This doctor was ready to give up and slip away painlessly. Then his dead father appeared in his dreams, with a message.
I wanted only to sleep.
In medical school, we were taught that death from renal failure was a painless way for the suffering to slip into the comfortable abyss. I had watched end stage cancer patients finally succumb in this way and imagined it to be a gentle descent into oblivion, a sweet release from the constraints of illness.
I had not realized that the process was, rather, a series of painfully rapid tumbles. I was not aware of the intense lucidity of that final moment until I stood on the precipice of life and death and had to make that fateful choice to stand or fall. As a young doctor with decidedly unfinished life, that decision proved surprisingly difficult. While my mind was clinically evaluating my own pathophysiology, the patient edged dangerously closer to the intoxicating lure of sleep.
It was my first December in California and only a few days before a long-awaited holiday reunion in the cold northeast. As a National Health Service Corps scholar, I was repaying my obligations by working in an area of great need, learning the Spanish language of so many of my patients. The success of our practice had become almost overwhelming, with our births doubling to 80 a month, an increasingly busy emergency department, and a surgical schedule filled with no fewer than five cases a week.
I was the sole physician in a practice comprised of 11 wonderful yet overextended midwives. I pushed myself past any reasonable limits. After a two-week period without any rest or more than three hours of uninterrupted sleep, I had decided to go for a run on the beach. The fact that the combination of exhaustion and exercise could be dangerous never occurred to me.
Running had always been a stress reducer, and I had become accustomed to the normal aches and pains of outpacing one's limits. I'd no difficulty training for an upcoming marathon, but this day, after only eight miles, my muscles began to fail me. Soon I was vomiting sporadically. Perhaps only a fellow runner could understand the need to finish the 10 miles I'd planned for my run. Only someone in my shoes could comprehend my greater need not to give in, to continue running, to compress a lifetime into half as many years.
My father had been diagnosed with colon cancer when he was just 37 years old. My sister and I were barely teenagers and my brother, Brandon, was a baby. We'd watched as my father died slowly for four long years. I came to believe, perhaps subconsciously, that I, too, would die young. If my father, the fearless stock car driver and incredibly strong electrician couldn't beat death, I had no chance.
In many ways, that childhood epiphany remained one of my greatest motivators. I was going to live a lot-and fast. I started running and never looked back. I became the first in my family to attend college, and never had a doubt that I would attend medical school. I started racing even harder against the clock as I entered my 30s, the final decade of my dad's life. If I were going to die young, at least I would live more life than my age would reflect. I wouldn't allow that goal to be obscured by mere physical discomforts or even minor heartaches.
But on that fateful Monday evening on the beach, I was forced to stop in my tracks. Acknowledging that my traditional coping mechanism had failed me, I staggered back to my house and went to bed.
Gradually, clinical acumen triumphed over personal denial as worsening symptoms over the next 30 hours forced me to admit that I was likely suffering from rhabdomyolysis. After another 12 hours without urine output, I knew that acute renal failure had followed.