Ronald Mathew was dying and he knew it. He was 84 years old and the soft alveoli in his lungs that normally imbibed oxygen with each breath were being replaced by scar tissue—a condition called Pulmonary Fibrosis.
It had begun insidiously, with a subtle feeling of shortness of breath years ago and progressed to the point where he felt he was slowly being drowned. We had tried different medications, but were unable to stop the progressive and relentless advancement of scar tissue. I started seeing him a few years ago when the right side of his heart, that had to work harder, was starting to fail. The only treatment left was a heart and lung transplant. He, however, was not a fit candidate.
“I think I have had enough,” he said to me in my office. “I cannot go on anymore.” We both knew that this day would come someday, just like we all know we will have to face the inevitable and yet never talk about it. We would always steer away from the topic of dying, and try another modality of treatment to continue on the unstable path we call life. I did not try and talk him out of his decision. His wife was with him and seemed to be at peace with his decision.
We decided to admit him to the hospital to treat any underlying infection and keep him comfortable. Later that evening, when I was done with my patients, I dropped by to see him. It was a Friday and I was off that weekend. I took off my white coat, changed into regular clothes and went into his room to say goodbye as a friend and not as his physician. He saw me, smiled and acknowledged the change.
We talked about his life, his ambitions as a young man, his children, career and life in general. His wife held his hand the whole time. I consciously did not look at the monitors, spewing out information about his failing body. We spoke about how we met, our relationship and he spoke about his last supper in a light-hearted vein. We shook hands. When I looked him in the eye, he seemed content. I walked out without looking back. I got home in a melancholic mood, hugged the kids and felt thankful to be alive.
When I got back to work on Monday and logged into the hospital computer, he wasn't on my list. I walked by his room and there was a different nurse. There was another patient, and another worried looking wife. The nursing unit was a beehive of activity, as usual. The world had moved on. It was like my patient had never existed, except in the hearts of a few people.
Death is part of being a doctor, part of being alive. We all know it is inevitable, but react differently to the prospect of it. It does not discriminate. In today's divided world, there is no discrimination in death. Race, sex, economic status, educational qualifications and professional success have no bearing on the ultimate outcome. In healthcare, it is a statistic that is frowned upon. Lawsuits are filed, and careers and lives destroyed on its account. Our lives are extremely short in the context of time, and when it is almost over, we hope there is something more. We invent places like heaven and stories of reincarnation, of souls, judgement, hell and eternal damnation.
Science is more cruel. The real truth is the body is a biological specimen that ages, degenerates and decomposes. Once you are dead, there is nothing more. Hell and heaven are right here, and generally related to the choices we make. I wonder when my time comes, whether I would be ready and at peace like Mathew. Would you?