Thursday, March 31, 2005

Death Be Not Proud

The Enterprise's loudspeaker popped once and Captain Kirk's voice rang throughout the ship as he made the following announcement:

"Ladies and gentlemen, I've got some bad news and some good news. The bad news is that our engines have overheated and will explode in about an hour. The good news is that I have ordered all crew members to stop working and join me for champagne and caviar."

Shouts of "Hooray!" were heard throughout, and dancing couples appeared in the corridors. "I've never seen such a happy crowd," remarked Sulu.

"Highly illogical," said Mr. Spock.

Every so often a patient will make a comment so incongruous that it freezes me in mid-thought as if I was doing a double-take in a silent movie. This moment of paralysis is usually followed by the appearance of a ticker tape headline inside the mind announcing "THIS STATEMENT IS INCONSISTENT WITH REALITY...BE ON ALERT FOR PATHOLOGICAL DELUSIONS." Often the alarm goes off simply because a patient disagrees with what I feel is a brilliant plan to combat the malefactor cancer, and we all know that a doctor's judgment is only slightly less stupendous than his size XXL ego. Surely only a deranged mind would reject a chance to experience the wonders of modern medicine. Even more peculiar is the patient who seems oblivious to the perils that lie ahead once the body is defiled by malignancy.

As an example I offer the case of Mr. X., who had lung cancer that had spread to the liver and was recently hospitalized after developing severe back pain. As if things weren't bad enough, his latest scans showed new tumors on the spine - an awful complication that can cause terrific suffering. Two days after admission, though he smiled as I strolled into his room. "I've never felt better in my life," he said. "I feel wonderful - I'm going to beat this disease; I just know it."

As I stood there in front of him holding a radiology report that was about as encouraging as a military dispatch to Berlin in 1945, I felt ashamed because part of me wanted to ask him what on earth did he have to be so joyous about? After all, one could state that my main excuse for being so tra-la-la annoyingly cheerful is because I am not living with cancer. My patient, however, in the absence of a deus ex machina was doomed. What therefore was the source of his optimism?

Maybe my focus was off, and the question I should have asked was: what is the message here? This brief scene, hardly the pivotal sequence of events in the unlikely event our relationship was ever transcribed into a Broadway play, on the surface seemed insignificant and easy to explain. The patient was obviously in denial as a defense mechanism against the agony of looking into the future and seeing only the abyss.

That summed it up quite neatly - except for the fact that I didn't buy into this denial theory. He had no aura of fear about him - in fact, he was genuinely happy. Rather than sit on the man's bed and meow out a few platitudes of counterfeit support I decided to hold my tongue and ponder further. I considered the possibility that his Pollyanna outlook was merely a reflection of his personality, that he was one who cried "Get thee behind me!" to any dark thoughts that had the audacity to slither up from the cellar in an attempt to spread melancholy. Yes, that made perfect sense - he's that fellow with the rose-colored glasses they write country-western ditties about.

Or was it something else?

The sound of his voice stayed with me as I drove home that afternoon. Something within it seemed to be reaching out, not just to me but to the world. I remained puzzled until I finally practiced what they preach in the more fashionable medical schools, viz. the art of empathy. I put myself in my patient's place and suddenly the source of his euphoria was as clear to me as the stop sign I just ran.

He was expressing gratitude - gratitude for his remarkable relief from pain, for the powerful treatments against cancer that exist for his assistance, for the chance to be discharged and return home. In his own way he was giving thanks for the gift of life itself, even if this life was destined last no longer than the turn of an hourglass. When one lives with this deep appreciation of life every minute is a feast to be savored, every step an affirmation of the strength and independence of the human spirit. With this attitude even death itself becomes puny and pathetic, for its power over us is only through fear, and once our fear is gone, then just as the poet Donne replied about eternal life:

And death shall be no more; death, thou shalt die.