I saw this patient today who was dying. Not dying in the immediate sense where people were running and shouting and drawing up meds and charging up paddles. No, not like that.
But still, he was dying.
Mr. Ward had been seen at another hospital with what he described as a "sour stomach" and "feeling weak." A few tablespoons of baking soda and a little milk of magnesia hadn't helped. Two CT scans and one biopsy later that pain in his stomach proved to be something of much greater concern than the "ind'gestion" he'd initially told them he thought it to be. This was cancer.
Cancer not only in his abdominal cavity but also deep down in his bones. And this kind of cancer is not the kind that can be wrestled to the floor by chemo or pinned to the mat by radiation. At best, those things could keep certain symptoms at bay but, short of a miracle, Mr. Ward was dying.
At this visit, he was joined by his daughter. She looked devastated by the news and he was quiet and peaceful. With glistening eyes, she asked questions about her father's condition. And with each answer, she said, "Thank you, doctor." Even though her mouth was appreciative, her morose expression made it clear that she would rather not hear what we were saying about her father.
But not him. He was as cool as a fan.
"What all y'all got to do to get this on behind me?" he asked matter-of-factly.
"Well," I started, "the best place for us to focus is on how you feel. How do you feel?"
"I feel like I want to get this on behind me. That's how I feel."
His daughter looked at me carefully and then spoke before I could answer. "Daddy, your body is very sick. It might not be that simple."
"What you talking about? Tha's why I'm at the doctor!"
"But Daddy you. . .you have cancer going through your body."
"There you go! Don't be sayin' nothin' to me 'bout that ol' cancer, neither. Look like the minute somebody go and start calling something cancer it jest get worser." Then he turned toward me. "Jest tell me what all y'all need to do and I'll be there."
"Are you in pain, sir?" I asked.
"I have a little bit of pain on my side. Other than that, I'm alright."
"Okay," I answered. "We can help with that pain, okay?"
"That sound good to me," he replied. He rubbed his thumb across the front of the soiled baseball cap resting in his lap. That hat looked like one he'd worn every single day for quite some time. In red, white, and blue it had big letters sewn into the front: OBAMA.
I smiled at him and thought for a moment about that hat and the fact that he'd lived to see Mr. Obama take office. Something about that offered me a bit of comfort in the face of all this bad news. I paused, thinking carefully what to say next.
In the silence, his daughter let out a large sigh and straightened up in her chair. Instinctively, I reached out for her hand. She let me.
Something about that gesture struck a cord with Mr. Ward.
"They got a medicine for this, right? I mean, y'all got something that can knock this on out, right?"
"Mr. Ward, sir? We have things to help you feel better. We don't have something to completely make it go away."
Now his daughter's eyes were brimming with tears. He looked from side to side--first at her, then at me, over to her, and back to me.
"Then what do that mean?"
"Every person is different, Mr. Ward. Most people who have this kind of cancer. . .um. . .they. . " Something about the way he was staring at my mouth made me feel nervous about my choice of words. I hated the thought of robbing him of his peace. But I needed to be honest.
Sometimes the easier thing to do is punt the hard questions like this over to the cancer specialists. To simply give the most vanilla answer you can and leave the slow singing and flower bringing to them. And in many instances, when things aren't exactly clear, that's acceptable. But his query was not about five year survival or percentages. It was a simple question to which I knew an answer.
"Mr. Ward, sir?" I exhaled and tried again. "This kind of . . .um. . cancer. . is a kind that works really hard to shorten your life. Even when we fight against it, this particular kind flicks us away like gnats. So a good thing to do is to make sure you feel okay, you know? Like make sure you're not in pain and feeling all bad."
"And jest die?"
I swallowed hard and looked back at his daughter. She decided to help me out. "Daddy, it's all up in your bones."
"Sir, I. . . " The minute I started talking he swung his head back from his daughter to me. Something about the look on his face told me to stop talking.
"What you need to know and you need to know is that that ol' tumor ain't the only thing in these bones, you hear me?" He pointed from side to side at each of us then patted his chest. "Like Jeremiah say, 'It's like a fire shut up in my bones!' I got faith. Even if y'all don't. I got faith in the Lawd and what He can do."
His daughter looked down at her hands like a child. Even though she was easily in her forties, she quickly regressed when her father spoke firmly. Finally, in a tiny voice she pleaded, "Daddy, you want His will. That's what you want. That don't mean I don't have faith, Daddy. It don't."
"Well, you HAVE not 'cawse you ASK not! See, that's the problem with y'all young folks. Yo' faith ain't even like a mustard seed!" He held his two fingers up to demonstrate the minuscule scale of that metaphoric mustard seed. Then Mr. Ward shook his head and then looked back at me. "So when I'm 'posed to see the cancer doctors?"
"Um, you see the main cancer doctor or oncologist on Monday and you have the appointment with the Palliative Care doctors tomorrow."
"What do 'palliate care' do?"
"They focus on your symptoms. Make sure that your pain is controlled and lots of other things."
"Is that the same thang as the hospice?" Mr. Ward asked with eyes narrowed.
"No, sir. It isn't." Which technically was true. At least, sorta kinda.
"Alright then." He slid his tattered Obama cap on top of his head and gave his arms an exaggerated fold. His daughter was staring at him still, her face filled with emotion. Mr. Ward did a bit of a double take and then rolled his eyes. "Come on, here, and finish up 'cawse both a y'all depressin' me!"
We wrapped up the visit and Mr. Ward and his daughter went on their way.
Throughout the day, I thought a lot about Mr. Ward and his take on his diagnosis. I let his words on faith (or even attitude depending on what you believe) marinate with me and wondered where the line should be drawn between that and reality. I still don't know the answer.
Sometimes I find the overly pragmatic patient even more disturbing. And I'm not sure why.
I guess I wrote about this encounter because it made me think about faith and attitude and myself. I say things to people that include "the facts" and have gotten into the habit of habitually buffering it with words like "This is only the information we have available to us medically. There are definitely times--depending upon what you believe--where it becomes clear that we don't have the final say on the outcome." And that always seems to be met with nodding heads and "Yes, Lords" especially at a place like Grady Hospital. Which always seems to make me feel better about what I'm saying.
But does it really matter how I feel about what I'm saying? My guess is somewhat--but it matters much more how the patient feels.
As far as Mr. Ward goes, that over-worn baseball cap with the 44th president's name embroidered across the front of it seemed to say what he wished I had:
"Yes, we can."
He replied, "If you have faith as small as a mustard seed, you say to this mulberry tree,
'Be uprooted and planted in the sea,' and it will obey you."
~ Luke 17:6