Vic

Once in a while, in the middle of an ordinary day, I have a grab-me-by-the-ears, shake-me-to-the-core encounter. This happened a while back, and I am better because of it. A better mom, a better wife, a better physician and hopefully, a better Christian. Special thank to the patient and his family for granting me permission to share the story. (Name has been changed to protect privacy)."

"Maybe you just want to come take a look at him," the nurse said after I answered the page. She was referring to Vic*, an 88 year old man who was being treated for pneumonia. He had been doing great that morning, and during rounds I'd made plans for discharge the next day. I arrived to find him in the bed, moaning a bit, and not seeming to mind the several liters of oxygen that were blowing into his face through a mask. He didn't respond to my voice, and a painful rub to his chest produced only another groan. The day prior, when I'd assumed his care from my partner, I'd verified his code status: the orders were for the patient to be a full code (meaning in the event of an emergency we would resuscitate him with chest compressions, a shock to his heart of necessary, and medications to restore a normal heart rhythm, if indicated). He mentioned at the time that he did not wish to be intubated, or placed on a machine to breath for him, for any reason.

I ordered several blood tests, and EKG, and a CT scan to try to determine what had caused his sudden decline in status. As I began to get results back, the patient became more responsive. He denied any pain or shortness of breath. He slowly became aware of his surroundings and began to converse, despite his low blood pressure. "He was a Lutheran minister, I believe," he said.

"Who's that?" I asked.

"I heard him on television, and I believe he was a Lutheran Minister. He said 'bury me a Christian,' and I believe that's the best eulogy I've ever heard. Just bury me a Christian."

I smiled and replied, "yes, that is a nice summary, isn't it?" and went on to further assess his vital signs, his level of pain and comfort, and whether he'd experienced any new symptoms that may offer more explanation.

His lovely wife had come to eat lunch with him that day, and I was informed by the nursing staff that she hada been waiting in the lounge. She knew nothing of the recent events. I headed down the hall to update her on his now guarded condition. Upon his arrival, I spoke with the patient's son outside the rooom. "He got pretty sick on us. He's talking about eulogies in there. He seems to know what's happening. He looked great yesterday, and sometimes people who are dying will rally and look great and then before we know it, they pass away." I encouraged him to have a conversation with his parents again about their wishes if the patient were to decline again.

"I'll let you know if anything changes," said his son. "Thanks for all your help." I left the room to attend to other patients.

That evening I stopped in to check on the patient. "Vic, if you get sick again like that, what would you like me to do?"

"Bury me." He said simply. "I'm 88 years old. I'm ready to die and we've all got to die sometime."

I'd heard that statement before from people in various stages of life and various levels of health. I took note of it and reminded myself to address it again in the morning. I noted his marginal blood pressure, invited him to call if he needed anything, and left for the evening.

The next morning I arrived to find the patient sitting up in bed, alert, and smiling. His blood pressure was somewhat better, and clinically he was much improved. Again, he denied any pain, stated he was breathing without any difficulty (although he was still requiring some oxygen to maintain his saturations) and was without any complaints. I mentioned the events of the day before and he smiled at me. "You're doing a good job," he said. "I know you're doing everything you can, and I know its your job to do everything, but I'm ready to die. I've lived a long life and I'm ready to go. My family knows I'm ready."

"My job, Vic is not to do everything. My job is to do whatever it is you want for me to do, and to take good care of you while you're here. I'm not God and I don't make those decisions, but I can tell you that I respect your decisions. I won't do anything heroic, and when the time comes, I promise not to stand in your way." Tears started to run down my cheek, and I let them, and my voice began to crack. I solidified my promise and rewrote the orders so the patient would not be resuscitated or transferred to another facility for any further intervention.

"I appreciate that," he said. "Thank you."

"It's been a pleasure meeting you," I said. "I'm going to be a better physician and a better person because of you and I want to thank you."

"You're a good doctor. It's been a pleasure knowing you as well." He then refused his breakfast tray, smiled, thanked me in advance for calling his family, and closed his eyes to take a nap.

I walked down the hall, tears spilling somewhat freely. I was so humbled and admittedly, a little bit overwhelmed. There I had been, sitting next to a hospital bed, holding the hand of a gentleman I'd met a mere 72 hours prior. There I had been, having a conversation with someone who was tiptoeing on the edge of this earthly life, so ready to exit, so clear of his intention and his destination. His next assignment was to spend eternity with Jesus. In the middle of my ordinary and hectic day, I got to hold one man's hand and take a peek as he stared death (and salvation and eternity, amen!) square in the eyes. Silently I prayed for him, in thanksgiving for his 88 years and for the opportunity to meet a man who would be such a witness to me. I thanked God for the courage to have the conversations we'd had, and I asked for forgiveness for the times I've let earthly demands distract me of ultimate goal.

I called his son. "I had a good chat with your dad today. He's dying. He's ready. I wrote the orders not to resucitate him, and when the time comes I promised him I wouldn't stand in his way. He's thinking pretty clearly today, so if you want to come back and spend time, I think that would be a good idea."

"He's ready. We're ready. Just keep him comfortable. Thanks, Doc. You're doing a great job."

It felt so good to know everyone was at peace with Vic's decision. And ready. I began to ponder my own mortality. It's really that simple. In the end, bury me a Christian.

The next morning I walked in and reciprocated his sparkling smile. We talked about plans for his dismissal, and he had a few simple requests so he could be more comfortable during the day. We agreed on a plan to continue his current cares, but not to start anything new. He assured me that he was comfortable and that he wasn't having any pain. I informed him that his primary physician would be back the next day. I thanked him for the chats. I told him that I would be taking a few days off to spend with my family, but that I would check in on him when I got back.

"So I'll see you Monday," I said with a wink.

"Maybe I'll just see you another day," he said with a wink.

"And I will very much look forward to that day," I said as I walked out.

The next day, after checking out to my partner and handing over my hospital responsibilities, and after ignoring my "To Do" list and playing in the grass with my children, I received a text message from my partner:

Vic will see you another day.

Thank you, Vic. May you rest in peace. I'll see you soon.