Blog | Thursday, September 28, 2017

Respect at the end of life


When I walked in and tried to shake his hand, he took one step back. He clasped both hands together and nodded in my direction. His expression was warm, though. Kind even.

But, still. He didn't shake my hand.

The center of his forehead had this slight hint of hyperpigmentation. Because his skin was already a velvety confluent espresso shade, most wouldn't have noticed it. But coupled with him not wishing to touch my hand and his somewhat exotic facial features it came together for me.

This wasn't personal. No, it was not.

The conversation about his mother was serious. His face was cloaked in pain and his eyes were glistening with tears that he dared to counter his stoic persona. “Please, doctor. Do everything. Everything you can possibly do,” he said. The words came out staccato and firm, blended with his unmistakable mother tongue. I understood him, though.

I did.

But his mom. She was sick. The kind of sick that doctors can't simply put back together. The kind that, in an elder with other serious health conditions, often leads to everyone agreeing to step out of the way of the inevitable. “Let go and let God” the Grady elders call it, a concept that, in this situation, almost always resonates.

And you know? Even for the ones who don't hold fast to Jesus Christ, they, too, are usually on board with the letting go piece. At least, in my experience, they are.

So I realized that these two scenarios are where I am most comfortable. The bible thumping, hallelujah shouting families who have Jesus on the mainline at all times and the pragmatic ones who either don't subscribe to or are unsure of higher powers but who are just steadfast in their belief in love. The approach is the same really. It focuses on reducing suffering and achieving death with dignity. You toe the line of faith and pragmatism the best you can.

“We want everything,” he kept saying. “Everything you can do to help.”

I swallowed hard and glanced at my feet. I explained about how sick his loved one is. And I spoke more about how her body is nearing the end of life.

“We can focus on her comfort,” I said. “Helping can often mean doing the things that make her not feel so bad. Sometimes when we do things we stand in the way as a person tries to rest. Like, the feeding tube we talked about. It could help her live longer but it could also cause suffering. And, like I said, stand in the way.” I was grasping. I felt my voice trailing off.

“Stand in the way? That is not possible,” he replied. Now his thick accent had a ripple of something indignant.

“I'm not sure I know what you mean,” I said. I could tell he seemed offended.

He sat up straight and stared at me intently. “In my faith, we don't believe this is possible. To stand in the way of His will. You are a part of the will of Allah. The doctors and the things you can do to keep her alive. No person can stand in the way if she is to die.”

I just stayed quiet. It was super uncomfortable. Still, he let me writhe in it. Finally I spoke. “When you say everything, tell me what you mean.”

“I mean all that can be done to keep her alive. If her heart stops, you help it come back. Whatever things you have that can be tried. We want her to stay alive.”

“But … “ When I said that one word his eyes trained onto mine and away from his mother. “You want this, even if it could mean her suffering?”

“We do not look at it in this way.” He swallowed hard and sighed. I could tell he wanted to cry. “We do not …” his voice cracked and he cleared it hard and went on. “We do not say do nothing. We do not do that. What you do to try to help is okay. We want it all. If Allah is ready for her, she will go.”

After he said that part he stood up from his bedside chair. That was his way of letting me know this discussion was over. ”Okay,” I said. Then my voice grew softer. “Okay.”

“Thank you.”

“Thank you for talking to me,” I responded.

We both just stood there for a few beats staring at his mother. Her comatose body lay limp and peaceful. Her chest rose rhythmically with each breath. And that was it.

“Okay, sir. Remember, my name is Dr. Manning, okay? Let me know if there is anything that you need or if you have more you'd like to discuss later.” And just like that I reached my hand for his, immediately wanting to kick myself for forgetting that he wouldn't shake my hand. “Oh, yes. I'm sorry.”

I turned toward the door and slipped through the partial opening. As I pulled it closed, I could see him placing a cover over his mother's shoulders and pressing his lips to her head. Then he dropped his forehead to her chest and held it there. At that point I turned away since watching felt like a violation of his privacy.

What I am learning is that the expression of love looks so many ways. But no matter what, there is always something universal about the tenderness between a mother and her child. Regardless of what I thought about the decisions he made, there was no denying that every single thing he did was rooted in love. In that sliver of a moment, I made up my mind not to ask him about this again.

I would respect their wishes. I would respect their faith. I would respect their love.

Yeah.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.