I am not sure what prompted me to get out of bed, leave home, and visit the 92-year-old lady in room 612 at the hospital.
I had met her three days earlier when she came to the emergency room with shortness of breath and an elevated fever. The diagnosis was straightforward: bacterial pneumonia and congestive heart failure. The treatment was standard: antibiotics, diuretics, oxygen and bed rest. And yet, despite the case being so seemingly straightforward, there was something about her that was not typical.
Maybe it was the lovely Scottish accent that caught my attention. Perhaps it was the sparkle in her aged eyes. Or could it have been the family and their signs of affection toward this woman that had so preoccupied me? Each had personal moments with her, touching and caressing her, laughing with her, and recounting memories from their lives in communities far distant from here. Each had told her how much they loved her; and each undoubtedly had private moment contemplating how much they would miss her.
So, already in bed for the night, I found myself yearning to know more about this old lady with the Scottish accent and why she was so special to those who loved her. And time was running out.
I hurried to her bedside and found her as I had 17 hours earlier. She was struggling to breathe, still searching for a comforting rest when none was to be found and still ever so valiantly battling an illness that was consuming her limited physical reserves.
I greeted her and reached to hold her hand. She seemed surprised to see me so late at night but clearly appreciated my presence. As we talked, with my witnessing her labor to communicate even simple phrases and sentences, it troubled me that this old lady, who had obviously touched the lives of her children, grandchildren, nursing staff, and now even a young doctor four years out of residency training . . . this special old lady was fighting to defeat an illness she could not possibly overcome.
I had seen it before in people dying from various causes. Often I wonder why such a struggle exists when death is so imminent. Perhaps it is the patient's perception that he or she must continue the "good fight" to the very end. Perhaps the patient does it for their loved ones -- that parental fear of not knowing what will happen to one's children. Or is it fear of the unknown: Will the covenant revealed to them as children of the faith hold as promised?
I suppose no one will ever truly know the single reason for the struggle we often see at the final phase of life -- the one I now saw in the old lady with a Scottish accent.
In medical school we were taught to maintain our distance from patients, physically and emotionally. Never must we become attached to the suffering a patient endures. Avoid talking about our own struggles with illness and uncertainties. And, by all means, never venture beyond discussions of physical science, diagnoses and treatment, and into the territories of fears, emotions and spirituality.
Well, that night in room 612, I violated that clinical practice model for the first time.
For reasons I suppose I can only attribute to the callings of the Holy Spirit, I leaned over, held that old, wrinkled, arthritic hand, and whispered in her ear to stop struggling, to strive to envision a peaceful, joyful memory of years gone past. I encouraged her to pray for God's gentle touch. And to my amazement, I whispered (for the first time in my career) that I would pray for her.
I had no idea how she would take that statement. To my relief, she smiled back. In her eyes, I saw her appreciation for my showing that I did care and for my allowing a spiritual dimension to enter our relationship as doctor and patient.
An hour later I was back home at my bedside praying in earnest that the God we all share would soon embrace the old lady and free her from the distress that so consumed her.
She died later that morning with most of her family at the bedside.
The events in room 612 happened about four years ago. Since then, I am more willing to reveal a side of me that we, as medical students and resident doctors, were admonished never to expose. I pray for patients and their families. I will tell patients or their loved ones that I will pray for them during their time of duress; on rare occasions, I'll cry with the family as we all grieve the loss of someone who has touched our lives.
But the lesson for me from that experience is deeper yet, for I realized another side of healing not taught in medical school. I gained an appreciation for how we, as health care providers, might be failing our patients.
In an era when technology offers so much promise for cure and comfort of various maladies, and in an era when science has sadly surpassed faith as the source of hope for the patient and his or her loved ones, I came to realize how crucial it is that the doctor, as scientist, acknowledge his or her role as friend, comforter and, yes, even as minister. The Gospels and scriptural passages demand nothing less from us.
Now we are confronted with physician-assisted suicide. My experience in room 612 is the greatest argument I have against it.
Too often death and dying is transformed from a spiritual experience into a callous, scientific event where faith and hope are confined to brief encounters with one's minister in between doses of antibiotics, nebulization therapy and vital sign recordings. In our zeal to comfort and cure, we have lost sight of the fact that death and dying is a living experience -- similar to that of a father witnessing the miracle of birth or a mother smiling with mock surprise as her 3-year-old daughter presents a toad discovered among the flowers. Death and dying is a living experience that should not be compromised by science and technology.
There are, of course, many other arguments cited by those in opposition to physician-assisted suicide. Those arguments range from violations of the Hippocratic oath to fears about the "slippery slope" and the impact on the handicapped and mentally impaired within our society. These arguments have been clearly brought forth in a report the Michigan Commission on Death and Dying recently formulated in response to the actions of Dr. Jack Kevorkian. These arguments will certainly be brought up in other states as various legislatures entertain the legality of euthanasia.
It is easy to accept at face value what Kevorkian is espousing. It appears to be a humane and dignified way of dealing with the terribly unpleasant experiences of the sick and dying. As with the story of the lady m with the Scottish accent, most death does come with discomfort and distress. So it is not too surprising that, according to a Detroit Free Press survey, 50 percent of adults in Michigan favor assisted suicide. More disturbing is that over two-thirds of Catholics favor the concept.
Have they not been instructed in the teachings, traditions and wisdom of our Judeo-Christian heritage? Have they been poorly informed by the theologians, ethicists and philosophers of our time? Have the secular media given the clergy, ethicists and theologians an adequate voice in the debate? Where does the life of Christ fit into this controversy? Does the crucifixion have no greater meaning than the words and actions of a retired pathologist?
Death is not always a pleasant experience. I remain uncomfortable with my own mortality. I, too, struggle with the uncertainty we all must face some day. In my job I witness sickness, suffering and death that, if viewed in other than a spiritual context, would be perceived as horrible. I can cite examples of pain, confusion and anguish witnessed at the bedside.
But I can also cite, in those same examples, experiences of faith, hope and comfort displayed not only by the patient but also by his or her loved ones. It is this spiritual experience, potentially the most sacred moment in a dying person's life, that science and secular society must not deny us.
Experienceing death and dying offer each of us an opportunity to gain, regain or enhance our relationship with God. Witnessing death and dying offer each of us an opportunity to fulfill the calling so clearly stated in the Beatitudes. It is such moments of ministry that allow God's presence to be manifest in our actions and counsel.
Part of the problem in this debate is that we, as physicians, have failed to provide the most significant form of treatment for the dying: an acknowledgement that life is ultimately not controlled by those of us in the medical profession; that spirituality, touch, prayer and embrace are far more significant healing treatments than penicillin, chemotherapy, respirator management and surgical intervention. Perhaps, most importantly, we as physicians have failed to remind the dying and their loved ones of the role of faith and hope during this final and most sacred moment in their lives.
Physician-assisted suicide -- any form of euthanasia -- is wrong; it is also unnecessary. Technological advances in pain and discomfort management have been astounding in the 10 years I have practiced clinical medicine. No longer should someone be overwhelmingly uncomfortable during the final phase of life. But these technological advances pale when compared to the services provided by Hospice programs now in most communities. These programs, staffed by nurses, clergy and volunteers offer incredible care and compassion to patient and family and create an environment that maximizes the spiritual, faith healing experience for all present at the bedside.
If we, as care-givers, alter our approach toward caring for the dying, we may more effectively lessen, if not eradicate, the fear associated with the dying process. We can accomplish this by providing physical comfort, by bringing human and spiritual dimensions back into the practice of medicine, and by prayerfully living according to the Gospels -- as I learned from the old lady with the Scottish accent in room 612.