A Final Act of Gratitude

Abstract

As a medical student, I was trained in psychology and ethics courses to believe that suffering is a state of being that patients want to escape—that in their old age, patients would naturally and rationally want to relieve their distresses. When I left the classroom and entered the world of clinical rotations, I found this to be less of a hard-and-fast rule and more of a loose emotional shortcut. In particular, one elderly man demonstrated that the state of suffering is far more complex, and as much as it is an aching miserable state of being, it can also present itself as an opportunity to show gratitude and generosity. Mr. Joe Banks (real name withheld) was a 78-year-old African-American man living in New York who was being taken care of by family members. Disabled by multiple medical problems that hindered most day-to-day activities, Joe, as he preferred to be called, felt utterly humiliated, particularly by his inability to clean himself after soiling. Joe's saving grace was his son and daughter-in-law, who had left their jobs in the South to tend to his multiple ailments. I met Joe when he was hospitalized early in November 2008 for severe abdominal pain during my geriatrics rotation. At that time, Joe's regular physician briefed him and asked for his decision on advance directives. To me, Joe looked like he was dispirited and in poor physical condition, so it came to my great surprise that, if needed, Joe would opt for full resuscitation. There was such dissonance between his body language and his affirmation that curiosity got the better of me, so I asked him how he came to such a decision. Joe's decision, although not unusual by any measure, was the result of a unique decision-making process. In his younger days, as a housekeeper in the medical intensive care unit, he disapprovingly saw what happened to patients in those conditions, but then Joe's thoughts turned to his loved ones—his son and daughter-in-law. Both had provided him with comfort. They enjoyed being with him and served him lovingly, without any sense of burden or sacrifice. Joe explained that he could not leave them with such apparent ease; it would be an insult to their efforts. Instead, he wished to return their love and impress upon them that their care was the most important thing in the world. In short, Joe could bear the pain of daily suffering but not the pain of disappointing his loved ones. Joe Banks taught me more about suffering than any textbook could. Physical suffering is indeed a potent source of human motivation, but so too is gratitude. The fact that someone would be willing to prolong his suffering to demonstrate his appreciation is a testament to the nobility of the human spirit. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the author and has determined that the author has no financial or any other kind of personal conflicts with this paper. Author Contributions: The author is the sole contributor to this paper. Sponsor's Role: None.