Patient’s decision leaves lasting impression

She had one foot in the grave and we knew it was time for her to let the other one start sliding in there with it. If she agreed, we would stop doing those things we had been doing to keep her alive, and do only those things necessary to keep her comfortable. Her care would be “comfort measures only,” and her code status would be “do not resuscitate” – “DNR” or “no code” in the efficient parlance of health care professionals.

That status would mean when her heart stopped, we would not try to restart it. When her breathing stopped we would do nothing but give thanks for her peaceful end. If there were something in our bag of tricks we could do to prolong her life a bit longer, we would leave it in there for the next patient, and pull no more rabbits out of the hat for her.

Becoming a no-code and getting only comfort care was the rational thing for her to do, of course. The slope of her decline was so steep we could no longer get much of a toehold to administer treatments that might hold back death. Spreading cancer had won this battle, and was just waiting for us all to give up her ghost. The doctors now agreed it was time to let her go, the nurses agreed it was time to let her go, and it remained but for the patient to agree it was time to let herself go.

It was easier for the caregivers, you see, because unlike her, we were not 40 years old and dying, and we were not going to die within days of deciding to stop the aggressive treatments. When she paused in making her decision, it gave me pause as well, to consider what it must be like at 40 to decide you will be dead in a week or two. To face that moment of decision, to know that simply saying “OK” would quickly bring my end? I doubted I would have the courage.

The thoughts about what that would be like for me swirled around my head as I finished my hospital rounds, slowing my step and weighing me down with sudden insight into what she might be thinking as she weighed her decision, and what I would be thinking were I in her condition.

I don’t want to die, but it’s not the idea of dying that I hate. It’s the living I will miss, and giving that up is what I hate. I don’t want sometime soon to be the last time I will feel my wife’s face against mine, warm and wonderful every time since the first time I felt it. And that zing in my heart when I see my children, I don’t want there to be a last time for that, either. I don’t want there to be a last time I will see my wife’s eyes in my daughters’, or hear all three of them laugh the same way because they have been laughing together for 20 years.

And why do I have to know the moment when I have slipped the mooring of my place on earth and started to drift out of life’s reach? Why can’t the cosmic decision that leads to my death just happen without my knowing, and without it being a conscious decision on my part? Why does last Christmas have to be my last Christmas? And no more golf, no more Patriots games, no more sunrises; had I known there were to be so few in my life I would have sipped the joy of each more slowly, as though they were great cups of hot coffee with cream and sugar. Damn it, I don’t want to die and it’s not fair. And dammitalltohell, but on the other hand I am more tired than I ever thought possible, and slipping away with no more fighting this disease might be like going to bed for the sweetest sleep ever.

A short while later, the patient decided to be a no-code and have only comfort care, and a week later, she was gone. Her obituary said legions about the magnitude of her decision to stop postponing the inevitable, for hers had been not only a life left behind too soon, but a life full of people and purpose left behind as well.

I thought of her again this December as Christmas approached, as my home filled with family and my life filled with cheer. I promised myself to remember her on Christmas morning, when her memory will remind me to give thanks for another day of a good life because it is a gift not given to everyone, and foolish to take it for granted.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.