Hektoen International

A Journal of Medical Humanities

Sarah’s lesson

Henri Colt
Laguna Beach, California, United States


Painting of St. Germain l’Auxerrois à Paris

Claude Monet. St. Germain l’Auxerrois à Paris. 1867 Alte Nationalgalerie, Berlin, 79 × 98, W.84. Source

Sarah put her hand on my forearm and dug a fingernail into my white coat. “Doc, I druther you not call my husband in just yet,” she said.

“Doc?” I smiled. “You never call me Doc.” I finished installing the morphine pump and set the dose at an hourly rate. The intravenous line fell like a noose from a bag of saline slung above my patient’s shoulder.

“I just need to be sure I have your full attention.”

Her southern drawl sounded almost comical. I knew she was exaggerating to make a point. “He wants to be here,” I said, “when it’s time.”

Sarah ran her tongue over her chafed lips. “I’ve told my family everything I had to say. The kids are all grown up. My husband is too. They’ll be all right.”

“I’m worried he won’t understand.” I tried to imagine how he felt, alone in the hallway outside the room.

“It’s called letting go, my friend. It’s Buddhist.” She propped herself up on her pillow and pulled the bedside table near. I almost spilled her water cup when I pushed it within her reach. She would not have wanted me to hand it to her.

Sarah squeezed my forearm as if she read my thoughts. “You can handle it.”

“I’m not sure.” I looked at the wall clock over the door. It was well past midnight. Everything was ready for surgery in the morning, but our plans had changed.

“My husband will understand,” she said. “We’ve talked.”

“Sarah, just hours ago, you wanted to keep on fighting.”

“Y’all mean you wanted to keep on fightin’. I don’t recall saying so.” She grinned weakly before taking a sip.

The fluid in her chest had returned. The x-rays showed a new intestinal blockage, and her pain was unbearable despite narcotics. Earlier in the day, I advised surgery to keep her alive and arranged for a private room in the hospital. She called me after dinner.

“Henry, it’s time,” she said.

The palliative care team was out of ideas. Living three years with several metastatic terminal cancers was already a miracle.

Sarah’s hands shook as she put her cup on the table. We had been on a first-name basis since our first meeting. She said I reminded her of someone. Her eyes closed. I pulled the bed curtains in a vain effort to lessen the noise from the hallway. The rattle startled her.

“Where is everybody?” she said.

“They are outside,” I whispered.

Her closed-mouth smile bewildered me. She had the same smile when I first confirmed the metastatic nature of her cancer years ago. Her symptoms began while vacationing in Paris, and being a physician, she immediately sensed the diagnosis. She was in the church of Saint-Germain l’Auxerrois, she told me, a stone’s throw from The Louvre. The church was built from a mixture of Gothic and Renaissance styles. Her vivid description of its stained-glass windows and tower bells made me forget how thousands of Protestant Huguenots were massacred there by French Roman Catholics in 1572.

“It’s where I met the love of my life,” she confided later. Naively, I presumed she meant her husband.

“My goodness no,” she said coyly. “I mean my French lover, my youth, everything I could have been.”

I am not sure why, but from that day onward, we bonded. Just as strangers might unexpectedly become intimate travel companions, we shared our life stories without the typical reservations that inhibit most doctor-patient relationships. When I bragged that I had learned to connect emotionally with my patients, she scolded me. Your desire to understand others is commendable, she said, but it’s meaningless as all get-out unless you first discover your own humanity, and that is the work of a lifetime.

Our chats were long conversations that caused delays in my clinic and prompted reprimands from the administration. I did not care. I dreaded our frequent encounters when she was ill, yet I also looked forward to them, guiltily.

She never talked down to me despite our forty-year age difference. Nor did she discuss her family, work, fame, or any of her well-known scientific discoveries. Instead, she shared her love for painting and early twentieth-century art. She could recite the Rubaiyat of Omar Khayam as well as the poetry of Robert Penn Warren and Wallace Stevens. The way she told me she almost dropped out of medical school to become a sculptor made me think I was listening to someone writing a novel.

“Promise me somethin’,” she insisted months later, after yet another palliative procedure. I was discharging her from the recovery unit. She could not button her blouse. The simplest gesture had become difficult after rounds of chemotherapy left her once-dexterous surgeon’s fingers insensitive and clumsy. Her breathing was labored, her abdomen uncomfortably distended. She could not eat without being nauseous, and painkillers blunted her ability to think. Dying was also living, she remarked. It’s all part of the adventure.

“You must promise me,” she said, “that when the time comes . . .”

I tried to interrupt, but she put her fingers to her lips.

“Now, hush your mouth,” she ordered. “Give me your word that you will turn up the morphine, gently, so I don’t wake up.”

That was not a request, I thought. Her decisional powers were unquestionable. I was intimidated, but her strength of character was inspiring. I remember nodding affirmatively, but it was a devil’s bargain, and today it was time to pay.

I felt uncomfortable standing over her. Stupidly, I folded my arms. I quickly dropped them to my side. “Your call this evening was unexpected,” I said.

She patted the quilt she had brought from home and motioned for me to sit beside her. Her closed-mouth smile had a warmth I had not seen before. “Isn’t it always?” she said.

“I have you on the morning schedule.” I was desperate.

“I am sure you do,” she said. She tugged at her nightshirt under the covers, then struggled to button her collar with trembling fingers. “But we have an agreement.”

“Yes.” I helped her with the last button.

“So, let me tell you a story about the love of my life.”

I swallowed hard. The room was bathed in a grey, cold light from fluorescent bulbs. I did not know what to do with my hands, so I folded them in my lap. I felt like a model in one of Modigliani’s paintings.

She put her hand back on my forearm. Her drawl was musical. “We met at that same church I done told you about before. He wasn’t religious mind you, but he liked serenity. He was a short fella, muscular, with bright eyes just like yours, and black hair thick as a mop. Lookin’ at him made me laugh, but I’m tellin’ ya, when he looked at me, I thought I saw the secret of life itself.”

She paused to breathe. Her lips quivered. “I figure it took us an hour to jaunt up the hill to Montmartre, and by the time we passed that monstrosity called the Sacré Coeur church, I was in love. We bought fruit and bread at the market, and yes, fresh eggs—for the mornin’. He told me his name, it was a king’s name, and I drew his portrait while sitting under a cherry tree that overlooked all of Paris. It was like something out of a movie. We even lived in a garden apartment near Picasso’s old place called the Bateau-Lavoir on the Rue Ravignan. Soon enough my poor neck was covered in passion marks, and a few days turned into a year.”

She put her thumb and two fingers to her lips, smacking them. “L’amour,” she said, smiling the way the French smile when the wine is good, and a delicious meal is over.

“What happened?” My question stuck in the air.

“Reality. I didn’t have the gumption. I fled. I returned to New Orleans and medical school. Eventually, I found another man and bore his children.”

She glanced at her feet under the bed covers, as if studying her position, then raised her chin. She squinted and furrowed her brow while I fought back tears, trying to restrain my emotions.

I wanted to say something meaningful, but I was tongue-tied and sputtered something foolish.

“You’ve helped thousands of people.”

She waved my words aside. “Well, bless your sweet heart. That means a lot.”

I heard the door open. Sarah’s husband pulled the curtains and quietly kissed her on the forehead. He sat in the corner of the room, saying nothing while she slept.

An hour passed.

“How do we know she wants to die?” he whispered.

I was still sitting on Sarah’s hospital bed, watching her heart rate fall. The seconds lingered between breaths. Her body was beaten, but her eyes were steadfast when she opened them, though she seemed surprised each time she emerged from her slumber. When I saw her close-mouthed smile again, I knew she had made her decision.

“It’s your first time,” she said.

I nodded.

“We always remember our first.”

I swallowed hard again. My eyes were burning.

“Let’s do it,” she said. She nodded faintly before pushing the back of her head into the pillows. I released the lock on the intravenous line above her shoulder, causing the liquid to flow faster through the plastic tubing. Sarah waved at her husband and put her hand back on my forearm. She winked. “I’ll see you on the other side.”




HENRI COLT, MD, is a physician-writer, award-winning medical educator, and adventure traveler whose short stories have appeared in Rock and Ice Magazine, Adelaide Literary Magazine, Active Muse, Red Fez, and elsewhere. He is the editor of The Picture of Health: medical ethics and the movies (Oxford University Press). He is professor emeritus, University of California, and a medical ethicist.



Fall 2020  |  Sections  |  End of Life

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