On your own terms

How would you like to die?

Peacefully? On your own terms? Is there dignity in early retirement, so to speak? Or does the dignity lie in the struggle, the fight to the very last gasp?

“Look at me.” I knew not to look. “How would you like to die?”

I doubled back without realizing. Sensing my surprise, my attending broke eye contact with the patient and returned my stare. Three seconds felt like an eternity.

“How,” there was a brief pause in his cadence, “would you,” another one, “like to die?”

He enunciated every syllable. There would be no doubt in his words, no question in his intent. He was soft, understanding, and at once cold, so cold, and calculated, and firm.

We were seated, the both of us. My attending’s legs were crossed, I was leaning forward. Before us, tangled in bed linens, was a shell of a man. He had made no positive progress in the week since we operated on him. We had taken a detour from afternoon rounds to see him again, to give him the pep talk he needed, I thought.

On the way in, I learned from my attending that earlier in the year, before the cancer took over, he was a runner. He was conversive, jovial, energetic. He laughed. He was fit, chiseled, confident. His cheeks were filled in. More than anything else, he was communicative. He made sense.

Now, he was sunken in, malnourished and weak, barely audible except for the few words that escaped him — mainly yes and no. He smiled, but it was always out of place, and just as clumsily it would disappear. He was here for the ride, nothing more.

My attending was soft again. The man, who by now was propped up with pillows, looked to the side of his bed. Surgical drains hung over the edge of the mattress, suspended in air, the red-yellow slurry a sign of what we already knew: our plan had failed.

He was recently diagnosed with late-stage small bowel lymphoma. I met him one week ago when we offered him a palliative surgery to bypass the mass and provide him with direct feeding access. If we improved his nutrition enough, he could tolerate more chemotherapy. Then, and only then, he would have a chance. I was blinded, perhaps, by my own hope.

Gently, my attending explained to the man his prognosis. He uncrossed his legs and moved in. The man nodded. More words were shared. Then the pauses in between the words grew and grew until the ensuing silence allowed them to sink in.

We left the room, a different burden weighing on our shoulders than the one we came in with.

The man agreed to hospice care. The very next day he was discharged. He made it only a few hours. His daughter called. He was resting peacefully, and it was on his own terms.

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