Accompanying a Peaceful Passing

For nearly a month, Mr. A had struggled to climb the clinic staircase leading to room 307. He had just turned eighty. As he made his way to the room, he recalled that he had been married to Mrs. D for more than four decades. They had been happy. Understanding, tolerance, and loving were the secrets to their fruitful marriage that had brought them three wonderful children. Over the course of the preceding few weeks, Mr. A and his wife’s attending physician had developed a good relationship based on trust. Mr. A often communicated to him his thoughts and life experiences. As he entered the room, he found the attending physician examining his wife, who was in the same condition she had been for two weeks. “Good morning, Mr. A. Can I have a word with you?” The figure in white stood up and led an already hunchedover Mr. A to the waiting room. “Doctor, what can we do? Even though my wife has fallen into a state of deep sleep, I believe she is suffering.” His eyes filled with tears, his brow sank, and his face filled with desperation. “As I’ve tried to explain, your wife has advanced-stage ovarian cancer. I hospitalized her so that we could start chemotherapy, but it became impossible due to acute renal failure with anuria, meaning that she can no longer urinate, which has brought on the profound sopor.” “You told me that a week ago. You explained that inserting the pigtail ureteral stents would improve her kidney function, but that hasn’t happened,” Mr. A answered the physician, revealing an understanding of his wife’s abysmal and unusual clinical condition. He was a very well-informed and learned man. For a moment the doctor was stricken with grief. The suffering of his patient and her family permeated him. In medical school he was taught to refrain from emotional involvement with patients, because it would affect his scientific objectivity. However, it was extremely difficult in this case. He believed that the doctor–patient–family relationship is more than just applied science—it is also humanity. “We must limit curative remedies. Your wife’s condition can no longer be treated medically. Her illness has progressed, and her kidneys are no longer functioning. We are treating your wife with supportive therapies and focusing on her comfort,” said the oncologist, making a visible effort to hide his emotions and continue with his work. There was a moment of silence in the meeting room that day. It was just a moment—a moment that seemed eternal to the doctor. “So you mean you won’t start dialysis on my wife? I understand. Nothing more can be done now.” In an instant, the anguish and fear of losing his partner of so many years caused Mr. A to melt into his seat. Nothing more can be done. The words echoed in the physician’s mind like the sharp crack of lightning on a stormy night. Later, they would play over and over. Nothing more can be done. There’s always something more we can do, the medical professional thought. Oncology is more than just curing the patient or allowing them to live longer and better with their affliction. It is also accompanying patients and their families in the transition toward death. It’s helping, it’s serving, it’s ensuring a peaceful passing, with respect and dignity for the dying person. It’s ensuring you give them love. He raised the cup of coffee that he had made hours ago at the beginning of his rounds, but it was now cold. “Did her children from abroad arrive yet?” continued the doctor. “All three of them. They said goodbye to their mother like you suggested. They are top-notch professionals and human beings. We are both very proud of them.” “You’ve done a great job,” said the doctor. “As you know,” he continued, “your wife will continue to receive regular treatments. And with regard to euthanasia, the law prohibits it.” “I know, but even if it weren’t, I wouldn’t ask you to do that. Our religion doesn’t allow it.” That’s it, thought the doctor. Maybe if I request that she be given her last rites, then this poor woman can finally pass and rest in peace. He had forgotten the importance of spirituality in these cases. The oversights of academic training are all too many. And so it was. Mrs. D was given her last rites in accordance with her religious beliefs, surrounded by her husband and loved ones. The doctor had taken care to ensure that they all were present. It had been difficult for him to obtain an exception from the director of the clinic. But Mrs. D still could not urinate and remained in a profound sopor. “Doctor, I know that we’ve done all we can, but nothing has changed. She moans in pain at night and all day. She’s suffering and can’t rest.” The doctor and Mr. A met again in the same waiting room. Mr. A had lost a considerable amount of weight in the past month. It was as if he were being consumed from the inside out. “As you’ve mentioned, we’ve done everything medically possible. Though it’s true that, given her condition, Mrs. D should have already passed and be resting, there are exceptions to the rule,” answered the doctor.