Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like.
Please meet Mr. Jefferson.
Mr. Jefferson had long, lacy eyelashes and puppy dog eyes. His smile was a mile wide. When I came into his room, he spoke first, welcoming me. I knew of course that this would be a unique experience.
“Hi Dr. Murphy, the nurse told me all about you,” he smiled.
“Well,” I quipped, “it’s either all lies or a paid endorsement,” and I reached out to shake his hand.
He reached out and gave me his wrist nub. There was no hand. I shook it without pause (emergency medicine prepares you to react normally in abnormal circumstances).
Continuing to attempt a “normal” patient encounter, I asked, “So what brings you in today?”
“Well, this for one,” he pulled back the covers to reveal his swollen, tense abdomen. He had the appearance of having swallowed a couple of basketballs and the veins of his belly were bright and distinct, criss-crossing like a Google map of winding highways.
“Oh, yes, I see,” raising my eyebrows a bit while noting in his chart that he has required paracenteses recently.
Before I could begin to question the reasons for his girth, he continued on, “And I need to see the hospice people.”
“You do?” I asked, rather shocked. I was no longer able to “act normal.”
“Yes, ma’am,” Mr. Jefferson replied. Then he said, “Doctor maybe you should sit down.”
Mr. Jefferson proceeded to tell me his life story in a brief and touching vignette. He had married his high school sweetheart. They had a marvelous life together until he began to suffer the ravages of poorly controlled diabetes. Two legs lost and one hand amputation later he could no longer take her dancing. Then his kidneys and liver failed. Now he was on dialysis 3 times a week and had needles stuck into his belly on a regular basis to relieve his suffering.
“But now, I’m done. I’m ready to ‘go home’ and I need hospice to help my sweet wife to get ready for me dying,” he said as he reached out his wrist nub to pat my hand.
I responded just like any highly, trained professional would: I burst into tears.
He responded gently to me. “Oh no, really, don’t cry for me doctor. You see, I’m OK with this. I’m even looking forward to it, because when I get to heaven I’m going to do a Christian dance. I will have my hand back and I’ll be able to move my legs. Then, I am going to practice dancing till my wife comes to join me.”
I think I cried a little harder.
I attempted to straighten myself up but could not, so I reached out to hold his wrist nub and apologized. “Mr. Jefferson, I am so sorry that I’m crying but I have never met anyone like you. You see, I spend a lot of time talking to people about how to make dying peaceful, but you …”
“You don’t worry about me, doctor, I have perfect peace. Perfect peace.”
I was speechless.
Finally, I got myself together and we made a plan to draw more fluid off his belly and to call in the hospice nurse for intake evaluation.
As I turned to leave, I thanked him for giving me the honor of taking care of him. And then I said, “Mr. Jefferson, I will always remember you.”
Smiling, he said, “I will always remember you too.”
Monica Williams-Murphy is an emergency physician and author of It’s OK to Die.