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Doctor, I'm Ready to Die

“Doctor, I am ready to die.”

I knew her from a few years back. This patient of mine.

I am a hospitalist, and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different. I saw her once many years ago when she was gravely ill, and we managed to pull her through and she survived. Because of that we never forgot her, and she remembered me. At that time, we found a cancerous lesion in the lung, but she did okay and was discharged home.

By the time she came back to the hospital years later, the cancer had spread and she was sicker. She was proud, though, because she had made it this far even though her oncologist had told her she only had six months to live. It’s been two years and a half. And yet the cancer ravaged on.

Now she was dying.

I came to her room. From afar, you could tell she was short of breath. I told her how the cancer had spread and caused fluid in her lungs to accumulate, making it hard to breath. I explained our options, ranging from doing invasive procedures to non-invasive care, including comfort measures and letting nature takes its course. She waited patiently for me to finish. Then she smiled and said:

“Doctor, I am ready to die.”

I said, “Are you sure?”

“Yes.”

I proceeded to explain to her what we could do to help the transition go painlessly and smoothly, to allow death as comfortably as we could. She listened attentively, nodding her head in agreement. She asked that I not tell her husband. “At least not yet,” she said. “He does not have the strength to hear those news.” I acquiesced and promised to honor her request.

Later that day, I came back to see her because I knew the husband was coming to visit her and would ask for me. I explained to her husband as best as I could what the plan would be for the next few days. I did not mention the words “death” or “dying” but used words like “comfort measures” and “supportive care.”

As I kept explaining the plan to the husband, I kept looking back at my patient. In my patient’s eyes, I saw courage – and fear, too. And yet, I saw more of courage. I felt her uneasiness as I was talking to her husband, fearing that I might slip my tongue and break my promise. But I did as she asked.

I stooped down to her and hugged her as tight as I could, knowing that it probably would be the last hug I would ever give her. I planted a soft kiss on her cheek. She knew. She could tell that I was ready to break into tears but was just holding out. She kept smiling. Her eyes were telling me that it’s going to be okay. I said goodbye.

On my way out the door, I told her that I would be off the next day and wouldn’t be back till next week. I explained that someone would take over tomorrow and carry out the plan we discussed.

My last words to her were “I will see you again.” I lied. I won’t. Not in this physical life. She understood. She smiled.

I left the room and went straight to the bathroom to be alone. I cried unabashedly. I barely knew this woman but I cried like someone close to me had just died.

I do not know why, though. I am not sure why.

I never even discussed with her what she believed about death and dying. Most of us physicians do not even venture to ask patients what they believe – let alone discuss our own beliefs – on what happens after we die. We swear to preserve life and we are the superheroes who save patients from the throes of death. And yet, we cannot even discuss death with our patients. With ourselves. Death, who is our sworn nemesis. The enemy we do not even understand.

What is death? Is it just an illusion or a metaphorical doorway, and we actually continue on living afterwards as what most religions of the world say? Does consciousness persist without the body, or does it cease to exist once the body dies?

I was very religious in my early years, but later on my understanding of life and spirit expanded beyond the limitations that sometimes religion brings. Nowadays, my system of beliefs and understanding about life (and death) is based on experiential knowledge, which to me is subjective yet at the same time very personal. I would rather have that than believe in truths that others believe just because they were told to do so.

When it comes to death, however, how does one experience it and live to tell the tale? Wouldn’t that be the ultimate experiential knowledge on death? One agnostic neurosurgeon, Dr Eben Alexander III, heroically published his near-death experiences in a book entitled Proof of Heaven and seems to have been lucky enough to have had some personal experience on the matter. Not all of us are that fortunate.

So why was I crying? I still do not know.

Is it my humanity showing through in this materialistic and dualistic world that knows life and yet sees death as nothing but an end? Is it a lack of conviction about life beyond death? For, if we know with certainty that we exist beyond dying, what is there to fear? What is there to lose? Did I cry because I was so conditioned that death and dying is a bad thing, when in reality it is not? Or am I just projecting onto the situation some underlying fear or loss that needs to surface?  Did I cry because here in front of me was a brave woman, afraid of the unknown, and yet ready to face it alone with calmness and great courage?  Or did she awaken my inner compassion, the one that makes us human?

I stopped thinking and just kept letting the tears flow. And they flowed till I was empty…

Dr. Eduardo Pinto

(Author’s note:  This article speaks of a real patient, but the details of the encounter have been altered to the point of fiction in order to protect the patient’s privacy. The gist of the experience remains unaltered, and it is what inspired this writing.)