Your wife sits on the plastic sofa, struggling to hide the misery marching across her face. The nurse sits beside her prepared to attempt to soften the blow of our discussion. You are tucked into the recliner with your heavy, waterlogged legs elevated to help reduce the swelling. Your face is painted with the pallor reserved for the poor souls who have survived septic shock. The air is tainted with a musty, decaying, chemical pollution reserved for Intensive Care Units.
The appropriate demeanor escapes me as I struggle to find the correct tone for the questions I have to answer on this obscenely neon form. The bright orange paper would be better utilized on a hunting lease. My fingers are cramping under the strain of my attempts to hold my trembling at bay. The gravity of this conversation intimidates me. I am horribly under- qualified for this.
I scoot the bedside table out from between us and take a seat on the freshly made hospital bed. I attempt something like a smile. Would it be terribly inappropriate for me to crack a joke? Do I minimize the seriousness of this talk?
Slow, deep breath.
I intentionally avoid eye contact with your sweet spouse. This is your decision. One of the few things you still have complete control over. I owe it to you to not mess this up.
“So, I have a form that I have to discuss with you before I can send you home. I know you have already had this discussion, but I have to clarify the specifics and record it so we have a record of your wishes.”
I glance down at the first item, Cardiopulmonary Resuscitation. CPR. A horrifying act which can sometimes saves a life. I have to ask you whether you want someone to attempt to intervene if your heart stops beating.
Usually, I make a point to say that I ask everyone this question and reassure my patient I am not anticipating this issue.
Today, I am sending you home to stop treating your terminal disease. I am tasked with clarifying your directives to healthcare providers.
“Joe, the first thing on this form is if you want someone to attempt to restart your heart if it stops.”
You shake your head no.
Check.
Strange how such a permanent decision is indicated with a check mark. It feels like there should be at least a paragraph written there. Perhaps a reassurance to everyone they are doing the right thing. How can doing nothing be the right thing?
The next item addressed several different options if you develop respiratory failure. I have to ask about each one.
“If you stop breathing or if your breathing is ineffective do you want to have a tube placed so we can put you on a ventilator?”
Vigorous head shake.
“Even if it could be a temporary or reversible problem?”
Slight hesitation. You mutter something that resembles a no.
“Would you want noninvasive mechanical ventilation, which is a mask that provides pressure and can sometimes help?”
I get a blank stare.
“Ummm. Joe if you begin to have trouble breathing do you want to be brought to the hospital for us to attempt to keep you alive with machines? Even if they would not require intubation?”
I wait while you appear to consider these options. Finally you glance at your wife and whisper “no.”
I go through the rest of the details spelled out on the form. Coming to the hospital if your condition becomes worse. Artificial nutrition if you is unable to eat. Intravenous hydration if you cannot not drink.
I have stutter and stammer my way through each question. I fight the urge to try to convince you to keep fighting. I want to encourage you to “beat the cancer!” This is just a battle, I know you can win the war.
I look over at your wife and realize she is crying. I desperately need to fix this. I need to give her hope. I look down at the form you have painstakingly signed and initialed and read the most annoying words possible.
Black Ink Only.
I glare down at my blue pen. The blue and orange remind me of the colors the football team wore when I was in high school.
I also realize my cell phone number is written in the forbidden blue ink instead of the office number as my contact number.
I don’t want to admit my ineptitude. I want you and your wife to trust I have done everything the way I should. I don’t want to give you a reason to doubt your decision. I pull my pager out of my pocket as if is vibrating an alert. I rush back to the nurse’s station and ask for the form.
“We already gave it to you.”
Now I have to admit my inability to follow directions to someone else. I start choking and coughing as acid comes from my churning stomach burning the back of my throat.
It turns out they have run out of the orange paper. She can’t print me a new copy. EMS is here waiting to transport you home and I have not even written your prescriptions.
Finally someone finds me a new form on a different floor. I stand at the counter and carefully fill out everything but your signature.
I walk back into the room and lie. I tell you I was unaware there had to be two copies.
Everyone knows this is not true. You graciously let my obvious gaffe slide. I ask you if you need anything else.
“Yes. I do. I need a hug.”
I can barely compose myself. A few tears manage to escape. The lump in my throat prevents me from speaking. So, I lean down and give you a hug.
“Thank you for taking care of me. Now, is it okay if I take my pills with a shot of Knob Creek?”
All four of us bust out laughing.
“Well, you are dying. You can do whatever you want.”
I brace myself for the stony silence I generally earn when I say something exceptionally blunt. Instead, all three of you laugh even harder.
I have to excuse myself to write the prescriptions you need to fill before you get home. I know I will never see you again, so I take the chance to hug you and your wife one more time.
I’m not gonna lie, more than a few tears were shed on the drive home that night.
