Listen

It's taken me a while to write this:

Sometimes the way God can align my life's little stars amazes me.

I mentioned a while ago that I'd had to tell one of my patients that he had lung cancer. It was so. hard.

But, as it turns out, what comes after a terminal diagnosis is infinitely harder.

J (alias) was stoic, but his wife needed my hand for holding. I was happy to offer up what little effective medicine I had.

The brevity of the time from diagnosis to near-death astonished me. The chemo, done in an effort to stave off the metastatic disease for a month or two at most, had destroyed most of his normal organ function as well.

Finally, the family decided, it was time for hospice care. If nothing else, they wanted to see his pain relieved. They settled into a strange new--albeit surely shortlived--normal and prayed that J would somehow make it to meet his first grandbaby. I prayed too.

They were often close to my thoughts.

Except not at 1 o'clock in the morning, which is what time it was when I finished up an admission during a brutal call night. I grabbed my coat and headed for the door. I still had to drive over to the other hospital we cover and admit another patient. These nights have taught me to just put my head down and keep moving.

Before I left, I checked the online ER charting system to see if any other patients of ours were in the ER. Our practice wasn't listed in the PCP (primary care physician) column for any other patient's. Phew. 'Maybe you should just ask the ER doctor's if they know of any patient's who might need to be seen." 'No, no,' I thought back, 'I just need to go get started on the next one. No one's listed in the computer anyhow.' But the thought persisted, as the good ones are so prone to do, and so I relented.

I stopped by the doctor station. "Anyone have a patient of ours pending?"

"Uh, yeah, actually I do," one doctor piped up.

NOOOO, I thought. Why, oh, why did I ask? There's always this fear that if you ask, the ER doctors will ask you to see and/or admit someone they otherwise would have sent home.

"Really? There's no one listed in the computer."

"Yeah, actually, I think he's your patient. You know J, right?"

"J's here??"

"Yeah, I wasn't going to call you until later, but since you asked. He is having some difficulty breathing. I know he's on hospice care, but his wife got scared. If you want to talk to them..."

"Yes, yes, of course. Thank you for letting me know."

What a strange coincidence, I thought.

I went into their room. "Dr. H!" They were relieved to see a familiar face. The wife's face was lined with panic and J's face was lined with fatigue. The work of breathing was taking a toll. He looked very sick, but was still awake, alert, talking. I examined him. Let's keep him overnight, we decided. Yes he was supposed to be on home hospice, but the staff wasn't being as attentive as they should have. I stepped out of the room so that I could write up his orders. I was tucked away in a little cubby working on them when I heard someone start wailing. Yikes, someone really sick must have just come in. I kept working.

Suddenly, a frantic nurse poked her head around the corner. "Your patient is dying out here!" she barked.

"What?!" My papers spilled to the floor as I stood up and raced toward their room. I could see the wife. Wailing.

I walked in, trying to offer up some calm in a tempest. I assessed the situation. J was staring straight ahead, not seeing, not responding. Not looking very 'with us.'

"Is he dead, Dr. H? Is he breathing? Is he BREATHING?". The rise and fall of his chest, and a heartbeat on the monitor, let me know that he was still, on some level, alive.

"Yes, he's still alive." More questions, more answers. I mainly tried to defray the fear.

We put an oxygen mask on, we gave him pain medicine, and then we waited. He was a DNR (do not resuscitate) so we did not do more.

The wailing softened into crying and expressions of love. It became clear that these were his final hours. They passed. His oxygen level began to drop. His breathing slowed.

"Can he still hear me Dr. H?"

What do you do when you don't have all the answers? "Yes, he can hear you."

Family and friends filled the small ER room. I held J's hand. I thought of what a good man he was and how well he had endured this illness. I thought of all the people who were in this room, and of all those who loved him. It was time to say goodbye.

After the final breath was taken, they looked at me. I went through the technicalities required to 'pronounce' someone.

"He's gone."

And it was back to wailing as the finality of it all settled in. Followed again by peaceful mourning. I wondered what to do next. There were technicalities to be dealt with, but they seem so out of place in these situations. Somehow we worked them out. We sat quietly and we hugged. Then I finally excused myself to go admit the patient at the other hospital.

"I can't believe you happened to be here tonight," the wife said before I left.

I know. I know. They usually go to the other hospital. I'm one of several doctors who share call. If I hadn't asked...If I hadn't listened to a thought....The ER doctor surely wouldn't have called me until it was too late.

She said she'd call me with the funeral information, and then I left.


I arrived home during the early hours of the morning. Almost daybreak. I slipped my key silently into the lock and let myself in. I didn't want to wake my baby or my husband, though I wanted desperately to hold them. I walked to the guestroom and fell to my knees.

'Heavenly Father,' I prayed. And then I talked to Him about what was in my heart. About the equal parts of depression, gratitude and astonishment that were filling up inside of me. About the meaning of life and suffering and death. About how grateful I was to Him for paying attention: to one small doctor on call and to one of a million families who was suffering. For putting us at the same hospital at the same time at the same hour on a Saturday night. About miracles and healing and my small part in those things. And about my understanding of eternity, and more importantly, eternal families.

I put my pager on the nightstand. My white coat lay crumpled next to the bed with my stethoscope inside.

Then I laid my head on my pillow, and I waited.

Sleep never came, but peace finally did.