Ode to a Patient
"You have to help me", she urges. Her warmth penetrates the sterility of my windowless office. Her fluid brown eyes speak a language of their own. An open wallet reveals a family picture, a relic of happier times. I avert my eyes. She has terminal lung cancer. Multiple treatments have failed.
"Isn't there anything?" His face is contorted in a plea.
She is 32, dying. I am 32, charged with saving her. The more desperate she becomes, the less I deliver. She sits awkwardly in the cramped waiting room, holding up a tired body and a worn spirit. She must think she is just another person down the list though her young age and vulnerable situation make her anything but. Over the months, I have grown to admire her resilience. Most days I struggle to hide my dismay at her worsening state and if I am sometimes a little forceful in my assertion that we have exhausted our options, it is because I want to avoid injecting false hope. She regards me as her saviour but when the door closes behind her, I question the existence of a god more crudely and intensely than she. Week after week, her prayers and mine go unanswered. She weeps. I feel terrified.
Her five-year-old daughter holds her hand as she heaves into a bowl. Can she sense my scant reassurance? My heart aches, as I instinctively think of my own son, confident that I will return home to him. I watch helplessly as she is wheeled away, crying in agony, a wounded animal. "We will make her more comfortable", I whisper. Mutual desolation fills the air.
"Last night, we waited so long in emergency", he says, accusation and grief merging into one. What I would do to return her those needlessly spent eight hours, revisiting the painful details of her sentence. I hand him my phone number. It is my way of saying I will do anything to make her numbered days more bearable.
"I will try any drug, however toxic", she beseeches.
In her absence, I scour the literature, ask the experts. There is nothing. Surrounded by advice, I feel lost in the wilderness of an incurable disease.
Why did I become a doctor? To heal the suffering of others, not to observe from the sidelines a young life brazenly plundered. What is the point of witnessing the agony of patients? Guilt and venom wash over me, and then unrelenting sorrow at the sheer futility of my position as I preside over her untimely death. How will I move on? Is it even conceivable to reconcile with this injustice?
Soon she is in hospice. I visit her everyday, unable to shirk my moral obligation. Sometimes, finding her asleep, I steal away unnoticed, guilty but grateful for the respite from confronting her death and my impotence. Then, the drawings of her children arrest me, brightness forced on a bleak landscape. As I remove my coat to sit down, revealing the full bloom of a pregnancy, I am mortified at the thoughtless juxtaposition of life and death in the making. But with clouded eyes and shaking voice, she congratulates me warmly. Outside, I weep, wondering how any world design could include wrenching mother from child.
She fades away, her pleas drying on parched lips. One day, she whispers, "Help me die so I don't have to think about losing the children anymore." Her words fall like blows. Far from distancing myself from her plight, I feel broken imagining it. I hold her hand in silence, quivering at the horror of her circumstance. But I am stunned when I too find myself hoping she dies soon. I want to slip away into an abyss of darkness where I can violently shake off her very memory. Conflict fills my head. I hate the idea of being her doctor, no longer sure whether I am helping or hurting. What is essential about this experience for either of us, I wonder? "I can't hasten your death", I say, "but I won't abandon you." I am ashamed at the courage I must summon to say this.
She dies after clinging to life by a seemingly endless thread. She denies pain to avoid more sedation. She feigns strength to smile at her children. She still asks about experimental treatments. Then she sinks back, defeated. Silently I curse her fate, failing to see reason in her tortured journey. My faith in medicine melts before this testing spectacle. When my birthday arrives I suffer a form of survivor guilt.
He calls me after her funeral. I am infinitely relieved to have missed it. My colleagues console me that the therapies failed her and her body betrayed her. But somewhere in our journey, her fears, hopes and desires merged with mine and I feel an abject failure.
She left me a note. It took me a long time to open it. All it said was, "Thank you for listening."
Ultimately, the lesson I learn from her illness is far too simple. Drugs might outgrow their use but not compassion and respect for the sick. It is human for doctors to feel and admit sadness at the struggles patients' face, even therapeutic to recognise our limitations. Patients understand that we do not possess all the answers. What they expect however, is a partnership founded on empathy and respect. To listen closely to patients, to heed their suffering has little to do with the science of medicine and everything to do with the art. If I remember this for the next 30 years of my practice, her death will not have been in vain.
by Arnold Zable - Author
Written with compassion, skill, and great honesty, this is an aching portrayal of a doctor's helplessness and despair at the fading life of a patient: a young mother with children. The author reflects upon the moral dilemmas with intense empathy, and documents the hard-won lessons that she wrings from the experience.
There is an extraordinary symmetry, captured in the lines: ‘She is 32, dying. I am 32, charged with saving her. The more desperate she becomes, the less I deliver.' The doctor receives, a final note from the patient, handed on to her after the patient dies, with the simple statement: ‘Thank you for listening.'
Back to top
