Four Perspectives

Pin It Trudging up the hill on the west end of the Summer Road Only jag of my daily jog I came across a rare phenomenon, a downed tree. From the roots. Being on an incline, having grown at a tilt, the soil being especially muddy at this rainy time of the year and from who knows what other nature-al reasons, gravity had it's say. It was a tall bull pine, not massive in girth but impressive in reach. I'm always taken aback by an uprooted tree, by the size of the earth ball it pulls up, a Paul Bunyan size pancake, and the crater it leaves behind. The intricacy of it's private self, it's underskirt of roots now exposed is always interesting but not quite right, as though I shouldn't be seeing what I am seeing. It is certainly too large to cover up. I stared at it for a few minutes puffing warm steam into the cold air. The only sound at that time of the morning was my own lung's wheeze and pump. I gently stroked one of the tree's roots. I murmured aloud, "Awfully sorry, old man. A bit of a shock to us who pass you by every day unaware of what forces you have had to exert for who knows how long to resist the relentless pull of gravity."

Mr. Lou Becker is dying, one of my patients. I have had to talk to him about it today. He is asking me questions that make it impossible to skirt around the inevitable. I can't seem to get used to this. In my naivete I never expected to lose a patient, the same as I never expected to lose a child. I've never anticipated this to be part of my job. I've always assumed patients have already talked to their Dr.'s about it. Perhaps they have and they weren't completely satisfied or perhaps they have denied again the verdict or they simply blocked part of the conversation. Or perhaps they need validation from another source. Or they just want to talk about it to another human being, though a stranger, who will listen anew. Whatever it is, I have many, many times had to quickly compose in my mind as gentle a straightforward discussion with the dying as I can muster. I certainly never take it casually. I consider it a sacred honor but I don't particularly like doing it. It drains me emotionally for the rest of the day if not haunts me for another day or two after that. I think I'm barely above awkward at it.

I find I can hardly help myself wanting to touch them while we talk and that feeling is almost always reciprocated. As I brush their arm with my fingertips or rub their shoulder or stroke the top of their head they clutch at my hand. Most often we end up holding hands the whole time we talk like two frightened school children strengthening each other for the walk to first grade. Three things are always the same. Always. One, I never feel any braver than they do. I feel a large amount of frustration because I know some things about their future that most of them do not know but how to share that with them I do not know. I've never believed in death bed repentance and this feels a little bit like that. On very rare occasions I do share some of what I know with a patient and I am always intensely happy after that. More often, it doesn't seem like the time. I mostly listen.

Two, they want to describe to me how they are feeling deep inside. And those feelings are mostly descriptions of physical things, the way their chest cavity feels like it is going to tear apart or explode any moment, that they are trying to breathe around a concrete band encircling their rib cage, that they just can't get a sweet breath of air no matter what they do. That they feel like an old bass gasping as they flop around on the ground. These are feelings that for some reason they are ashamed of or they have tried and met with no success at conversing about them with their spouse.

Third, every old man who gets to this point with me always says the same thing. Identical. Verbatim. "It isn't that I'm afraid of dying, ma'am. It's just that I don't want to leave her alone (referring to their spouse)." It has taken me 32 years to finally realize that what they are saying is, "I am afraid to be left alone." After all, their wife will not experience full grief for some time, right now to care for him is a terrible burden on her, physically as well as emotionally to the point that when he does die, for a while it will be a relief. That is life's physical cold, hard fact for all of us. He will finally stop leaning so heavily on her. So it can't be that his is honestly concerned for her being left alone. He just doesn't know what is in store for him after death. Will he be alone? As far as I can figure, it all harks back to the Garden. The man could not be left a lone man in the Garden of Eden. It's elemental for them.

I repeat, "Awfully sorry, old man. Bit of a shock, isn't it? For you. . . for us." Then I add under my breath almost, "There are wonderful surprises ahead and everything will finally be fair."