As physicians, we bear witness to the health and life events that unfold for our patients. We diagnose and treat diseases. We watch as our patients find partners and celebrate as they bring new life to their families. Yet when the challenge becomes great for our patients, our role must change. We must do more than bear witness. We must shepherd.
When I first began seeing John as a patient, he had already survived two cancers. Over the next six years, I witnessed as he suffered falls, aspiration pneumonias, a tracheostomy and its complications, G-tube failure and more. And with each battle he and his family fought on.
So when he was admitted again, I was concerned but confident he would pull through. But this time it was different; the complications began to mount. So when I got the page from the ICU intern that said, “John’s blood pressure is 60/40” I knew I had to head right over.
At the hospital I met up with his sons and his wife. I shared a quiet embrace with each of them. We assessed the situation: John was seriously ill in the context of frequent hospitalizations and multiple complications. What to do?
These decisions at the end of life are not easy. Would his recovery be complete? Would he end up with new impairments? Would he be back in the hospital again soon? Should we fight on? So many questions; none with definite answers. Doctors aren’t so good at prognostication.
As I started talking with the family, though, I quickly realized we were on the same page. It was John’s time. The best way I felt I could serve John at that moment, then, was to not just bear witness, but to shepherd his family through this difficult time.
What his family needed first was validation that they were making the right decision. Since I share their Catholic faith, when I looked down at John’s hands and saw him holding the Holy Rosary, the conversation became easier. Because we all believed the celebration of the afterlife was at his doorstep, we talked about our role being to let him walk through that open door. We decided to switch the goals of care to comfort.
The next day, I was not surprised to hear that John was still alive, rallying a bit. John lived by Dylan Thomas’ words, “Do not go gentle into that good night.” It was short lived. Later that evening when I got the text message from John’s son that he had passed away, I was sad and at the same time felt confident that we had taken the right path. I believe his family feels the same way.
I also took a few moments to pause and reflect on the great responsibility I have as a physician, a responsibility I hope doesn’t change as models of care shift. It is truly a gift to bear witness to the changes in my patients’ lives and a greater gift to shepherd them through the times that challenge them.
Will Harper is co-founder and co-CEO, Engaged Health Solutions and is the head team internist for the Chicago Blackhawks.