Then he descended back into unconsciousness. His breathing stopped for twenty or thirty seconds at a time. I’d be sure it was over, only to find that his breathing would start again. It went on this way for hours.
Finally, around ten after six in the afternoon, while my mother and sister were talking and I was reading a book, I noticed that he’d stopped breathing for longer than before.
“I think he’s stopped,” I said.
We went to him. My mother took his hand. And we listened, each of us silent.
No more breaths came.
Epilogue
Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be.
We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?
The field of palliative care emerged over recent decades to bring this kind of thinking to the care of dying patients. And the specialty is advancing, bringing the same approach to other seriously ill patients, whether dying or not. This is cause for encouragement. But it is not cause for celebration. That will be warranted only when all clinicians apply such thinking to every person they touch. No separate specialty required.
If to be human is to be limited, then the role of caring professions and institutions—from surgeons to nursing homes—ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.
I never expected that among the most meaningful experiences I’d have as a doctor—and, really, as a human being—would come from helping others deal with what medicine cannot do as well as what it can. But it’s proved true, whether with a patient like Jewel Douglass, a friend like Peg Bachelder, or someone I loved as much as my father.
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MY FATHER CAME to his end never having to sacrifice his loyalties or who he was, and for that I am grateful. He was clear about his wishes even for after his death. He left instructions for my mother, my sister, and me. He wanted us to cremate his body and spread the ashes in three places that were important to him—in Athens, in the village where he’d grown up, and on the Ganges River, which is sacred to all Hindus. According to Hindu mythology, when a person’s remains touch the great river, he or she is assured eternal salvation. So for millennia, families have brought the ashes of their loved ones to the Ganges and spread them upon its waters.
A few months after my father’s death we therefore followed in those footsteps. We traveled to Varanasi, the ancient city of temples on the banks of the Ganges, which dates back to the twelfth century BC. Waking before the sun rose, we walked out onto the ghats, the walls of steep steps lining the banks of the massive river. We’d secured ahead of time the services of a pandit, a holy man, and he guided us onto a small wooden boat with a rower who pulled us out onto the predawn river.