One of my favorite patients died last week.

My reaction to this was not quite what you would think: I smiled.  No, I didn't smile because of his death; I smiled because of his life.  I smiled because I got to be a part of that life.  His death wasn't his tragic end, it was the exclamation point to his life.

I am around a lot of death - it's one of the things that makes being a doctor different from other jobs.  My goal with all of my patients is to keep them healthy, to relieve their pain, and to do my best to keep them alive.  Ultimately, though, it's a losing battle; 100% of them will eventually die.  That's why I don't like statistics about how many people who die due to inadequate doctoring.  Our job is to resist an irresistible force.  We are standing up to the hurricane, the avalanche, the flood.

If you only measure a story by its ending, we all live a tragedy.  Even a belief in life after death doesn't remove the loss death represents.  (I often have to remind my Christian patients that even Jesus wept because of death). But being around death has also taught me that even seemingly tragic deaths aren't always tragedies.  Sometimes being in the presence of the dying isn't sad, it's inspiring.  Sometimes I consider myself lucky to be with them.  Sometimes it's an honor to be their doctor.  We don't always stand against death, sometimes we get to stand with the dying.

My relationship with this patient started without distinction.  He was a few years younger than me, worked with his hands, and was generally healthy.  What made him different was his ever-present smirk.  He was subtle and soft-spoken.  It took me a few sentences' delay for me to catch a joke he had slipped in without drawing attention.  I'd stop, smile, and his smirk would grow.

Then things started happening.  He came to me with unusual symptoms, and after running tests I still was without an answer.  I sent him to specialists, and they couldn't explain his symptoms either.  His symptoms worsened, and he started missing work.

Eventually his picture clarified, and the news was not good: his condition was progressive and untreatable.  It was also rare - the kind of disease that happens in people three decades older than him.  It's not supposed to happen in young, healthy men.

It was a tragedy: a man in his prime with a family is stricken with a disease he "shouldn't" get.  I added him to my list of people I am going to ask God about.  Why does this kind of thing happen?  He should be living a long and healthy life, but that choice wasn't given to him.  He just kept getting sicker and sicker from a disease he shouldn't have had.  As time went on and as the disease progressed, the situation became clear: he was dying.

Standing helplessly while someone you like dies is usually hard.  The visits are uncomfortable and quiet, and I get a sinking feeling when I see them on my schedule.  But he was different; it was as if nothing had changed.  I never saw him sulk, I never heard the word "unfair," and I still had to listen carefully for the subtle jokes.  When many would have been angry, frustrated, or depressed; he just smirked.

His attitude was infectious.  His wife never complained either.  I was always happier after his visits, and so was my staff.  Eventually he came to the office with a skilled nurse, and they were always smiling.

His death was not a surprise when it finally came.  But what did surprise me was my response.  I will miss him and his smirks and subtle jokes.  I do wish he had lived out a long and healthy life.  But he is no longer on my list for God.  He lived better while dying than anyone I have seen.  He inspired me, my staff, and anyone else fortunate enough to cross his path.  It was the fact that he was dying that made his life so remarkable and how he faced that fact that leaves me richer.

Perhaps we shouldn't ignore death.  We are all dying, yet we always seems surprised when it happens.  Maybe we need to follow my patient's lead and die well.  He didn't ignore the obvious, complain about what's normal, or bemoan his bad luck; he faced his end as he faced the rest of his life: with a smirk.

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