answer surprised me. This was a huge step for a man who had never looked inside. I knew I was being invited on a sacred journey. He trusted me. It was a trust that was not to be broken.

“That will work out fine for me. Just remember, you can never tell what experiences life may still have to offer you.”

Jack was in charge of our conversations.

“How am I going to know when time is getting close? I am getting impatient.”

“We often look at how things are changing. In your case, changes seem to be happening on a weekly basis. You likely still have weeks, possibly months left. But things can change quickly without any notice. I usually tell people not to wait to have those conversations that are really important to them.”

“I haven’t been very close to my family. Maybe it’s time I started to really talk to them?”

I nodded my head.

“How did things go with your family?”

“It was hard to start the conversation. By the time we finished, we were all crying. I am so glad we talked. We all felt better afterwards. (Pause.) I had a dream2 about my aunt last night. She lives in Regina. We were very close when I was young.”

“Would you like to share your dream?”

“Sure. We talked about when I was growing up. We did a lot of laughing. Towards the end she wished me well on my trip. It was really nice to see her.”

“Do you remember how you felt in the dream?”

“Yeah, I was excited to see her and glad to have our conversation.”

“It sounds like you got some closure with your aunt.”

“It was really hard when they told me I had cancer. I knew something was wrong. I was losing weight and feeling very tired. At first my doctor didn’t listen. He seemed very arrogant. You know, ‘Doctor knows best’.”

“How long has he been your physician?”

“A long time. We have been through a lot together. (Pause.) Could it be that he was only trying to protect himself?”

“Sometimes it is hard to admit that our patients are in trouble.”

Sometimes Jack was sleepy or too tired to talk.

“I worry that I may lose my train of thought or not be able to have a full conversation with you.”

“Don’t worry, I will be here for you in whatever way you need.”

“Would you like to hold my hand?” He slowly took his hand out from under the covers and took mine. We spent that visit in silence.

Things slowly shifted for Jack. The nurses noted that his spirit lightened. He was able to have fun and joke with them. He acknowledged he did feel better. He jokingly said, “Maybe it is our talks.”

Experience has taught me the importance of boundaries between my patients and myself and the power of genuine caring and love. After much reflection, I decided to give Jack something to remind him of me when I was not there. A touchstone. I found the perfect gift, a carved angel holding a red heart. The day I gave it to him, his family arrived unexpectedly. I left it with him.

When I returned three days later, it was still unopened on the windowsill.

“Would you like to open it now?”

“Yes.”

The delight in his eyes and the joy in his voice as he opened the gift affirmed I made the right decision. He held the angel in his hands and looked at her.

“It could be both positive and negative.”

“What do you mean?“

“The Angel of Death or the Angel of Love. Even though I say I want the end to be here, I do wonder if life still has more for me to experience.”

This was our last conversation. He died peacefully four days later with his family at his bedside. We had six weeks together.