Goodbye, My Friend
By Michael R. Bowen (02/11/03)
If you practice medicine long enough, you will see life's ending more than a few times. Knowing its inevitability, and having tried everything you could to stave it off, you learn to accept it and move on. But I think for every physician there is at least one patient in his career whose passing hits especially hard, one patient whose death, though the dispassionate intellect knows it cannot be prevented, the doctor's heart refuses to recognize.
Some readers may recall that I described, in a column about veterans, how one elderly gentleman could not hold back the tears when I asked him about his Army service. That was almost seven years ago, and from then on I grew increasingly fonder of that old man. Looking at his chart today, I see that I really saw him much more often than was medically necessary, just for the pleasure of his company. He had what I like to call a "good face"; one glance at it and you could tell there was a fine person inside.
We would dispose of the medical business, and then sit back and talk about history and current events until the office nurse tapped on the door to remind me I had other patients to see. In the Fall, he would invite me to hunt the woods behind his house, the house his father built, and where he had lived his entire life. As often as not, I would hunt the morning, but spend the afternoon in his kitchen. I remember well the day he brought out the memorabilia of his artillery battalion, and I listened to his stories about friends who survived and friends who did not.
His wife was a very determined woman, and a few years after our first meeting, she decided that I was not the right physician for him and insisted he transfer elsewhere. As luck would have it, I was the physician on call the night she came to the hospital to die. None of us ever said a word about the separation, and I gave her my best although it was hopeless. The next day I heard a familiar voice talking to my receptionist, and we took up our old relationship where we'd left off.
During the last year, he had been slowly failing. I tried this, I tried that. I enlisted the help of the cardiologist and the pulmonary specialists, and frequently tried to pick the brains of my colleagues in the hopes that I'd been missing something. Looking back now, it's clear they knew I was kidding myself, but they kindly indulged me. Sometimes on the telephone with his family, I'd get the feeling it was they who were trying to console me, not the other way around.
Last evening when I visited him, I found that he'd developed pneumonia. I put on my best doctor manner and explained my treatment plans, the antibiotics I would use, the changes in his other medicines, and my overall impression that I would be able to turn things around. He listened patiently, but the look in his eye told me that he'd decided it was the end. I was the only one left who hadn't faced reality. In any case I set my plans in motion, signed out to the physician on call, and went home. This morning I found his chart gone and his bed empty. A kindly nurse, keeping an eye out for my arrival, had an arm around my shoulder and consoling words in my ear before I fully realized the truth.
My friend had strong faith. He was ready, and he went with dignity, just a few days before his 91st birthday. He had lived a full and honorable life. But now they are paging me again, and something's going on in the intensive care unit. So farewell, my friend. I know where you went, and I'll meet you there. We have an appointment.
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