An Unexpected Blessing

It’s the end of our second clerkship, and I’m on the psychiatry consult service for the third week. We got called towards the end of the day to assess a patient ”expressing suicidal ideation.” The only details we had were that the patient, Mrs. P, was a 79-year-old woman who had been diagnosed with cancer.

I walked in the room expecting to see a frail, despondent figure lying far beneath the covers of her hospital bed.

What I saw instead was a woman standing at the sink dressed in an outlandish polyester shirt, scrubbing her hands and looking like she was, quite happily, on her way home. I let her know who I was, and she told me with a smile she didn’t need a psychiatrist.

She had come to the hospital two days before for a laser excision of a squamous cell cancer of the tongue, and during that procedure the cancer was found to be quite advanced; so much so that extensive surgery with a probable loss of her ability to speak or eat would be required for her survival. Mrs. P, I read in the chart, had declined all future procedures. And in her way, she began to tell me why.

Mrs. P had lived a full life, with a career as a librarian, a passion for literature and music, and a great love between her and her husband, and for her son. Her son had committed suicide six months earlier after a long battle with alcoholism. Her husband had died some 25 years ago.

Yet she reflected on her life as being blessed, and without tragedy, she said. I asked her, as I was supposed to do, if she had ever been depressed. “Hasn’t everyone?” was her reply. I asked for her definition of depression and she said, “It’s when the bubble is gone.”

But her bubble wasn’t gone yet, she said. The doctor had given her six months, and she preferred to live her remaining days on her own terms. When the pain got too bad, she said, she would end her life, with the help of her copy of The Final Exit. And I knew as I sat there with her that her regrets were few, and her mind, and her heart, were sound. An “incredible example of ego integrity” said my attending.

I cried after saying goodbye to Mrs. P, not because of sadness about her foreshortened future, but because to see and feel that integrity, that force that is so decidedly human, is one of the most beautiful gifts that medicine has to offer us. It is an unexpected blessing from our patients to us.

I cannot think of another career where you have the privilege to be within someone else’s human experience right beside them, and where you are so vividly reminded of the deep connections between us all. These are the moments after which you are changed forever.

The world I left this morning as I walked into the hospital was no longer there when I walked back out. Every face I saw had an expression, every movement a purpose. These are the times when life slows once again so we may soak up our surroundings, and our faith, compassion, and dedication are renewed.

Part of my job before I left today was to let the ENT service, which consulted us about Mrs. P, know that Mrs. P was not in fact a danger to herself and could be allowed to leave AMA.

I described to the ENT resident how we came to this resolution, and he let me know he would indeed discharge Mrs. P home, but it would not be against medical advice. I like to think he connected with Mrs. P as we had, and knew that her decision to face her death on her own terms was an unequivocal triumph for her life.

jessmith@ucdavis.edu