End of days, beginning of life

Originally published in The Ottawa Citizen July 17, 2001

Mr. H., a World War II veteran was posted 24 times in 27 years while serving in the Canadian Armed Forces. He is proud of his accomplishments and his actions demonstrate quiet dignity and honor. He has told me stories of his military life. Stories about sacrifice, dedication, honor and integrity that children, not to mention some adults should hear. Now, at age 78 I have told him he has inoperable kidney cancer because it has spread to his lungs. He would not survive the operation.

We talk openly about palliative care and his funeral arrangements. He discusses it in a matter of fact way. He has prepared himself and set his affairs in order. His eyes betray great sadness and fear. He is a man without a family. He never married. His friends are gone. He is alone. He talks to my patients in the waiting room. One patient asks me if he is okay. He is “such a sweet man” she says, “but he looks so lost and alone.”

As he limps into my office, cane in hand, I wish I could change his future. The unfairness of life once again is cruelly played out upon those who have sacrificed the most. This man helped protect our country. And he is already forgotten. His wish is to die in a veteran’s hospital. This is arranged but he hopes they can accept him in time with the waiting lists such as they are. His pain is noticeably worse but he refuses pain relief for now. My nurses and I offer him whatever help he needs. Despite the rationing of care now-a-days, he is grateful for what he has received. This man deserves better but he would never say so.

Last March at the Ottawa General Hospital, I had the privilege of meeting Mr. R., a strong, independent fifty six year old man admitted to our family medicine service. Five weeks earlier he was on a “trip of a lifetime” cruise with his wife. After the trip he went to see his doctor because of fatigue. Two weeks later he was hospitalized for liver failure due to spreading cancer. His family was devastated. There was no warning, no time to prepare themselves. His liver could not produce the protein his body needed to keep water in his blood vessels. Everyday fluid would leak into his abdomen, legs, hands and lungs. He would always be thirsty. But the more water he drank, the more bloated he would become. Each day his lungs would fill up just a little bit more with fluid. His breathing became more labored, his skin more yellowed. Toxins that normally would be neutralized accumulated in his body.

He was a man losing control of his life, a completely new and frightening experience for him. Yet, he wanted to be in control to the very end. He wanted to know how he was going to die. He asked the dreaded question, “How much time do I have?” The residents and I answered all his questions. He had about 2 to 6 weeks to live. We were determined that he would die with honor and dignity. We talked about pain control and that he should be comfortable. His family wanted a private room so they could personalize it for him. We shook hands. When we left the room one of the residents burst into tears. I cannot imagine someone I hardly know telling me I am about to die a horrible death in front of my family.

He resigned himself to his fate. Instead of withdrawing he spent the rest of his days telling his family how much he loved them and how proud he was of his children. His family remained with him. Seven days later he died. His family was with him until the end.

I am truly privileged to have met these courageous and selfless men. Facing the ultimate fear they demonstrate the strength of the human spirit. One alone and in silence, the other more concerned for the well being of his wife and children and dying in the loving embrace of his family. At the end of one’s days all that one has is dignity, honor and respect. I have seen many throw their souls away for the most trivial of reasons. My fear of the slow decline of these societal values is somewhat eased when I meet people such as Mr. H and Mr. R.

Right after seeing Mr. H., a beautiful sweet 2 year old girl comes into the office with her mother who is expecting her second child. The girl has that high-pitched voice that just melts your heart. I balance her upon my knee so she can hold the Doppler to her mother’s abdomen to hear the baby’s heart beat. She is so happy. Her world is wondrous.

From life to death, from innocence to life’s final destiny and all the experiences in-between— all in one day. Teach your children well.

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