Helping People Die, or, R3: Internal Medicine

His name was Ray, he was a lovely old man, and he had metastatic cancer.  When he got his diagnosis several weeks ago, initially the plan was to fight it; CyberKnife had shown some decent results with his type of cancer and his family really wanted him to beat it.  The only condition was that he had to gain some strength back before he could begin treatment.  Instead, however, he got weaker.  He quickly lost his appetite and his immune system.  When his family brought him in to the hospital, he was suffering from a bad infection that had set in insidiously but deeply.

The first day I came on his case, I talked with his family as Ray slept.  I told them that for most of our lives, living longer and living better are the same thing, but sometimes we reach a point where those two options fork away from each other.  I told them that we had reached that crossroads with Ray.  The next day we stopped the antibiotics and the blood pressure meds, the fluids and the suppositories, and placed him on comfort measures.  I asked if I could pray for them.  It was a very peaceful prayer overall, intercession for a family that has accepted what is coming and has started mourning, which God can use as its own kind of healing.

I walked out of the room scrubbing tears off my face and ran into their nurse, who looked at me with concern.  "Oh, praying with the dying never gets easier," I said as lightly as I could.  She nodded, mouth twisting with understanding.  "You would think with time," she said, laying a hand on my arm, "but it never does."

I actually love the oncology floor because the nurses and techs acknowledge things like that a bit more readily.  And it doesn't seem to be getting easier, at least not for me.  This time I think I actually mourned in aggregate, seeing as I prayed several faces of past patients that I assisted in the dying process.  The sense of grief lingered with me the whole day, making it hard to move on to other patients who needed me to be present.

I cried all the way home.

I don't know why internal medicine does this to me.  I find it exhausting.  It certainly is honourable work, helping families navigate the medical system and helping terminal patients die well... but I personally can't sustain it.  Whatever distance other practitioners have that lets them disengage easily, whatever perspective they have that helps them feel that death is not a failure, I just don't have it.  I think this is an area where God wants me to grow, but I'll admit that I don't understand how.  There's a balance there that I have always struggled with.

Ray died about a day after being placed on comfort measures.  He was surrounded by his family, and there was laughter as well as tears.  I can tell his was a life very well lived, and I'm glad he's free from pain and finally home with his Father.  One of my duties in these situations is to declare time of death.  After I had done what I needed to in the room, we prayed again, and as I was about to leave, Ray's daughter stopped me. "Thank you so much," she said, "for helping us to have this time and let him go.  He gave us so much.  We were grateful as his family we could give him this last gift - to pass naturally and in peace."

Honourable work indeed.