Grace Notes: A Good Place to Die
I wanted to record this essay before Mr. Abel died. I imagine, had he lived, he would have said, towards the end of our next office visit, "Now about that essay; that was really something." And then, as I prepared to leave the room, he would’ve asked: "So you think I’ll make one more month."
But I had only a title and a few sentences jotted down on the day he died. Mr. Abel had convinced me that he would make it, one more time.
He was a very determined man. We first met in December 2006. A colleague of mine referred him because he felt Mr. Abel would not tolerate treatment for relapsed acute leukemia. But Mr. Abel had a different feeling. "I think I can make it," he said.
He was partially right. He achieved a remission after spending a longtime in the intensive care unit and his recovery from the treatment took several months. Then, after a year, the leukemia relapsed a second time. When additional treatment did not produce a third remission, I recommended end of life care. He went elsewhere and received treatment.
I did not think he would survive. Nor did I think chemotherapy would produce another remission. So I was quite surprised when, six weeks later, he returned in a remission. As I examined him I posed the question that was troubling me: "Mr. Abel," I asked, "If you had followed my advice, you would be dead. Why are you here? Why do you trust me?"
He replied, "Dr. Cripe, you know everything they know. I trust your knowledge. You have a different philosophy, that’s all."
For the next nine months Mr. Abel was relieved—and more hopeful—when, each visit, the blood tests demonstrated a continued remission. But he also took to time to prepare me to prescribe chemotherapy if and when the leukemia recurred. He would assure me that he could make it even if it required more chemotherapy. "I’m not looking forward to it, but I believe I can do it," he would say. So when the leukemia recurred a third time, I prescribed chemotherapy.
There were many complications. A few days before he died, there were still leukemia cells visible in his blood. He was wrapped in blankets, his face barely visible. "So what now?" he asked. There was no doubt in my heart that it was time to care for him as he died. But I hesitated. Then he saved me. "I am not going to make it," he said. "But I am glad I stayed with you. This is a good place to die."
Mr. Abel may not agree with this but I believe, in that final year, he also was preparing me to care for him as he died. To trust a physician is to place confidence in the knowledge of the physician to act in one’s best interest. But I almost faltered. I was thinking about what chemotherapy I could offer him. I think Mr. Abel knew it would be especially difficult for me given our history; I think he prepared me to hold fast and remember that my knowledge provides a good place for some to get better; my philosophy provides for others a good place to die.