Stories from the Stethoscope: July 2020

I met Bill while I was moonlighting as a hospitalist. He would come in almost every month with urinary tract infections. He was in his late 70’s with advanced dementia, bed bound and had a catheter to help drain his urine. One of the things that impressed me about him was his moments of clarity. Although many times he would not speak or even make sense there were times he could be profound with just a few words. He lived in a nursing home year-round, but I would talk with his wife on the phone about his care. She once told me he was an accomplished author who wrote novels about sailing. Google confirmed his impressive credentials. I asked him which was his favorite story. He replied without hesitation, “All of them.” I asked him during his next hospitalization, “what can I do for you?” He replied, “Let me die!” I was so taken back by the clarity and emotion in this comment. I called his wife to have a general discussion about the family’s feelings about end of life decisions and what Bill had just told me. She shared that her son was adamant about not giving up on his father and was refusing to allow her to pursue a Do Not Resuscitate order. She gave me permission to share my experience with her son and she would support any outcome that develops from this. I reached out to Bill’s son who lived about 50 miles away. I shared my enjoyment and experiences taking care of his father over the last few months. I also shared what Bill told me. I suggested he come out to visit and we all just talk. He agreed and I met him at the hospital the next day. He was a supportive son who loved his father. I told him just to talk to his father. I am not asking you to sign any paperwork but just to talk to your father and share how you feel. I stood by the door as he leaned over his father. He told Bill how much he loved him, and he did not want to lose him. Bill sat quietly and listened. He asked his father why he wanted to die. Bill said, “I have had enough.” His son cried and embraced his father. He realized he would never give up on the love he felt for his father, but he needed to let his father be at peace. He said, I will call mom and we will do what you want us to do. The family talked, and they decided not to send Bill back to the hospital and let him stay in the nursing home from now on. About two months later, Bills wife surprised me by dropping off one of his novels for me. I talked with her and she shared that he died peacefully and thanked me for helping him. End of life discussions can be the hardest in medicine to make. I never force my beliefs on a family, my role is to share my experiences and shed light on the decision that lies before them. I eagerly took the book home and opened it up that evening. As I was about to begin a tear came to my eye and I put the book down. I realized I was a part of my favorite Bill story and anything else would never come close.