|“A walk into life’s sunset.” Photo by author.|
Her head is bald, her face pale. Only a couple of weeks have passed since her latest cycle of chemotherapy, which imposed its ravages but offered no benefit. The disease is marching relentlessly ahead, the survival horizon drawing closer each day. She is alive only with the help of strong medications that maintain her blood pressure, and an implanted catheter drains liters of fluid from her abdomen daily. More than once I have drained fluid from her chest to relieve her breathlessness. She is exhausted but awake and lucid: the few words we exchange during my rounds tell me that she is aware of her circumstances and outlook. She does not anticipate a miracle, but rather wants relief from her suffering.
Her attending physician informs me that she wants to go home, wishes to end her days in her own bed, in familiar surroundings, among her loved ones. I cannot object to such a request, even though there is a significant risk of her dying in transit. We have nothing more to offer by medical means. I go to visit her one last time.
Her sister is present by her bedside, as she has been all these days. She looks up and smiles as I enter the room. The patient’s eyes are closed but she half opens them when she senses a new presence by her bed. We go through the routine questions: how are things, how does she feel, is her breathing OK, can she take liquids orally, is there anything else I can do? Yes, doctor, please leave us your phone number, just in case. No problem, the cell phone is available 24/7. The sister has finished with her agenda, now it is the patient’s turn. She opens her eyes again, forces a half smile, and forms a barely audible “Thank you” with her pale lips. A reward in kind, above and beyond any monetary fee, a memory to cherish. I stroke her cheek with the back of my hand. “God be with you,” I respond. Farewell.
ANTHONY PAPAGIANNIS is a practicing pulmonologist in Thessaloniki, Greece. He graduated from the Aristotle University of Thessaloniki Medical School. He trained in internal medicine and specialized in pulmonary medicine. He holds a postgraduate diploma in palliative medicine from the University of Cardiff and is a postgraduate instructor in the same at the University of Thessaly. He also edits the journal of the Thessaloniki Medical Association and blogs regularly.