Grace Notes: Faith, Hope, and Love
And finally this week, Dr. Larry Cripe with his latest Grace Notes essay. This one is called "Faith, Hope and Love."
Recently I was asked the most challenging question I’ve ever been asked as a physician. And I am not sure I answered it honestly -- the first time.
The patient was a young woman with several small children. Her parents had taken turns staying with her or helping her husband at home for the six weeks she was in the hospital. Then, after only a few days home, she was re-admitted with an infection and persistent leukemia. I met with them to discuss her options. During a moment when, I presume, she realized that she would most likely die regardless of her choice, she asked, in a meek distant voice, "What would you recommend if I were your daughter?" I glanced over at her parents.
Young people are not supposed to die of acute leukemia. She was potentially eligible for an experimental transplant. She could even be cured: if we could treat the infection; if the leukemia did not progress before we found a donor; if her kidneys, heart and lungs, and liver remained healthy; and if all the anticipated and unanticipated complications did not occur. And if she survived the transplant and it was enough to overwhelm the leukemia. Wasn’t the only answer: go for it, no matter how slim the odds?
Yet people young and old do die of acute leukemia. Parents and children do endure losses of unimaginable magnitude. When do we choose to concede death is inevitable only at the final moment of life? When do we choose to conserve the remaining time with some sense that preparing for death may make the unendurable slightly less so for those we leave behind?
I equivocated: "I would honor, respect, and support any choice you make," I said. "But what should I choose," she asked, "What would you recommend if I were your daughter?" Her question struck at ununprotected place. There was an answer that struck me as true but not what she would want to hear.
Faith. Hope. Love. The greatest of these is love. Many of my colleagues have a greater faith in medical science than I, a belief that a potential good justifies risking great harm. But from the bottom of my heart I knew she would die. Looking at her parents, I felt that I —- as a physician -- should lead her towards the aggressive, support the clinical trial. And yet I could not. I knew how hopeful it would seem to discuss antibiotics, donor-screening, or the need to consider further chemotherapy if a donor were not found soon. And yet as a parent, I thought of love.
We discharged her to receive antibiotics at home to see if she would improve. A week later her local oncologist called me and asked if I really believed she had any realistic options? No, I replied. He took care of her as she died on hospice at home.
I never had the opportunity to answer her question a second time; to say what was in my heart that night. I wished I had replied, "I would scoop you in my arms and carry you far away from the hospital and cherish every remaining moment." In the end I wish I had trusted that her parents’ love was enough to carry her to wherever she was going.