Send me an angel A dying man’s relentless pursuit of life leaves his doctor wondering how to inspire him to let go

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Do you believe in God, doctor?” Roger Evans, a 63-year-old patient with advanced cancer, asked me one morning during my hospital rounds.

As a cancer specialist, I had been asked a lot of unusual and often very difficult questions. But this question was most unusual. Not because physicians tend to feel omnipotent, and not because resorting to God is tantamount to a doctor’s defeat.

Nothing of the sort. The question was unusual because it came from Roger.

Roger was a staunch atheist. The only time he uttered “God” was to curse someone.

“God damn it, I’m going to defeat this son of a bitch … cancer,” Roger had declared when I first met him in my office. He slapped the pathology report on my desk. “With your help or without. This is do-or-die, no questions why.”

I looked at his wagging finger, his resolute face and that intense gaze. I knew I had a tiger by the tail.

Roger was a World War II veteran who for many decades had smoked Chesterfield cigarettes.

Roger himself was every bit an impressive man: tall, flat tummy, piercing blue eyes and the crew-cut hair that stood out like an army of silver needles. He carried a handsome cane.

“What’s the deal, doc? Army, Navy or the Air Force? Or all the way, three-way attack?”

My jaw dropped. “Three-way attack?”

“Chemo, radiation or surgery,” Roger clarified. I laughed. He did too. I thanked God for the lighter moment.

Mrs. Evans, sitting beside him, did not laugh. Her jowls bracketed her still lips. When our eyes met, she blinked and looked down. She seemed to have learned to live with her intense husband.

“Well, Mr. Evans,” I began to say. “In your case, the tumor has already … um …”

“Nope! Roger. Just Roger. And please put all your cards on the table. I can handle it. See this.” He pulled up the pant sleeve on his right leg. The cane resting by the chair fell down.

I gasped, looking at his artificial leg. He walked so perfectly balanced I’d have never imagined he wore a below-knee prosthesis. Regaining my composure, I asked, “How did you lose your leg?”

“How? Fighting against Wehrmacht!”

“Wehrmacht?”

“Hitler’s armed forces. Operation Overlord. Can’t forget that day, doc. As soon as Eisenhower said, ‘OK, we’ll go,’ from the English coast, within hours, 3,000 landing craft, 500 Navy vessel escorts and 822 parachute carrier aircraft took off for the Normandy beach, between Caen and the Carentan peninsula of France. We the Americans, 1st Division, had to fight Germans face-to-face at Omaha beach.”

Roger’s face turned blood red. He was animated. As he gestured, his nicotine-stained fingers shook. “And these were no sissies. German Coast Division 352nd! If we didn’t close the gap between Gold and Omaha at Post-en-Bessin, and capture Carentan on June 12, there was no way we could have liberated Western Europe. World would be different today. But I paid the price. A German grenade blew up my leg. But,” he said with a sigh, “I’m proud.”

That was quite a story. I just listened to his fascinating tale that day. Later I would learn it was all true. Nothing was spiced up. It was on the second visit, after I had gathered all the medical reports, that I got in a few words of my own.

Unfortunately, they were not as exciting as Roger’s. His lung cancer had spread into the liver, obviating the purpose of surgery. Radiation would only numb the liver capsule and relieve the pain. But Roger had no pain! And chemo offered no cure, only a 20 percent chance of the tumor shrinking in the liver. And the lesion could grow again after the chemo stopped. But that’s all there was to offer. It was more like a psychological palliation.

I had begun to like Roger and his spunk. I wasn’t sure I wanted to twist his arm for a marginal drug that could compromise the quality of his life. I felt frustrated. I felt cornered. I shouldn’t have become an oncologist. Self-doubts overwhelmed me. The outlook, to put it mildly, was bleak.

I presented my doubts to him. Without flinching an eyelid, he asked me to start chemotherapy. I wasn’t surprised. “Let’s go for it,” he said. He stood up smiling. Week after week, Roger dutifully showed up for chemotherapy. Each week he received intravenous fluids, antiemetics and the anti-cancer chemical. Roger took the chemo “like a man.” All 12 weeks of it. No complaints.

And now the moment of truth. Roger underwent a gamut of restaging: CAT scans, chest X-ray and a blood test. I was not sure I should have asked him to undergo those tests. What if we failed? There was nothing else to fall back on.

Had Roger defeated the “S.O.B.”? The answer was on the CAT scan: There were more lesions on the liver.

At first, Roger did not react to the sad news. He sat quietly, stoically, grinding his teeth, his jaw muscles rippling. He stared out the window and tapped his cane. Then he gave me a piercing look and abruptly walked out of my office.

The third day Mrs. Evans called. “Doctor, Roger doesn’t sleep,” she said. “He paces all night long and reads all about his cancer.”

The next morning Roger showed up at my office without an appointment. He had an idea.

“How about a needle biopsy of the liver?” he asked. “How about testing the cancer cells in the laboratory and finding out what chemicals they are vulnerable to?”

This concept was comparable to taking a throat culture or urine culture and plotting the sample in a multisectional petri dish where antibiotics contained in different sections show which antibiotic killed the most bacteria. He told me he had called the National Cancer Institute and spoken with a representative on the hot line who had given him the idea about this “in-vitro-chemosensitivity essay.”

“Fine,” I said.

The next day Roger was in the hospital having a CAT scan-guided liver biopsy, in which a radiologist inserted a thin needle to obtain a small amount of tissue for testing. Despite my assurance that I would call him as soon as I got the results, he called my office relentlessly, practically every day.

On the seventh day, the results were ready. It was a case of not-so-good news and bad news. None of the chemicals tested exhibited convincing effectiveness against the cancer cells, but some chemicals were partially effective.

“Partial or not, I want to be placed on these chemicals,” Roger demanded. I yielded, grudgingly.

Maybe he was grasping at straws. Maybe it was the right approach as he saw it. Again there was nothing to lose. I had only one fear. I hoped Roger was not getting too set to follow an irreversible path from which he could not look away. But then, how can you walk away from life or even a little hope of it?

He went back on chemotherapy. At times, I went to the hospital in the evenings to see him. He needed to talk to someone. I held his hand and talked about topics ranging from cancer to camels in Africa. He ground his teeth a lot. His dentures were practically worn down. Once, in his sleep, he broke the upper plate. All that frustration!

I spotted fatigue in his family. Nurses were also unanimously convinced of the futility of the second-line chemotherapy. I was losing hope, too.

This drama continued for two more months. He was now losing weight. His diabetes was getting out of control. At times, during conversations, he would develop mental blocks or just doze off. The family’s patience was wearing thin.

Nevertheless, Roger wanted to go on with this treatment or that. It did not matter whether the option was an established treatment, merely an idea or cancer quackery.

Once he came up with the idea of trying massive doses of vitamin C. Unfortunately, he was already taking them at home. He knew I didn’t approve of his desperate treatments.

A few weeks later, Roger became awfully sick. He was suffering from liver failure, jaundice, tremors and water retention in his abdomen. His mental faculties started to fail. I sat down with his family and told them Roger did not have too long to live.

“How long is ‘not too long’?” his impatient son asked.

“Oh, um, a few days to a couple of weeks.”

Mrs. Evans looked tired, her eyes glistening. She swallowed and looked away.

To Roger’s displeasure, I stopped the chemotherapy. The priest came to see him at his family’s request. He threw him out of the room.

“Get out of here, you bunch of fatalists,” he screamed. “Don’t you have anything better to do. Go coddle a nun. Something.”

Roger’s wife was ailing from bad arthritis in her hip. She was not in any shape to look after him. Help from home care and visiting nurse agencies wasn’t enough.

Roger needed emotional help. He flatly ruled out seeing a priest, psychologist or psychiatrist. Roger was torturing himself. At times, I felt he was torturing me, too. I felt as if he had tied my feet and still expected me to dance.

I am an oncologist who has seen many deaths, and it dawned on me: Roger was afraid to die.

He was clinging to thin bed sheets, not ready to say good-bye. But deep down, I figured, he was sad, angry, dejected. Behind the veneer of joviality and toughness, this man was depressed and scared.

How could I inspire him to let go? Succumb to death? I’m a physician! A pro-life person. I’m not a euthanasianist. In medical school I was prepared to deal with life, not death. Suddenly my education felt incomplete. I didn’t know what to do. I resorted to God. To prayers. God! Show Roger how to let go! End his suffering. O Heavenly Father, call him home!

Then something strange happened. One evening, as I was about to enter Roger’s room, I heard him talking to someone very energetically. His voice was strong. It sounded like the old Roger, when I had first met him. Was he turning the corner and embracing a miraculous recovery? I stopped in the hallway and listened.

“Dee! My honey,” Roger said, “so nice to hear your voice. After all these years! My God, you never thought of this old man.”

Visiting hours were over. Who was he talking to? Perhaps someone on the phone, I figured. Roger went on.

“I’m sorry, darling, I’m not ready to go home yet. Doctors are not done with me here. What? You’ll come to get me? Sure, sure. Not yet, OK?”

When I entered his room, Roger was crying. I stood beside his bed, dumbfounded. I had never seen Roger cry. I looked around. Surely, there was no visitor. The receiver on the bedside phone hung in the air, emitting an eerie screech. I replaced it on the cradle. Cold air blew in through the frosted window; autumn had arrived prematurely. Days had shortened. I closed the window.

Feeling dolorous, I sat beside Roger, on his bed. He quickly wiped his tears and apologized for being emotional.

When he regained his composure, he asked me, “Doc, can I go home?”

I hesitated: “Um, sure. When do you want to go home?”

“Tomorrow.”

“Yeah, sure. Tomorrow is fine. I’ll make the arrangements.”

“Thanks, doc.” He held my hand and squeezed it gently. Those intense blue eyes exuded peace. No anger.

It was then that he asked me that question: “Doctor, do you believe in God?”

His gentle squeeze broke my reverie. I looked at him, befuddled.

“That’s OK, doc,” Roger said softly. “It’s a personal question. You don’t have ….”

“No, no. That’s all right. Really. Yeah, I believe in God. I even pray,” I replied somberly.

He smiled. “Will you pray for me?”

I again hesitated, not being sure what he would ask me to pray for. Was this all a joke? I played along.

His answer stunned me. “Tell God,” he said, sighing. “Send me an angel.”

Studying his face, I nodded.

That afternoon, seeing patients, I continually thought of Roger. I listened to all patients in my office absent-mindedly. When I finished my day it was 7 p.m. Instead of going home, I returned to the hospital to see Roger.

Again, I heard him talking. I paused outside the door. Who was he talking to? I looked at the nurse in the hallway, dispensing meds from her cart next door, questioningly. She shrugged.

“Dee! My sweetheart,” I heard him say cheerfully. “Well, you got your wish. I’m ready to come home. I know, I know, you’ll take good care of me. Nope, I’m not afraid. Bring on your horse, I’ll meet you at the door. I love you, too. Bye.”

When I entered, I saw Roger’s back. He was on his side, facing the window. There was no visitor. The window was closed. And the phone was on the cradle. Who was he talking to? Himself? Was he hallucinating? Who was Dee?

Hearing my footsteps, he turned toward me, spryly. And smiled at me. I forced a smile and sat down beside him on his bed, my mind spinning. If Roger wasn’t confused, and he wasn’t talking on the phone ….

Who’s this Dee? A daughter? A friend? A niece? An acquaintance? I was mystified.

Roger sat up abruptly and embraced me. “Thanks, doc. For all you’ve done for me and my family. You are a very patient man.”

When he left his embrace I said, “I wish … I … I could have done more for you. I’m sorry, Roger.”

“Come on!” he said, in a joyous, shrill voice. “You did what you could. Right? Most of all, you put up with me! Didn’t you?”

We chatted for a while. He told me some jokes. We laughed. I’ve forgotten all his jokes, except this one about Winston Churchill:

“Churchill said to Lady Astor, whom he passionately despised, ‘Madam, I hope you forgive me for my humble remark, but you are the homeliest woman I’ve ever met in my entire life!

“Infuriated, Lady Astor growled, ‘Mr. Prime Minister, you are drunk!’

“‘That may be so, my dear lady,’ replied Churchill flatly with the cigar in his mouth. ‘But tomorrow, I will be sober.'”

I let out a hearty laugh. Roger went on: “So Lady Astor stood up abruptly and wagging her finger at Churchill, she snarled: ‘Mr. Prime Minister, you are so blatantly rude. If you were my husband, I’d poison you instantaneously.’

“‘Believe me, Madam,’ said Churchill, smirking. ‘If I were your husband, I’d take it – most readily.'”

We both laughed like never before. I hugged him and headed home. During supper, my wife asked me why I was so somber.

I brushed it off. “Oh, nothing. Just a long day.”

That night I couldn’t sleep. I tossed and turned, thinking about Roger, and thinking about Dee. Who was this person who had completely transformed Roger? I should have asked Mrs. Evans. Maybe tomorrow. Got to got to sleep. I looked at the bedside alarm clock: 1:03 a.m.

I prayed to God to send Roger an angel. And I thanked God for bringing Dee into Roger’s life. It must have been 2 a.m. when I fell asleep. But it didn’t last long.

I heard my bedside phone ringing. Tilting my head – heavy like a wrecking ball – I looked at the alarm clock. Fifteen past 4! The floor nurse was on the line.

Unnerved by lack of buzzer-calls, hollers or things thrown at the door by Roger, she had tiptoed into his room to check on him. Roger was sound asleep. An hour later, she would discover, he had fallen into an eternal sleep. Roger died peacefully. The nurse said there was a smile on his face.

I went to his funeral Mass. The church was packed: Roger’s family, friends and a lot of elderly war veterans. All his war buddies wore uniforms. Some arrived in wheelchairs; some hobbled along using walkers. The eulogy was moving.

The tough soldiers cited the tales of Roger’s heroism, his pranks, his generosities and above all his steely resolve – all ending up in tears. Some just hugged the Star of Normandy and wept.

My eyes teared up, too. I looked at Mrs. Evans. She looked too worn out to emote anymore.

Outside the church I hugged her. “Take care, dear,” I consoled her. “You know, I’m going to miss him, Roger.”

She hugged me tightly and said, “Doc, thank you so much for everything you’ve done for him, for us.” Then she introduced me to her family members.

I met Kathy, Antoinette, Phillip, Rebecca, Anthony, Mary and Roger’s son, Roger Jr. No one named Diane, Deirdre or anything like Dee was introduced. I kept looking around. Then I saw a little girl with curly hair wearing a floral frock, jumping up and down and holding Roger Jr.’s finger. Aha! I said to myself. That’s Dee!

I was wrong. Mrs. Evans said her name was Emily.

The next day I called Mrs. Evans to see how she was feeling. It was then that the mystery was solved. After ascertaining she was feeling a little better, I asked her the question:

“Do you have anybody in your family named Diane, Deirdre, or a resemblance?”

Mrs. Evans paused: “No. Not in my family. Why?”

“Oh, just, nothing. I was just, um, curious.”

I was about to say good-bye when Mrs. Evans offered, “We had a daughter.”

I listened, holding my breath.

“Roger’s heart and soul. His shadow. Hunting, camping, fishing, wherever he went, she went along with her daddy.”

“I see.”

“One day, Roger was busy reeling in a big fish. She fell off a cliff and ….” She couldn’t finish. A little later she said in staccato, “Roger wasn’t the same ever since.”

“I’m so sorry.”

“She was only 7.” Her crying got worse. I let her cry. When she quieted a bit, I asked, “What was her name?”

“Normandy. Roger called her Dee.”

Dr. A. Satta Memon is a cancer specialist at The Aroostook Medical Center in Presque Isle and associate professor of cancer medicine at Brown University, Providence, R.I. He changed the name of the family for this story.