Each and every discussion I have with a patient is different when it comes to end of life and I never know which direction we are going to go.
Looking someone in the eyes and telling them they are going to die soon is no small feat. It is one that eats me up just a little each and every time. I must say, I learn with each and every conversation I have. Some surprisingly go very easy and others are extremely difficult.
I still remember my very first patient in fellowship. A 19 year-old with sarcoma of the leg which had spread to distant areas of his body. Once out of the hospital I treated him with chemotherapy and he did well for quite some time. As a matter of fact, as time passed we each got to know each other well. We had many discussion about death and what the future held. Near the end I learned that he had built out of wood his own casket knowing that he would die soon. Could this have been easy? What was he thinking? I learned from the very beginning he knew his death was close and he took control of his life. He never let cancer control it. He never wanted to give up the fight and he did so to the very end.
A day which would become the last day we would see each other he presented to my clinic at the end of the day in a frail yet somewhat energetic state. Thankful that he was my last patient of the day not because I was tired but rather because I could spend extra time with him. You see, he knew this was our last meeting and he came bearing a gift. Two very small crown royal shots. My favorite drink and his. That day we toasted to our friendship and his life. He died shortly thereafter. He left me with memories and lessons learned.
As the years have gone by I realize that without death one can not live a life as intended. Could you imagine what life would be like without death? I would like everyone to think about this for a moment. Glorious things would become less glorious. Those precious moments we spend making memories would mean less and less. Death is a must because life without death is a life without meaning.