Two of the hardest things for a physician to deal with are death and dying.  Telling a patient that he/she was dying was extremely hard.  Telling a patient that their child was dying was devastating.  Over my 34 years in practice, I had lots of patients try to die.  Some were successful, others were not.  All of these patients offered up a lesson to be learned.  Every time I had to tell a patient that he/she or a family member was going to die, part of me died. 

On two occasions, the dying patient’s lessons pumped me full of life, hope, and boosted my spirits at a time when I needed a boost.  In the “House of God,” one of the resident’s decisions backfired.  The patient got worse and death was eminent.  The resident, being unable to forgive himself, committed suicide.  In retrospect, all physicians will have cases that haunt them.  Cases where, if they had turned right rather than left, their patient would have done better.  Living with those decisions weighs heavily on every physician I have ever worked with and contributes heavily to the epidemic of physician suicide that is devasting the medical community.

Now for my two teaching cases.  “X” was in his 80s.  “X” was in the ICU with chronic liver, kidney, heart and lung failure.  He was breathing 4 times a minute (not compatible with life).  His children wanted to take him home so he could die in his own bed with his family at bedside.  I told his family that he probably would die in the car but that there was no reason not to take him home.  He was discharged to home with no further medical care.  Four days later, “X” walked into his kitchen and got a cup of coffee.  “X” lived another 18 months.  He took no medication.  At my suggestion, he saw no doctors.  His chronic lung and liver failure clinically persisted.  “X” lived by the grace of God.  Every time he did see a doc, he got worse.  One of the premises of “The House of God” was that the best medical care was no medical care.  “X” was living proof of that premise.  “X” taught me that nothing is for sure.  “X’s” story gave hope to many!

My second story is right out of the pages of a Steven King novel.  However, it’s true.  It really happened.  I always hated prom night.  There was always a disaster to be dealt with on prom night.  On this particular night, an auto accident put best friends in the hospital: one in the ICU and the other on 4 West.  Both were critical; the patient on 4 West died at 3 am.  At 7 am, I made rounds in the ICU.  “R” was alert and talking.  Before I could say anything, he told me that his friend, “D,” visited him at 3 am.  “D” told him that everything was going to be ok and that he would stop by from time to time.  “R” was ecstatic that his buddy was doing so well.  I was blown away!  I dreaded telling “R” that “D” had died but “R” took it well stating that “D” reassured him that everything would be ok.

I quizzed the nurses who verified that they did not tell “R” about “D.”  “R” had no visitors.  At a time when my spiritual being was lacking, living through this was like filling my tank with jet fuel.  This story has helped many over the years. 

The hero of the book, the “Fat Man,” teaches his interns that the best medicine is no medicine.  “FM” believes that the more he does for a patient the worse the patient will be.  Crazy, right?  My first patient with cancer had an advanced rectal cancer.  My surgeon refused to operate stating that the patient had zero chance of surviving; and, even if surgery gave her a few more months, they would be lousy months.  I was young and aggressive, so I transferred her to another surgeon at another hospital for surgery.  She spent 4 months hospitalized and then died.  Her death was horrendous and has haunted me ever since.

There are many more stories. Having been there and done it all, I now agree with Fats. Doing nothing is always a viable choice; and, many times, it is the right choice.

Here’s your joke of the day.

A college professor reminds her class of the next day’s final exam saying, “I won’t tolerate any excuses for you not being there tomorrow. I might consider a nuclear attack or a serious personal injury or illness, or a death in your immediate family, but that’s it, no other excuses whatsoever.”

A guy sitting at the back asks, “What would you say if tomorrow I said I was suffering from complete and utter sexual exhaustion?”

The teacher smiles sympathetically at the student, and says, “Well, I guess you’d have to write the exam with your other hand.”

Here’s a second joke.

There was an American wrestler from Texas named John, who throughout his high school career had never lost a match. As he went on into college, he continued undefeated. He became a national icon and symbol of American strength.

News began to circulate of a Russian wrestler who was fierce and unstoppable. As each wrestlers’s legends grew, a match was set up between the two, America versus Russia. The match would be held in Texas.

John began training immediately. Every day his coach would tell him, “This Russian has a move called the Mongolian Death Grip. No one has ever escaped the Mongolian Death Grip. DO NOT let him get you in the Mongolian Death Grip.”

The day of the match finally came. Just before each wrestler stepped onto the mat in front of the capacity crowd, the coach once again said, “Whatever you do, do not let him get you in the Mongolian death grip. No one has ever escaped the Mongolian death grip”.

Four seconds into the match, the Russian had the American in the Mongolian death grip. The coach buried his face into his hands and cursed John for not listening to his advice. All of the sudden he heard the crowd erupt in a chant of USA, USA, USA. He looked up and saw the Russian pinned by John. The coach ran out to meet John and embarrassingly told him, “I didn’t see… Once he had you in the Mongolian Death Grip I looked away. How in the world did you get out of the Mongolian death grip?”

With heavy breath, John told him, “Well, coach, that Russian grabbed me and twisted my body in ways I never imagined possible. I was wincing in pain when I open my eyes and right in front of me were two testicles. So I bit them.”

“What???” said the coach… “John I don’t think that is legal. You could be disqualified.”

“I don’t know about that, coach. But I can tell you one thing. You ain’t got no idea how strong you are until you bite your own balls.”

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