Physician-assisted . . .

It is not as if it was the first time that I went to the home of a patient who was likely close to the end of his life. I often would find myself calling patients at that later stage when they are tired, weak, and often helpless. I feel an urge to go visit them, to see where they lived their life, to meet their close ones and to let them know that they are loved, cared for and won’t be forgotten. I do not actually say any of these things, but indeed have learned so much about them and about myself at those critical sensitive moments, and these moments have stayed with me forever. I can say with clear certainty that I have never forgotten any of the patients that I visited in their homes at that stage of their life. But this time, it was different, they had a definite date. They were going to Switzerland because in this country it is not a possibility. They booked a flight and in two weeks, on that Monday, they were going together: my patient, her husband, and their two grown children on the Monday and were returning on Tuesday without her. Read: New strategies must be implemented to deal with opioid crisis: Ontario science table So after delaying my visit as much as possible, and after walking by their house daily and saying hello each time, I decided that it was time. That time was of the essence, literally, and I had to go visit. I wanted to go visit, of course, but I also felt that I could not wait any longer. I did not want to go too early and did not want to go too late. And so I went to visit. I sat in their living room. It was not the first time I had been in their home. She had many physical disabilities and once in a while, I would go there to check her instead of making her come all the way to the clinic. She looked as usual, a little thinner than usual, lucid as always. She was in pain but refused to complain about that. She spoke with so much calmness. She had decided that it was enough and that she no longer wanted to suffer or to make others suffer. She asked me if I had ever had a patient who had decided to end her life like this, to which I answered, “No.” In my effort to give her a message of support and caring, I started by saying that she had built a beautiful family, that her grown children were so special and she continued my sentence by saying that she was lucky to have them and to have had such a wonderful husband. I tried so hard to be there for her and to make her feel loved, but could not help my tears rolling down my cheeks. I apologized for crying and said that I came to support her and here I was crying. I felt very close to them at that point and shared with them how I felt that the whole medical system had failed her and apologized for the fact that no solution was found to alleviate her situation. I tried to quickly change the subject because I certainly did not want to be in a position where they felt they had to reassure me. Having to keep my patient’s secrets as promised so many years ago, I have been feeling such a heavy load in my heart all week long. I find it so hard to walk by their house ( they live across the street from me) and I cannot share my sadness with anyone else. Read: 'Boiling point': Alberta doctors warn of health system collapse as COVID cases climb I now wonder why it was so hard and so sad for me, why worse than all the other times I had to be in that situation where I know, and the patient knows, that the end is near. I think that we never really know when or how it will happen. And not knowing instills in us an inkling of hope. In this case, we had a date and a time. And as time tends to do, it moved forward and exactly on Monday morning, I could not stop thinking about them all. As a physician of 30 years, I am not surprised that we could not help her enough, and I am not judging anyone because no one really knows how much suffering they can tolerate, until they are there. I just feel sad, at losing a very special patient and a very special person. I do, however, feel that I have learned so much from her, her loving husband and family. And I feel that I have been privileged to have been her doctor. She taught me a lot about pain, suffering and being brave. But mostly she taught me about myself. May her soul rest in peace. Addendum As we do in our tradition, I attended the home of my patient after the funeral and sat with many other people visiting and supporting the family. I again felt that it was indeed so hard for me to hold back the tears. I spoke with her husband, and her grown sons. And after some time, I left, hoping that they felt the support and the caring. And as I left, I overheard her husband telling his friend: “This is our family doctor. We cried together last week.” And I knew that it was OK that I had cried, it was indeed exactly what he and I needed. Indeed, may she rest in peace. Read more from Dr. Chiche-More: Working in my neighbourhood

Physician-assisted . . .

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