A dying patient's last wish

I examined my patient's face, searching for his response. He expressed no visible emotion. With a steady voice, he replied, "OK, doctor. If that is what you advise, let's do it."

I wasn't sure whether Howard was fully absorbing the gravity of the situation.

"No, doctor, they are not here," he said somewhat distantly.

"OK, then," I told him. "I will check with the primary care physician who referred you here and schedule you for surgery."

Howard was scheduled for surgery the next week. The surgery went well; the tumor was contained within the kidney. There was no evidence of metastasis into the lymph nodes. The blood loss was minimal, and he tolerated the procedure well.

After surgery, I walked into the outpatient department to look for Howard's family so I could update them. The nurse in charge told me that Howard arrived by himself and that she had not seen any family members.

I was surprised that no family member accompanied Howard when he was having major surgery. I turned to the face sheet of his chart to see who was listed as an emergency contact. He had a daughter listed with a St. Louis address and phone number. St. Louis is about 150 miles from us in Poplar Bluff, Missouri.

"She is probably on her way, Doc," the nurse tried to reassure me. With lingering concerns, I headed back to the surgical area. I did not see Howard's daughter that evening during my post-op rounds.

The next morning, I stopped by the nurses' station and inquired about Howard as I picked up his chart.

"He is doing great, Doc," the nurse told me. "He did not have any complaints. His vital signs are stable, he has no fever, and his post-op labs are looking great. He took very little pain medication. I wish all of our patients would do so well."

I walked into the room. Howard was awake and conversant. He said he was feeling well. I did not see his daughter or any other family.

"Howard, I don't see your daughter. Where is she? Is she OK?" I still couldn't understand why she wouldn't be there with her dad having surgery, or why Howard hadn't mentioned anything about her.

"She is not here, Doc. There's something I've been meaning to tell you. A couple of years ago, I was scheduled to go on an overnight trip with my buddies. On the morning I was scheduled to leave, I noticed my wife was not feeling well and had a fever. I talked to her, and she said she should be fine and told me to go ahead with my trip. When I left, she was still in bed with a fever. The next day, when I arrived home from my trip, I found her dead in bed.

"I was devastated, and our daughter blamed me for leaving her sick mother at home alone. She blamed me for her mother's death and stopped talking to me. I have tried to call her few times since then, but she has refused to talk to me."

Howard suddenly stopped talking, motioning that there was nothing more to say.

I felt sorry for Howard. His closest relative, his daughter, was not there when he needed her support.

The next morning when I went to the hospital, I called Howard's daughter. I introduced myself and explained the situation to her, that her father had major surgery to remove his kidney due to cancer. I reassured her that he was doing well but that he would feel better if someone who cared about him was at his bedside.

There were couple of minutes of silence at the other end of the phone, and she said, "I will be there doctor. I will be coming to see my father."

The next morning, I saw Howard's daughter, Lisa [not her real name], and her two teenaged daughters by his bedside. I also saw a different Howard: He was smiling, and there was new life in his face.

Howard was progressing well and was ready to be released on the fourth postoperative day. The pathology report was encouraging: the cancer was organ-confined with no extension outside, and it was of low grade. I gave Howard the good news and told him that he was ready to be released. He extended his hand and gave mine a gentle squeeze.

"Thank you, Doc, for everything," he said. "My daughter coming back into my life is the best thing that has ever happened to me, and I can't thank you enough."

Howard continued to do well. I removed his sutures 10 days later in my office, and his daughter told me that she would be taking him to her place for a few days. I wished them well.

A few days later, as I was starting out on my morning rounds, a nurse rushed up to me and said, "Doc, Howard was readmitted last night."

"What happened?" I asked.

"Last night he was admitted through the ER," she explained. "He was feeling weak and tired with fainting spells. He had low sodium and had EKG changes, so he was admitted to the ICU."

I went to the ICU. Howard had heart monitors and IVs attached to him. He was awake and otherwise stable. After I looked at the chart and spoke with the internist taking care of him, I did my best to reassure Howard and his daughter, who was at his bedside.

That night I received a call from a nurse in the ICU. Howard had gone into cardiac arrest, and the cardiac team was working to resuscitate him. I rushed to the hospital, only to find out that the attempts to save Howard had failed and he was pronounced dead.

With a heavy heart, I walked to the waiting room, where Lisa and her daughters were waiting anxiously.

When Lisa heard the news, tears started streaming down her face.

"You know what, Doc?" she said after a long pause. "My dad was so happy to see the family again and reconnect with all of us. That's what he wanted more than anything. He got something a lot of people never get. My dad got his last wish."

S.D. Madduri, MD, is a urologist at NorthWest Clinic, Poplar Bluff, Missouri. Send your feedback to medec@advanstar.com
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