“Hello? Hello, Mr. Bertsie. It’s Dr. Robey. I wanted to call you and check on you,” I said into the phone stopping my constant wrestling with papers and resting what was in my hands on my lap. Mr. Bertsie and I were meeting in the equinox.
“Oh, hello Doctor,” he said with a little relief, a little surprise, a little delight in his voice. “I’m doing OK. I walked the dog today.”
“Mr. Bertsie. Did everything go ok yesterday?” I pressed.
“Oh yes. They were all very nice and got me right in. I am glad to be done with it,” he confessed.
The day before he was an add-on to remove his hemodialysis catheter. They had placed it quickly to start him on dialysis not but four days before but then he suddenly changed his mind and decided against dialysis. I had made a lot of phone calls that day to have the dialysis catheter removed and was glad to hear it was taken out kindly, and he was treated well.
“I wanted to thank you for all you have done, Dr. Robey,” he began. I started to cry. I wanted to stop him because these words were the beginning of the last he would speak to me.
“It’s been my pleasure, sir. I respect your decision, and I know it was hard to know what to do.” I was holding back tears to speak clearly.
“I just think enough is enough and it’s OK really,” he said calmly and casually. “I’ve lived a good life,” he pondered. “Dr. Robey, I mean to ask you. What happens now? What … what exactly happens now? How long do I …”
“I understand, sir,” I interrupted. “You are different than the usual kidney failure patient. You don’t have kidney failure solely or primarily. You have cardiorenal syndrome and with that, it is more a relationship issue between the heart and kidney. Your heart and kidneys fail together. It may take weeks to months but usually within a month, and mostly you will grow more tired, “ I answered. The answers to such questions are so long and winding. I worried I lost him and thought perhaps I should have had his wife on the line too.
Silence presented itself as his mind conceived each grain of sand of dying’s hourglass.
“I want to thank you again,” he said. I felt his entire being press up against mine and my eyes flooded. It was like a hug across the phone line.
“Mr. Bertsie, I want to thank you. You’ve been such a delight to me,” I reached out and held on for a little longer.
My patients were now waiting two at a time, and I was pressed for time. I wanted to take the day off and stare at a wall. I wanted to stop losing friends but had many friends to still engage and travel with properly just down the hall.
Mr. Bertsie said quietly, “Well doc, goodbye.”
“Goodbye, Mr. Bertsie,” I trailed off and hung up. My day went on as planned but I was distracted. I learned long ago to admit to the distraction, so patients knew I did not mean to be rude but only wanted to be allowed to be human.
For weeks I carried a heavy heart and then I heard from his wife. She was driving with her son to look at funeral homes.
“Dr. Robey, thank you for taking this call,” Mrs. Bertsie said on the phone over the rush of street noises.
“Bernard is just at home in bed asleep mostly. He is not eating anything. He is moaning at times. He seems to smile if I touch him.”
“Is he comfortable?” I asked.
“I think so. Do you think Dad is comfortable? “ she turned to ask her son who was driving. “My son says he thinks so. What I wanted to ask you about is well … what to expect and well … when?”
Again the weight of the uncertainty laid on me to rectify and the length of the explanation choked me. That feeling was a strange barrier to crying.
I took a breath and then began as I had with her husband. “Well at this point he isn’t eating or drinking, and the focus is making him comfortable. You can stop the diuretics and pills and only use the sublingual morphine. The time is short, but I can’t tell you exactly when. Maybe the next 12 to 48 hours. What you and your son are doing now is very important. Once that is done, you should just be with him. Contact any family you have and let them come to see him if they want.”
I heard Mrs. Bertsie choke up. My long explanation managed to wrap around her throat and throw her down the precarious edge she was on.
“I see,” she managed.
I had promised them both a year ago when I was late coming in to see them dealing with another sad case that all things come full circle. “One day if you need the time I will be there for you,” I guaranteed.
She referenced this now. “You said you would take the time with us if ever we needed you like you did that day you took with someone else and was a little late coming in. I know you are busy. I won’t keep you. Thank you for all you did for Bernard. He really loved you.”
I lost it.
I hung up with a soft goodbye and left the equinox knowing Mr. Bertsie would soon pass. Grieving like this was hard. I sat back in my office chair. I heard the charts being placed in the exam doors.
I heard the next morning Mr. Bertsie passed that night in his bed at home with his family by his side. I hoped he face was soft, and his skin so bruised by blood thinners and poking stopped weeping and laid against soft satin.
The equinox is a certain place a doctor and a patient or the patient’s family goes. It only invites this relationship in. The deep sadness we feel there shows the light of humanity onto medicine.
Our only reason to embrace grief is to enter the next room and next relationship with heart.
Jean Robey is a nephrologist who blogs at ethosofmedicine.
Image credit: Shutterstock.com