Delivering Death, Delivering Life

I recently have had the chance to work closely with a Palliative Care physician while in my Internal Medicine rotation. Although we did not spend much time discussing the field of Palliative Care, we did spend time together delivering the news to one of my patients that although 2 weeks ago he was healthy, he now only had anywhere from 6 to 18 months to live. He has small cell lung cancer which is very aggressive and inoperable. The woman I worked with is a doc that spends 50% of her time working in Emergency Medicine and 50% in Palliative Care. I found this role very intriguing and am thinking of exploring it further.

Although I had a reasonable amount of exposure as an EMT to dying patients and their families, I have not yet had much experience as an MD with this. I have always felt a certain longing in my heart for those encounters though and miss my time as an EMT for just this reason. It may sound odd, morbid even, but I find those encounters the most satisfying, energizing and indescribably beautiful. So many people in our health care system don't NEED medical care - what they need is self care. They need the desire to be healthy & happy but instead of doing the work to maintain their own bodies they lead destructive lifestyles and only then do they turn to medicine for a pill to alleviate the consequences. These patients drain me.

It is the dying patients, the terminally ill, the trauma victims in the emergency room that make me feel alive, feel needed and ultimately humbled when asked to serve in their time of crisis. It is in those moments between life and death that you can touch their sorrow, their joy and their fear and you truly see something normally hidden. The families of those dying people radiate something brilliant that you can almost touch. You can see the tangible tendrils of love between those that will live and those departing. It breaks your heart and at the same time it fills you with love and a sense of what life is truly about, what truly matters. Everything is in balance and when you see the pain you also see the joy, they are one in the same and can't be parted. It is these patients that reveal the true nature of loss and grief and that similarly reveal the nature of love and joy.

As a healthcare provider I found the relationship to these emergent patients the most satisfying, beautiful and ultimately transcendent. It is where I found the love of medicine, not just the enjoyment, fascination or challenge. This is perhaps why I gravitated to Emergency Medicine in some respects. I have also glimpsed it in Surgery and perhaps understand what draws some students to travel that hard path. What I recently learned with my cancer patient though is that someone does not need to have their life draining onto the floor of a trauma resuscitation room to evoke that same space and need to serve in me. It is when I first entered someone's home as an EMT with screaming family members surrounding a blue and dying body that I first felt this focused sense of wonder. It was the immediate threat of death that seemed to reveal it all, but I just recently discovered that it does not take the immediate threat to reveal these truths. It simply takes the undeniable truth that death is about to arrive.

That is what happened this weekend when I told this young, 57 year old man that he was not going to grow old with his wife, he was not going to see his grand kids graduate. That instead he was going to see one more winter, two at best. He is a stoic, matter of fact sort of man and he took it with a clear and thoughtful face, but you could see it. The small things fell away and the person he was became clear. His sense of sorrow, joy and purpose became clear. He saw his own mortality and it was humbling to be the one to offer it to him. As I have seen in the days since, it is also an honor to be a part of this realization for him and having a role in making his remaining days alive good days seems very valuable and meaningful to me. It is not about "saving him" in the physical sense. It is about serving him. It is not about curing him, not about fixing his problems. There are no solutions. It is about giving him the chance to live every day without the distraction of pain. Without the physical suffering of his cancer and allowing him to fully experience whatever and whomever it is that he loves.

I want to see him return to his life without pain. I want him to have the time to love those close to him. Without our treatments he would likely be dead within a month or two. With the treatments he will be largely asymptomatic (without pain) for anywhere between 6 to 18 months. That time is a huge gift and I am lucky to be able to help offer it. This was a good way to spend my last few days.