{"id":2965,"date":"2024-04-24T15:30:07","date_gmt":"2024-04-24T15:30:07","guid":{"rendered":"https:\/\/ebling.library.wisc.edu\/corpus-callosum\/?p=2965"},"modified":"2024-09-04T21:04:05","modified_gmt":"2024-09-04T21:04:05","slug":"no-one-told-me-i-was-dying","status":"publish","type":"post","link":"https:\/\/ebling.library.wisc.edu\/corpus-callosum\/no-one-told-me-i-was-dying\/","title":{"rendered":"No One Told Me I was Dying"},"content":{"rendered":"

Nicholas Gallo, MD<\/em>
\nUW Hospital, Internal Medicine<\/em>
\nShort story<\/em><\/p>\n

 <\/p>\n

No one told John he was dying.<\/p>\n

Before I met John, he had already survived lung cancer twice. He was first diagnosed after a lesion was identified on a screening CT scan. This was treated with partial resection of his right lung. Rehab was challenging, but he persevered, returning home to a full, independent life where he worked full time and enjoyed his wife and family.<\/p>\n

Two years later surveillance imaging discovered a new spot on his left lung. A biopsy confirmed this was cancer, different from his first pathologically, a second primary lung cancer. Truly bad luck and the effect of smoking for fifty years. He pushed forward with both chemotherapy and radiation resulting in remission. After the second battle with cancer, life became more difficult for John.<\/p>\n

Radiation helped kill the cancer but also damaged healthy lung tissue. During the course of his treatment, a pulmonary embolism, recurrent episodes of heart failure, infections, and escalating pulmonary arterial pressures continued to stress his poor lungs. They became reliant on continuous oxygen for support. He spent most of his waking hours in hospitals, rehab centers, and medical offices, leaving little time for home and family. Uncomfortable hospital beds, white coats, needle pokes, and oxygen tanks became very familiar to John. Life became more about what his lungs needed, and less about what John needed. He gradually declined and his independent life once filled with work, friends, and family became a distant memory.<\/p>\n

I was a second-year internal medicine resident when I met John in the Emergency Department. He was being admitted for a recurrent episode of undifferentiated hypoxemia. I could tell that he and his wife were scared. When I looked into John\u2019s eyes, I could see they were hungry for air. His wife\u2019s eyes expressed concern fluctuating between John, his oxygen saturation, and me.<\/p>\n

\u201cHey John, I\u2019m Doctor G. I\u2019m one of the residents and I\u2019ll be admitting you to the hospital. I heard you\u2019ve been short of breath.\u201d He nodded in agreement. \u201cWho\u2019s here with you today?\u201d<\/p>\n

\u201cHey doc.\u201d He replied followed by a three second pause to catch his breath. \u201cThis is my wife.\u201d<\/p>\n

\u201cIt\u2019s nice to meet both of you. I\u2019m sorry it\u2019s under these circumstances, but I promise we will take really good care of you while you\u2019re here.\u201d After asking John and his wife to tell me about his medical history and recent symptoms, I followed with, \u201cJohn what are you most worried about?\u201d<\/p>\n

\u201cI\u2019m really worried I won\u2019t be able to find more air.\u201d Short pause. \u201cI\u2019m worried one day this is not going to get better.\u201d John seemed to recognize there would be a time when medicine could not offer a solution to his problem. I wondered if anyone had discussed this with him. Without knowing it, he had opened a door to discuss end of life.<\/p>\n

\u201cYou\u2019ve been through a lot John. What have other doctors and specialist told you about your lung disease?\u201d<\/p>\n

\u201cThey told me I shouldn\u2019t have smoked for all those years. That I have bad lungs from all that smoking\u2026 and the two cancers.\u201d<\/p>\n

I could tell our conversation was tiring him out. His abdomen moved paradoxically during inspiration and his neck muscles tugged with all their might to support a deconditioned diaphragm. He must have felt like a broken record repeating his story over and over again with each new medical encounter, but I had a few more important questions for John, so I pushed on. \u201cIt sounds like you\u2019ve been told your lung disease is pretty severe. And I\u2019ve read your medical history, so I know it\u2019s been a rough go over the past few years. Has anyone talked with you about how much time you might have left?\u201d<\/p>\n

I could sense the mood shift in the room. Fear and anxiety turned first to surprise, then contemplation. Pausing for air between sentences he replied, \u201cI haven\u2019t thought about time. I know I will die from my lungs, but I\u2019ve survived cancer twice. I figure I have a few more years in me.\u201d<\/p>\n

I knew it was time for me to wrap things up when respiratory therapy arrived to set up BiPAP. I was hopeful it would relieve his work of breathing, but it would be nearly impossible to have a meaningful conversation with him through the beeping and roaring of the positive pressure machine once it was started. \u201cI don\u2019t know how much time you have left John, but it may be shorter than you think. I\u2019m worried your lungs are getting worse.\u201d A short pause, this time for me to catch my breath, \u201cI\u2019m worried you are dying.\u201d<\/p>\n

It seemed like an hour passed before he replied. This time, the pause was not to catch his breath. He looked over at his wife. \u201cNo one told me I was dying. If I don\u2019t have much time left, I don\u2019t want to spend what\u2019s left in the hospital. I want to go home.\u201d\u00a0 There was no trace of denial or anger. In his heart of hearts, he knew what I said to be true.<\/p>\n

\u201cI hear you John.\u201d In silence his wife took his left hand. I offered mine, and he held it tight. Not a handshake but an embrace.<\/p>\n

With permission from John, I invited the palliative medicine team to meet with him the day after his admission. They helped us to continue exploring John\u2019s goals and offer ideas to improve his symptoms. We shifted focus from treating lung disease, back taking care of John and his symptoms. At discharge he decided to go home with more support provided through hospice. John spent his remaining months at home with family. The clinic visits, lab draws, bouts of testing, and long commutes to and from the hospital were replaced by familiar visiting nurses, a skinnied down medication list focused on his comfort, and supportive home health services. Small doses of oral morphine relieved his air hunger and knowing it was available alleviated the associated anxiety. He was treated for pneumonia and a COPD exacerbation at home with a short course of antibiotics and steroids when he developed symptoms, saving a trip to the emergency department and the inevitable admission that would have followed. John never returned to a hospital. He died at home four months after enrolling with hospice.<\/p>\n

I told John that he was dying. I hated telling John that he was dying. But I\u2019m glad I did.<\/p>\n","protected":false},"excerpt":{"rendered":"

Nicholas Gallo, MD UW Hospital, Internal Medicine Short story   No one told John he was dying. Before I met John, he had already survived lung cancer twice. He was first diagnosed after a lesion was identified on a screening CT scan. This was treated with partial resection of his right lung. Rehab was challenging,… <\/p>\n

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