What I Learned From A Dying Patient

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39 years old, PhD, scientist, brilliant. She was sent to the ICU team as a fascinoma, meaning a person with a constellation of problems the doctors couldn't figure out. This woman had been physically fine until two months earlier, and now she was growing progressively short of breath, had a little blood in her urine, and had pain in her toes, which were turning blue and red in the cold. Imaging showed that she had a growth on her aortic valve and that sections of her kidneys were dying. The doctors at the outside hospital had diagnosed her with blood clots in her lungs and started her on a blood thinner, but her condition kept worsening.

As the day progressed, we started all the needed tests and interventions to help sleuth out the problems and fix them. Hours into my periodic conversations with her and her mother and sister, her mother mentioned that my patient was agnostic. I realized that up to that point, perhaps because of the sheer rapidity of the way things were unfolding, I had neglected to take a spiritual history. Since I teach medical students and residents in physical diagnosis class about the importance of taking a spiritual history, you'd think that I wouldn't fall prey to this oversight, but I had. The literature shows that most patients want to be asked about their spiritual beliefs or non-beliefs, and that many think it rude if healthcare professionals don't consider this important aspect of their well-being. The question should be asked out of respect and in a non-judgmental manner. Thus, I said to her, do you have any spiritual values that you want me to know about that might influence your medical decisions?

We'll get to her answer in a minute. Within 24 hours of our meeting, the patient had been checked with an array of blood tests and imaging studies, and there it was. The biopsy showed angry cells with too much nuclear size for healthy cytoplasm and prominent nucleoli. Cancer.

It was everywhere then. It became a whirlwind because she got shorter of breath by the hour as the cancer and fluid literally filled up her lungs. We went from her arrival in the hope of figuring out what was wrong and seeking a cure, talking about how when she got back to her lab and students, she'd resume where she'd left off, to the depths of despair. The patient's conversations with her sister were difficult, to say the least, and at times they both got weak.

Eventually, they affirmed that they had to pave a way to prevent my patient's further suffering. With her mother, however, it was much worse. She looked at me through tears and fear and screamed, this is not fair, over and over.

Her sister began printing off her will from an iPad and having things notarized. It was surreal. I won't forget my patient's look of shock and surprise, as if she'd heard me wrong. When I told her that the cells we'd seen under the microscope were cancerous and that the cancer had already spread throughout her body, only eight hours after we told her that she had this incurable illness, she had no idea what was going on, and that our hope, which at the time seemed plausible, was to get her off the ventilator so she could talk to her family, she stopped breathing, and died quietly without any apparent awareness of suffering. Throughout the day, I tried to be diligent about ensuring that she was able to spend time with her mother and sister. The initial challenge was to use a specific approach towards sedation that balanced her comfort and her clarity of mind so that she could engage with the family. My last memory of this young scientist is that of her breathing, unconscious, and unaware of her surroundings. At this point, she was newly comatose on the sedation and painkillers as we removed the breathing tube and ventilator. I urged her family, nevertheless, tell her what you want her to know.

It helps families to have no regrets in the days that follow. The story is many things, and to you it no doubt means something different than it does to me. As this woman's physician, I find that one of the most enduring aspects of the story was the palpable oneness I felt with her, and in knowing how in sync we were with everything, body and mind. There was an unusually tight connection, and I sensed that we both knew it. Since antiquity, the greats such as Plato and Aristotle have taught us the concept of body, mind, and spirit as the fullness of existence, a triad still embraced by many today. My patient and I were in tune after talking about those first two, and then, when I took her spiritual history, she perceived that our beliefs diverged. She affirmed what her mother had told me.

Yes, I am agnostic, and it's okay that we differ on that. I nodded and was left to wonder how and why, without having talked about this earlier, she had both understood that we differed in this third piece of the triad and thought it important to offer me reassurance. An autopsy will answer many things, like what was growing on her heart valve and the source of her cancer, which we think was bowel, pancreatic, or ovarian. But no physical finding, microscopic sighting, or laboratory test is going to help me learn any more about her spiritual side. I remember her loving manner and her inquisitiveness about life.

I know that she was thinking of her estranged father, her students, and her nieces whom she'd never see again. She wasn't sure about the existence of the divine, but her courage, daring to face what was happening despite not wanting to hear the worst possible news, utterly confirmed the human spirit. She revealed the connectedness we have in all of our imperfect, vulnerable lives, and I can still feel it now. And a terrific job on the production, editing, and storytelling by our own Monty Montgomery, Dr. E. Wesley Ealy, here on Our American Stories. This is Lee Habib, host of Our American Stories. Every day, we set out to tell the stories of Americans past and present, from small towns to big cities, and from all walks of life, doing extraordinary things. But we truly can't do this show without you. Our shows are free to listen to, but they're not free to make. If you love what you hear, go to OurAmericanStories.com and make a donation to keep the stories coming.

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