James, age 64, was a successful businessman who had retired a few years earlier on his doctor’s orders, to reduce the stress in his life. His wife Helen, several years younger, was still working. When James suggested traveling, Helen declined, citing the press of work. She would retire in another year or two, and they would have plenty of time to travel then.
One day, their youngest daughter Rebecca, age 27, received a shocking call from her mother. The doctor had taken an x-ray, and James had a spot on his lung. It wasn’t this news that unsettled Rebecca; she didn’t really know what it meant. It was that her mother was crying, something Rebecca had never known her to do, not even once.
Desperate to restore a sense of normalcy, Rebecca said frantically, “Maybe it’s nothing! You don’t really know yet!”
Her mother said, “It’s something. I know.”
It turned out that Helen was right. James had lung cancer, and underwent aggressive treatment. He was in and out of the hospital repeatedly. All of the care did not buy him much time. Seven months later, he was back in the hospital. The lung cancer had spread to his brain, and one day he had a small stroke.
His doctor ordered an evaluation by a neurologist.
Rebecca was in her father’s hospital room when a doctor none of them had ever seen before strode rapidly into the room, stopping abruptly at the foot of the bed.
“What’s today’s date?” he demanded brusquely, without introducing himself or giving any greeting.
Rebecca and her brother David and her sister Ellie glanced worriedly at each other. Their father didn’t watch television, and recent vision problems prevented him from reading the newspaper. He didn’t listen to the radio. He was confined to a hospital bed and had been there for ten days. There were no cues to anchor him to the calendar.
He didn’t know the date.
“What day of the week is it?” the doctor demanded, equally brusquely.
Again, James had no way of knowing.
“How long have you had this?” barked the doctor.
Again, Rebecca and her siblings furrowed their brows. What was “this?” The lung cancer? And did that mean the date it was originally diagnosed, or was he asking for the date when James had been told that the cancer had spread to his brain, the reason for his current hospitalization? Was he asking for the date of the stroke? Or about the vision problems, which had followed? What was the doctor talking about?
James, like his entire family, was unable to understand what the doctor wanted and so could not answer the question.
The doctor turned sharply and in an instant he was gone. He had been in the room for no more than 20 seconds.
Rebecca was horrified when her father burst into tears. She had never seen her father cry.
“That man was trying to make a fool out of me!” her father choked out through his tears.
She didn’t know then that James would be dead ten days later, but she knew that he was dying.
She stood up straight and walked quietly out of the room. She found the doctor at the nurses’ station, filling out some paperwork.
She introduced herself as James’ daughter, and told the doctor that her father had started crying when the doctor had left the room. James felt disrespected and diminished. She explained that none of the family members, all of whom were mentally competent, would have been able to answer any of his questions if they had been in James’ shoes, and explained why not.
She said, “He’s dying. His birthday is two months away, but he won’t live to see it.” She asked the doctor why he had approached her father the way he had, why he had spoken to him so abruptly, upsetting him and making one of his last memories be an experience of extreme distress.
The doctor apologized. He said that he had not seen James’ chart and did not know what was wrong with him or any of the history of his condition. He had assumed that James had been admitted to the hospital because of a sudden, unexplained neurological symptom. He was very busy, and had a standard set of questions he asked everyone, and that is what he had done.
He blamed unspecified others for the crossed wires. “They should have given me a few sentences. They should have explained his situation. I didn’t know.”
Doctors are perceived as authority figures wielding great power. Even as James lay dying, he wanted the doctor -- who he didn’t even know -- to think well of him.
I often suggest that the purpose of health care should be “to enable people to lead the lives they want.” It would be reasonable to ask that doctors allow patients to lead even their last few days the way they want, with their dignity preserved, being treated by doctors with the same respect and thoughtful consideration that doctors expect from patients.