osodecanela | Lost it this morning.....

I'm sitting with a sense of impending loss this morning. Yesterday, I put one of my oldest patients on hospice. It's the right thing to do. I've known and adored this lady for a 1/4 century. (I cannot believe it's been that long, but it has. She was one of the first people to come to me when I hung up my shingle in 1987. She was 76 back then and I had just turned 31.

She's got what we term in the trade, the dwindles. She's failing slowly and with multiple medical issues mounting up and adding together, the end draws nearer each day. Hospice is intended for folks in the last 6 months of their lives, and I feel fairly certain, that's where we are with her. I'm not ready to say goodbye yet, but then it's not about me, is it? I know in my heart, hospice is the right route here, and involving them will hopefully make me more appropriate in my medical interventions, thinking first about the quality of her existence, and not it's length. It's what a provider should always focus on, but in reality, we don't always. Letting go, when you're emotionally invested, is not easy. It's often clearer, when there is a malignancy involved. It's simpler to acknowledge that the time is finite. However, when it's other medical problems, the ones which could worsen either 4 days or 4 months from now, sometimes it's not so clear. Over the last few years, it's been easier for me as a cross-covering provider, seeing colleagues' patients while on call, to question why we're doing the interventions we're doing. When you're the stranger, it's a bit easier I think to be dispassionate and to ask difficult questions, most often I find, why hospice is not involved.

I came in to the hospital this morning to see a very sick elder in my practice, a lady whose MS has taken a flare for the worse and who may or may not recover. That's the nature of her neurologic disease; it waxes and it wanes. She's too weak to eat now. Her swallow is affected and she has aspirated, resulting in a pretty serious pneumonia. When I arrived in her room, she was lying quietly in bed, hooked to O2 and a couple of IV's, her husband sitting by her side. They sat there together in the silence, holding one another's hand. They've been together 46 years.

Their devotion to one another swept over me. I smiled at them both, as best I could, but inside I struggled to hold back my tears, at the thought that soon, they are likely to be parted by nature. I did my job today. ordered what needed to be ordered, and prayed I made the right decisions of what to do. I left for my office, and once there, simply sat at the wheel and cried. The memory of my fear of losing LJ, as I sat in the waiting room while he had his coronary surgery 14 years ago crashed over me. My heart just aches for this couple, for their sitting with each other while they can, and in the knowledge they are likely soon to be saying goodbye. It was, no, is so painful, but again, the loss will not be mine, but theirs.

I called my husband when I got to my desk. I simply needed to hear his voice. I needed to hear his breath. I needed to hear him say, "sweetheart, what's wrong?" I will fold my arms around him when I get home, and hold him tightly. He leaves the day after tomorrow for a week, back east to see my mother-in-law. I need to be certain he knows just how much I love him, before he leaves, that I always have and always will. I have been so terribly reminded, tempus fugit.