“Hey, Doc, still dying. What’s new with you?” That was what one of my long-time patients said in response to my canned greeting upon entering the exam room.
Yes, I knew he had cancer; I’m the one who first felt it in his breast. Yes, I had seen the pathology report and subsequent scans indicating metastasis. Yes, I was coming off a much-needed, too-short vacation—reminded in an instant of the brevity of life by this wonderful man.
So starts our conversation. “How’s the boss?” I mutter, trying to buy myself time to collect my thoughts, since the wife question always slows elderly male patients. “Still putting up with me—but, hey, not for long right? Ha-ha,” he laughingly replied.
“Sir, it really is good to see you,” I respond, and segue into the usual questions about appetite and energy. Which lead (as I notice his emaciated face) to a conversation about what we physicians call goals of care and end-of-life planning.
“Oh, you’re good,” he says. “I see what you’re doing. You think it’s coming soon, don’t you?” As sincerely as I can (I try to channel Marcus Welby) and as honestly as I can, I reply, “Yes, I do, Sir. I want what’s best for you—always have. What do you want?”
This man—who decided to not follow up with oncology anymore because “that guy won’t stop; he would pump me with chemo until my last breath, god bless him”—says, “I’ve always appreciated you, Doc. You’re good man, you’re my family doc, you take care of all of us. But it’s probably time for me to stop seeing you and stop wasting your time.”
Over the next four months, I gave many hugs to many family members and held that patient’s bony, frail hand one last time. “Don’t feel bad, Doc,” he said. “None of gets out of life alive, right?” He saw it on my face. Did I miss something? Did my rote review of systems fail me? Did he have such parting thoughts? Did he wonder at the end if he’d eaten enough fruit and veggies, exercised enough, taken all his medications as prescribed? What really matters at the end of life is deeply personal and sacred.
As the bedside blurred, I gave him time, intention, and sincere words. The word “doctor” comes from docere: to teach. He taught me to sit, listen, and exist in those very human moments, to be not only teacher and healer, but to be human and raw when bearing witness to a life lived.