...From the plaintive voice of Jim Schmidt, a frustrated, vulnerable
man I met as a patient early in my internship, I have borrowed the title of this book. “Hey, Doc,” he called out as I entered his
exam room for the first time. With those words he tried to get my attention, tried to let me know what he needed from me as his physician,
tried to call me to action on his behalf. At the time he did so in anger and fear, a proud man trapped in a body experiencing inexorable
decline. Over time, I came to realize that whenever I heard those words, “Hey, Doc,” whether from Jim or anybody else, they held a
multilayered meaning, calling upon me as a physician for something important but not well articulated. I now know that when I hear
those words it is incumbent upon me to pay attention, for they announce a moment when a patient is about to tell me their truth, if
only I would take the time to recognize it beyond their words. In the end, that is my hope as you read this book—that you will discern
beyond its words something of the truths to which I have tried to give voice.
Though these truths are varied and complex, they
center around a common theme: listening to the heart. At first, as a physician, I was taught to listen to the physical heart
of my patients. This challenge, which consumed so much of my medical training, was to understand their physiology in all its intricacy.
Then came the realization that to truly serve as a physician for my patients, I had to listen to their emotional heart, with its even
more complex and challenging nuances. Finally, my patients taught me that if I wanted to become the physician I aspired to be, I had
to listen to my own heart, which has proven to be the greatest challenge of all.
Over two decades in medicine has taught me that the
most potent tool for healing we as physicians have is our heart. But each of us must learn to listen to our own heart before
we can touch and heal the hearts of our patients.
* * *
...A new smell brought me back. It began faintly, almost sweetly at first. Then, as we moved deeper down the hallway, it pushed aside the other smells, increasing slowly until it pinched. Formaldehyde. The odor wouldn’t stop growing, now piercing my nostrils, burning with every breath. Just then we stopped before two large, gray, metal doors. For the longest moment, nothing happened. Then, swinging back without a sound, the doors melted away, revealing a cavernous room filled with forty black, stone slab tables, each with a harsh metal light hanging over it. On every table lay a still, silent figure wrapped in white linens. Death hung palpably in the air.
Suddenly, all was frenetic activity as one hundred and sixty first year medical students flooded the room, desperately releasing the tension that had been building. “The M’s are over here,” I heard one call out.
“Come to me, baby,” another crooned. Nervous laughter filled the room as the dark humor began.
My fellow students streamed past, but I moved slowly, passing one table after another. Looking down at each still figure, I wondered, “Who are you? How did you come to be here? Did you donate your body to ‘science’? Is being preserved in formaldehyde and cut apart by medical students the noble contribution you had intended to make?” Silence was the only response. Yet, a thought formed that even in their silence they were offering to me the first lesson of my medical training. What was it that coursed through me but not them? What separated me, alive and conscious, from these still, dead shrouds? Soon enough I would learn the mechanisms that caused a heart to beat or a brain to transmit electrical impulses, but would that knowledge answer this, the most fundamental question? Raised a devout atheist, trained as a scientist, I paused at a threshold I did not fully understand. Something told me in this moment that once I began the scientific study of the human body, I’d never again engage this mystery with the wonder it deserves.
My wandering finally stopped when I found “my cadaver”. There were our names, crisply typed on a clean white paper taped to the black stone table: Schwartz, Sheff, Smith, Sullivan. My gaze rose from the paper to the figure lying on the table above it, wrapped in linens heavy with formaldehyde, the piercing odor now bringing tears to my eyes. The four of us surrounded the table. For a moment we shared something unnamed. The moment passed, and we began to unwrap the layers of linens on the arms and legs, then her torso, for we soon realized our cadaver was a woman. As I unrolled the cloth on her thigh, my gloved hand unexpectedly touched her skin. It felt surprisingly stiff and rubbery, with a cold that went beyond temperature.
Finally, she lay completely naked, except for the head which was still wrapped. The unnatural gray of her skin seemed to give off a dull, purple hue. Her breasts were shrunken, the abdomen concave, and her arms and legs extended out in unnatural angles. I reached for the linens on her head, but my hands quavered for a moment. Slowly, I unwrapped each layer, placing my hand under the back of her head to raise it with the unraveling motion, replacing it softly on the table each time. Why be so gentle, I wondered, but I couldn’t do otherwise. Her nose appeared, and then her chin and forehead. Her eyes, clouded and sunken, stared out blankly. Finally, her mouth emerged, pulled to one side, gaping open in a grimace that gave the impression she had died in pain, the agonizing moment of her passing forever frozen in her features. We could not bear to look at her face, so we rewrapped her head immediately...
“So I should make the cut right here,” I said, holding the scalpel above a point in the crease at the top of her thigh. The scalpel blade seemed suspended over the preserved skin. This is it, I thought to myself. I’m about to make the first cut into a cadaver. Then I will really have begun medical school. Nothing happened. My arm felt frozen as I scanned her body, taking in this stranger’s nakedness. Instinctively, I wondered if she would feel it. Then, by an act of will my hand and the scalpel descended into the rubbery flesh of her leg. She didn’t move. My first cut was done. I let out a breath I hadn’t realized I’d been holding.
* * *
...“It’s one thing to examine this anatomy in a textbook,” he continued, “but it’s quite another to examine it in a patient. Today you will learn how to conduct an examination of the female genitalia.” I was suddenly sitting bolt upright. So this is how it was to begin, I thought. My heart quickened.
“This is a speculum,” the white haired gentleman said, holding up an awkward looking duck-billed contraption. “It’s a gynecologist’s best friend. Learn how to use it well, and you’ll be doing right by your patients. Don’t learn how to use it well, and a lady who comes to see you once will never return. I will now teach you the art of the seductive pelvic exam.” He didn’t just use the word “seductive”, did he? “Your lady must place her feet in the stirrups and slide her vulva down to the edge of the examining table, like this,” he said, showing us a picture of a woman in the appropriate position. “This is what you’ll see.” A twelve foot tall vagina and labia filled the screen. “You seat yourself at the end of the table between her legs.” It looked remarkably awkward and embarrassing for the woman, but there was no doubt the examiner had a bird’s eye view of everything he was supposed to be examining. “It’s helpful to keep up a running explanation to the patient of what you are doing, or more precisely, what you’re about to do. Telling her what to expect goes a long way to helping her relax. Now here’s the seductive part.” I couldn’t wait to hear this. “If you immediately place the speculum in her vagina, the patient’s bulbcavernosus and pelvic floor muscles are very likely to go into spasm, sealing the vagina and making the rest of the exam difficult for you and painful for her. To avoid this, start by holding the speculum in your right hand, like this, but then gently touching her inner thigh with the outside of your right hand, at least halfway down to her knee. Then move up a few inches and touch her again. She’ll now know you’re coming.” An unfortunate choice of words, I thought. “Then touch her a final time just a few inches away from the vaginal introitus, the opening of the vagina. Resting your hand that holds the speculum there, with the other hand place two fingers in the posterior portion of the introitus and slightly spread the labia minora, the inner lips. If you’ve done this right, with the appropriate seductive technique, she should be able to relax and allow you to enter.” Did he not realize what he was saying? Apparently not. “Then insert the tip of the speculum into the vagina aiming down at a thirty degree angle. Insert it all the way in before opening it. Once fully inserted, spread the blades of the speculum.” Again a poor choice of words as the image of blades opening within the vagina momentarily made me squirm in my seat. “The cervix, the bottom part of her uterus, will literally pop into view.” A picture of a woman’s cervix as seen through the speculum now filled the screen...
“Once you’ve done this, carefully remove
the speculum. I said ‘carefully’ because if you let the blades close prematurely, you’ll pinch skin from the vaginal opening
between them, and you will never see this woman again. So be sure to maintain gentle pressure on the lever that controls the
blade opening as you remove the speculum. Too much pressure, however, and you’ll be stretching the vagina excessively, pressing
on the tender urethra anteriorly, and this, too, will be uncomfortable. Remember, too little pressure and you’ll pinch her skin,
too much pressure and you’ll be stretching her uncomfortably.” How the hell do you know how much pressure is too much
and how much is too little, I wondered almost out loud? I pictured myself awkwardly trying to remove a speculum from a woman
and could vividly see the blades close on her, hear her scream with pain, and watch her recoil from me. I shuddered...
“This looks a little more involved than learning to use a tongue depressor,” said one student to muffled laughter, “But we got to practice that before we had to do it on real patients. How do we practice this?” I listened carefully.
“We’ve thought of that. So we’ve arranged for you to practice performing pelvic exams this morning on ‘surrogate patients’. These are undergraduate women who have ‘volunteered’ to allow you to practice on them”...
The three of us huddled together, waiting for Dr. Hershowitz to return. “We’ll be ready for you in just a minute,” he had said, his white hair and starched white, monogrammed coat carrying an air of competence and experience I so clearly yearned for at that moment. The other two male students were in the year ahead of me, so they chattered away with a familiarity I didn’t share. Their jokes and nervous laughter reminded me of the gross anatomy lab. Left with my own thoughts, over and over again I pictured what I was about to do. I would walk in, calmly sit down, instruct the “patient” to slide down to the end of the table, take the speculum in one hand and subtly, unobtrusively, touch her inner thigh progressively closer to the vaginal opening, smoothly place the speculum, open it for a clear view of the cervix, obtain the specimens, remove the speculum carefully, and perform the bimanual examination. My thoughts were interrupted by Dr. Hershowitz’s return. “All right, who’s first?” he asked.
There was a long pause as we looked at each other. Should I volunteer? Was I ready? One of the other students stood up, and I breathed a sigh of relief. Not yet, I thought. He disappeared into the examining room with Dr. Hershowitz. I returned to vividly imagining every step of the pelvic exam procedure. I noticed my foot anxiously tapping up and down as I did. Sometime later, the first student emerged, a smile on his face. Was that a smile of relief? A remnant of his nervous laughter?
“How was it?” his friend asked.
“Piece of cake,” came the reply. So his smile was one of success and satisfaction I thought. Good. If he can do it, so can I. The first student left as the second student went in. I was alone now. I tried again to visualize the steps of the exam procedure, but instead my mind drifted to thoughts about the “patient”. What would make a college coed volunteer to undergo repeated pelvic exams by clumsy medical students? I figured they must pay these “surrogate patients” pretty well, at least by student standards. Why else would they do it if it weren’t for the money? My thoughts were interrupted as the second student emerged. He wasn’t smiling. He just headed for the door, like he couldn’t get there fast enough. Just as he left he called out over his shoulder, “Good luck.” What did he mean “good luck”? Why wasn’t he smiling? What had happened in there?
“Come on in.” I looked up into Dr. Hershowitz’s face. It was kind, wizened, with a soft smile that made the wrinkles at the corners of his eyes turn up. I stood up and walked stiffly into the exam room.
As I entered the room, I glanced quickly at the “patient”. She was beautiful! I hadn’t expected this. Even lying on the exam table, her long blond hair fell flowingly over her shoulders. Her features were soft and attractive. Her breasts were full and prominent, even lying supine. My heart began to race. “Michele, this is Dr. Sheff, the last of the medical students for today. Dr. Sheff, this is Michele.” Did he introduce me as doctor? But I’m not a doctor yet.
“Hi Dr. Sheff,” she said sweetly.
“Hi, Michele.” Did she hear the quiver in my voice? I looked briefly into her face. It was so open and friendly. She lay on the exam table, naked from the waist down, I knew. Her bare legs extended out from under the sheet covering her lap, a hint of the deeper beauty that lay beneath. I felt an unwanted stirring. Oh God, please don’t let me have an erection now.
“Don’t you think you should sit down,” I heard Dr. Hershowitz say. I tried to remember the steps to follow. Right, I thought, I should sit down. As I did, Michele raised her knees, placed her feet in the stirrups on either side of my ears, and slid down just to the end of the table. A musty smell of fresh vaginal secretions arose as I stared directly at her vulva, a small tuft of blond hair rising on her mons. Her vaginal opening was still wet from the KY Jelly of previous examiners, the wetness making her look all the more arousing.
“Here is the speculum,” I heard a strange voice say. I hadn’t realized a nurse was in the room with us. She was clearly impatient. I started to take the oddly shaped instrument. “Don’t you think you should put your gloves on first,” she said firmly.
“Thank you,” I managed to get out. I picked up the gloves, my hands trembling slightly. Then I took the speculum in my right hand. What to do now? Oh yes, use the fingers of my left hand to open her vagina. I reached forward. As I touched the lips, her vagina spasmed shut for a moment as her buttocks instinctively rose off the table.
“You probably should have told her you were about to begin,” Dr. Hershowitz prompted. Oh yeah, I’m supposed to tell her what I’m going to do before I do it. And her thigh. I forgot to touch her thigh first. OK let’s try this again.
“I’m going to touch the inside of your thigh first. Then you’ll feel my fingers at the opening of your vagina. Then you’ll feel the speculum going in.” That was better, my full focus finally coming to bear on what I was doing. The fingers of my left hand spread her vaginal opening slightly, and I placed the tip of the speculum into her vagina. It slid in easily. Now just press open the speculum with my thumb on this lever. “Oh shit!” I said half out loud as my thumb slipped off the lever, causing the blades to collapse and pinch her vaginal skin.
“Ouch!” she said as her buttocks jumped off the table again.
“I’m so very sorry, Michele,” I said. “Do you mind if I try it again?”
“No. I know you need to practice,” she said, after taking a deep breath.
“Thank you for being so understanding,” I said. “All right. I’m opening the speculum again. You should feel a mild stretching inside.” I looked in. No cervix.
“You probably needed to place it more posteriorly,” Dr. Hershowitz suggested. “Michele, I’m going to ask Dr. Sheff to remove the speculum and insert it again.”
“Sure,” came the remarkably calm reply.
This time Dr. Hershowitz put his hand over mine on the speculum and guided it in, pointing much more back and down than I had done initially. I opened the speculum, and her cervix popped into view. I started to take my hand away, but suddenly the speculum began to close, and I certainly didn’t want that to happen again. “What do I do to keep the speculum open?” I asked Dr. Hershowitz.
“Use your forefinger to tighten this screw here,” he said, pointing to a round-headed prominence on the speculum. I tightened it awkwardly, but the speculum stayed open. I took the necessary samples. This time, I made very sure to keep gentle pressure on the speculum as it came out. “Excellent,” I heard Dr. Hershowitz remark, the first positive comment I’d heard from him since we had started.
I stood up, and suddenly saw Michele’s face again. Instantly I felt the stirring one more time. I had been too lost in the mechanics of what I was trying to learn to even notice that I had been probing and manipulating the innermost recesses of this beautiful woman’s sex organs. The nurse placed some KY Jelly on the tips of the gloved forefinger and middle finger of my right hand. As I rubbed the jelly over my fingers I could feel its lubrication spreading, my mind associating this sensation with intimate memories I’d rather not be recalling at this moment. My fingers then entered her vagina smoothly and easily, reaching in for…for…what was I supposed to feel? Was that it? I looked up at Dr. Hershowitz with a quizzical look.
“You are trying to feel for her cervix which has the consistency of the tip of your nose,” he replied to my silent question. “The rest of her vaginal wall has the consistency of the inner portion of your lower lip.” Did he have to add this graphic detail? But the difference was helpful as my fingers recognized the firm round nub of her cervix.
Next I placed my left hand on her abdomen just below her belly button. Suddenly, I felt her hand on mine. For a moment the feeling was electrifying, but then she firmly lowered my left hand to just above her pubic hair. “There. That’s where you should feel it,” she quietly prompted. Feel what? I tried to picture her uterus, tubes and ovaries, where each was located, and to feel deliberately in each region, but it all felt the same.
“Michele is thin enough that you should be able to feel the contour of her uterus clearly,” Dr. Hershowitz commented, adding to the pressure I was already feeling. Silently, she placed her hand over mine again and pushed in much harder and deeper than I had felt comfortable doing. She was showing me how hard I could press without hurting her. There, was that it, I thought. It was terribly subtle, but I had the distinct impression of a firmness under my left hand that I could imagine was her uterus. I felt nothing in the area I was supposed to feel her ovaries.
“It would be unusual for you to feel her ovaries on your first exam,” Dr. Hershowitz reassured me. “That will come with practice. Now for the vaginal-rectal exam.”
I glanced momentarily at Michele’s face, but she was looking away, perhaps trying to relax in the face of what was about to happen. The nurse placed more jelly on my fingers. I slid the forefinger in her vagina and pushed the middle finger just up to the opening of her anus. With a silent pop, my finger entered. I advanced both fingers, feeling the delicate wall between her vagina and rectum. “Now repeat the bimanual exam,” Dr. Hershowitz prompted. Yes, that’s it, I thought as my hands went through the same maneuvers. I felt again for her uterus and again felt only the vaguest sense of a fullness. When I felt for her ovaries, I noticed her wince slightly, though I felt nothing but indistinct irregularities on either side of her uterus. I then withdrew my fingers with an unconscious sigh of relief. “That was fine for your first time,” I vaguely heard Dr. Hershowitz say encouragingly.
My eyes met Michele’s. “Mind if I ask you a question,” I heard myself saying.
“Not at all,” she replied, sitting up and facing me directly.
“Why are you doing this, being a surrogate patient and all?”
“Well, my friends told me about it ’cause they thought it was good money. While I could certainly use the money, I actually wanted to help you new doctors learn how to give a sensitive exam. I hated it when I got an exam from a doctor who was rough. So if I can help new doctors like you learn how to do it better, then that’s really important.”
“Thank you, Michele. You really did help me.” I left the room smiling.
* * *
...Just as I was heading to the on call room to try to grab an hour or two of sleep, the beeper on my belt went off. I stopped at the nearest nursing station to call the extension number on the beeper display.
“Dr. Sheff,” the voice on the other end of the phone began, “Mr. Walters in 217 has just expired. Could you please come pronounce him?”
“What happened?”
“He was a no code. Came in with end stage cancer.”
“I’ll be up in a few minutes.”
No need to rush in responding to this call, I thought. On the way up to the second floor, the phone call played over again in my head. “Dr. Sheff…” The words sounded so natural. I’d heard them many times before when patients had mistaken me for a doctor, rather than just a medical student. But they had always sounded odd—or more accurately, wrong. Suddenly I really was a doctor. Graduation from medical school, that day of celebration and relief, had produced this remarkable change. Suddenly I truly was “Dr. Sheff”. Just as suddenly, nurses, respiratory therapists, and laboratory techs turned to me to decide what to do. At this moment, they turned to me to officially usher Mr. Walters into death. I smiled at the absurd thought that without my fulfilling this ritual, Mr. Walters would not be allowed to be dead. The transformation resulting from the addition to my name of just one word, doctor, was truly extraordinary...
I arrived at the second floor nursing station and was greeted by the late shift charge nurse. “Thanks for coming up, Dr. Sheff,” she said kindly, realizing it was well after 2 AM. “This was a patient of Dr. Martinez. End stage pancreatic cancer,” she explained as she led me into room 217. There lay an emaciated, elderly appearing man with skin the color of a banana. His mouth hung open. Everything in the room was still. With a sudden flash of awareness, I realized I had managed to get through all of medical school without ever being present when a physician had pronounced a patient dead. My eyes met the nurse’s as she looked at me expectantly, assuming I knew exactly what to do. I looked back down at the patient, wondering what he needed of me at that moment. Make sure his heart has truly stopped beating and that he is no longer breathing, I thought to myself. The image of this man, shut in a casket and being buried underground alive because I had failed to confirm he was still breathing flashed before me. I removed the stethoscope that had been draped over my shoulders and placed the tips in my ears. Holding the other end over his heart, I listened intently. Silence. Leaning across his still body, I listened to the base of his lungs on one side, and then the other. Silence. Standing up, I felt for the carotid pulse on one side of his neck. Nothing moved. Just to be sure, I felt for the carotid pulse on the other side of his neck. Again nothing moved. Finally, remembering an image perhaps from an old movie, I brushed my fingers across the eyelashes of his open eyes. No movement. I looked up at he nurse, who seemed quite satisfied.
Just then, a short, balding man rushed into the room. His suit was wrinkled and his shirt collar open.
“Are you Dr. Martinez?” I asked, unsure as this was only my second day of internship.
“No. No.” He panted, winded from running up the stairs. “I am Mr. Walters’ nephew. Is he dead?”
“Yes.”
“Oh,” he answered uncertainly. Suddenly he brightened, “His wife is on her way in. She really wanted to be here when he died. Would it be OK if you stepped out, let her come in, and then came back?”
“I…I suppose I could.”
“Great.” With that, he ran out of the room.
The nurse and I looked at each other a little bewildered. While we waited for Mr. Walters’ wife and nephew to return, I sat down at the nurses station to review his chart. He was a sixty seven year old man who’d been diagnosed with cancer of the pancreas six months previously. He looked so much older than sixty seven, I thought. He’d undergone several courses of chemotherapy which hadn’t helped. The cancer had spread throughout his body, apparently causing him great pain. It had also grown locally in his pancreas, squeezing off the end of his bile duct, the tube that brought bile and other waste products from the liver into the small intestines. With his bile duct blocked by the cancer, bile backed up into the liver, causing bilirubin, one of the main components of bile, to build up in his blood stream. It was this bilirubin that had made him such a brilliant yellow color. He had been admitted three days earlier with the plan for him to die in the hospital. He’d been treated with morphine, and the notes suggested he had either been sleeping or in a coma for most of the past three days.
Just then, a rustling noise caused me to look up. Running down the darkened hall toward me were Mr. Walters’ nephew and a heavy set, anxious appearing woman, presumably his wife. They ran past where I was sitting at the nurses station and right into Mr. Walters’ room. Because of the late hour and my fatigue, it hadn’t been until that moment, watching them race toward the dead man’s room, that I fully realized what his nephew had asked me to do. He wanted me to pretend that I hadn’t already pronounced his uncle. He wanted me to conspire with him in creating a false impression for his wife that she had been there when he breathed his last. It seemed wrong. I had not only been raised to tell the truth, but felt a professional duty as a physician to tell the truth to patients. I’d also been taught in the clearest of terms that it was a crime to falsify a medical record, one that could cost me my medical license.
In the hushed late night darkness of this hospital ward, poised at a troubling moment of decision, forgotten words began to come back to me. “Every doctor-patient interaction is laced with the dynamic of power,” my hypnosis professor had stated. In this moment I realized that insight extended to family members of patients as well. I suddenly found myself with the power to ease this woman’s pain at the passing of her husband. But to do so, I would have to tell a lie—or more exactly, participate in creating a false impression. Which was more important, upholding my personal integrity as a physician as well as the integrity of the medical profession by telling the truth, or offering solace to a grieving widow? I recoiled at the thought that I was at risk of adopting the paternalistic, doctor knows best persona, something I’d rejected so thoroughly until this moment. My training as a therapist had taught me people heal best when the truth is not hidden. My experience in medical training had taught me the extraordinary courage ordinary people manifest in the face of the truth, especially at moments of tragedy such as the one unfolding before me. I’d come to believe that without truth, true healing was not possible. The power of the truth could not, and should not, be denied.
Yet another kind of power was at play here. Placed into my hands was the power to ease this woman’s pain. “You can use this power for the good of your patients,” my professor had asserted. “The best physicians do exactly that.” Did I agree? Would I use this power to participate in creating a falsehood in the name of healing? “If you are conscious of this power, you will have a choice.” At this late hour, the clear simplicity of black and white had no place. Shades of gray danced before me.
I waited a full minute, and then approached the room. Mr. Walters’ nephew looked up and, in a hushed tone said, “The doctor is here.” After a long pause, he took his aunt’s arm and slowly ushered her to the door. Looking down at the floor and shaking her head sadly, she stammered to herself, “He’s gone. I know it. He’s gone.”
The door closed, and the nurse and I found ourselves once again standing on either side of Mr. Walters’ bed. Awkwardly, we both realized there was nothing to do at this moment. It was almost difficult to keep a straight face at this supposedly somber time. I waited a decent interval, and emerged from the room.
His wife looked up into my face. “He’s gone. Isn’t he?”
“Yes, he’s gone.” She started to sob softly. I desperately sought something comforting to say.
Again words from somewhere in the past came back to me. “When giving bad news, review the history of events that led up to this moment….Remember, whatever words you say at this awkward moment will be repeated by family members and loved ones over and over again for years.”
“As you know,” I began somewhat hesitantly, “Your husband has had cancer for over six months. His doctor treated him with chemotherapy. He tried everything to save him, but nothing could help. He was admitted a few days ago, and has been receiving morphine since he came into the hospital. For the past three days he has been sleeping peacefully and died without any pain. I’m very sorry. Please let me know if there is anything else I can do to help.”
She looked up at me with wide, sad eyes. Suddenly she threw her arms around my neck. Burying her face on my shoulder she said in a torrent, “No. Thank you. You’ve done so much already. Thank you. Thank you.” With that, she released my neck, and her nephew slowly escorted her back into the room to say good-bye to her dead husband. Muffled sobs and the words, “I knew he was gone… I knew he was gone…Thank God I made it in time….” were all I could hear.
Slowly I returned to the nurses station. There, on top of his chart, was a blank death certificate. Only I, as the doctor who had pronounced him, could fill it out. For the first time, I began the ritual of completing this public record of a man’s death. Cause of death: pancreatic cancer. Date of death: June 22. Time of death…I looked at my watch. 2:58 AM. Though he had stopped breathing over an hour ago, and I’d completed pronouncing him twenty minutes ago, as his time of death I wrote down 2:55 AM. His wife will forever believe she was there when he died.
Perhaps this is what I’d done that had led his wife to thank me so profusely, saying I had done so much? Or perhaps it was leaving her with an image of her husband sleeping comfortably, dying peacefully and without pain after having suffered so much for the months leading up to this, his final night. Perhaps in that moment I had come to stand for all the doctors and all the nurses who had provided care and comfort to her and her husband during his entire illness, and she had poured out her gratitude to me because I was the doctor standing before her. I paused, another thought forming. Perhaps she was grateful for the relief of knowing that, at this moment of utter powerlessness, when she was forced to surrender the one most precious thing in her life, someone else had stepped in to assume control. In so doing I had also brought order and a semblance of meaning to this searing moment by reminding her that everything possible had been done for her husband, and that his death was the natural order of things...