I have cared for them both, husband and wife, now in their
80’s, for almost 20 years – she
a retired nurse and
he from his business. They are so typical of this “greatest
generation”, tough, enduring, hard-working, deeply faithful,
fervently independent, those
characteristics that allowed them to survive the Great
Depression, World War II and the
many challenges that come with life. They have seen their
share of joy but also
experienced much pain, especially the unexpected death of a
child. Now they are
facing their greatest challenge and I am intimately involved
in it – they are dying – she of
Alzheimer’s and he of severe pulmonary fibrosis; each one’s
life slowly ebbing away in a
way unique to their disease.
It is hard, very hard, to watch this unfold
though I have been here too many times, with other patients during my 28 years
as an Internal Medicine Specialist. Death and dying are part of medicine but
especially for someone like me in a full – time Internal Medicine practice.
Caring for those going through the dying process is always difficult and
emotionally draining. Over the years many become a blur and the memories fade.
But occasionally there comes a special person, or in this case couple, who you
don’t forget, whose life, and all that it encompassed, becomes intimately
entwined in yours. There is often a
final event as well that is etched forever in your mind and touches your soul.
That event occurred just last week. It moved me to tears, yet, strangely
enough, brought joy as well!
He was in
with a care provider from his new home where he and his wife had just moved, an assisted living facility
with an Alzheimer’s unit. He was no longer able to care for her as his lung
disease and increasingly frequent hospital admissions were paying an
irreversible toll on his body and remaining strength. He required 02
continuously and this once strong man now can only walk 15-20 feet before
having to stop and “catch his breath”. So he made the decision to break up
their home of 60 years and move into their new “home”. He did not want anyone
else making this decision for them. It was the one thing he could do that would
also insure his wife would be cared for even though she did not understand why
this was happening. It was hard, terribly hard. In their new home, she was not
able to stay with him. Her increasing agitation, combativeness and paranoia
precluded this. She had to remain in the “unit”. Alzheimer’s does far more than
take away ones’ memory.
I had not seen him in several
months. Fortunately he had not had a repeat hospitalization and medically he
was “stable”, a good word in medicine. He was noticeably thinner and weaker.
There was sadness in his voice, his eyes and his demeanor that I had not seen
previously. We spoke about his health issues and what, if anything, we could
do. By any clinical standard he was depressed and I had already addressed this.
All I could see, though, were the tears brimming in his eyes. All I could hear
was the trembling of his voice. All I could feel was the profound
sadness permeating the room as he told me how difficult this move had been, how
hard it was to see “the love of his life” in such a way. What do you say or do?
I did the only thing I could do. I took his hands in mine, hands tough and
calloused, that had done and felt so much in a lifetime, and I prayed with him.
We had done so many times through the years. As we finished, tears streaming
down his face, lips trembling with emotion, he said these final words, “I love
you”. Then he slowly stood up, hugged me and left. As I watched him move
painstakingly down the hall, walker in hand, oxygen at his side, my eyes filled
with tears – tears of sadness and sorrow. Suddenly, I found myself grateful
that I was in a profession that allowed me the privilege of being intimately
involved in the lives of people; the good and the bad; the joyful and the sad. When
all has been done medically then the real “art of medicine” begins, the warmth
of love given through a touch and the speaking of words, “I love you-
final words that are a precious reminder of why
I went into medicine.
“I love you, too”.
Andy Lamb, MD
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