I'll Be Back.

Abstract

I opened the chart and read the consult request: ‘‘Seventyfive-year old man with widely metastatic colon cancer, now with refractory pain and vomiting secondary to progressive bowel obstruction. Please help with symptom management.’’ I knocked on the door and poked my head in the room. The sweaty smell of sickness filled the air. ‘‘May I come in? I’m Dr Rousseau, and I was asked to come by and see you.’’ ‘‘Sure, come on in. I’m Wilson Roberts. This here is my wife Patsy. Please have a seat.’’ As I sat down next to his bed, I explained what I do and why I was there. ‘‘I’m glad you’re here,’’ Mrs Roberts said. We then spoke for almost 90 minutes. We talked of the Roberts’ lives, their children and grandchildren, and the struggles that attend a 40-year marriage. We also spoke of a plan to control his symptoms and reframed a hope for cure to a hope for comfort. I then stood to leave and hugged Mrs Roberts. ‘‘Mr Roberts, I’ll be back later and check on you before I go home. We have a plan, and that’s a good thing. We can help your pain and vomiting.’’ He looked at his wife and gave a smile. ‘‘I like that smile,’’ I said. ‘‘That’s a good thing!’’ ‘‘Thanks doc, I’ll see you later. And doc . . . thank you.’’ As I left the room, his wife followed me into the hallway. ‘‘Dr Rousseau, I know he’s dying, I just want him comfortable.’’ Then she paused. ‘‘How long do you think he has? Our three children are on their way, and . . . we just need to know.’’ I told Mrs Roberts I thought he would die soon, likely within a day, but that I would be back later to check on both of them. She thanked me and went back into the room and gently closed the door. As I hurried down the hall, the clock on the wall told me it was late in the afternoon. There were 2 new consults, and I needed to follow-up on 2 consults completed the day before. Both new consults would likely require family meetings that would consume 2 to 3 hours and leave me emotionally exhausted. And the follow-ups? They would likely require extended conversations as well. I grabbed some dinner, and before seeing the new consults, I called to check on Mr Roberts. The nurses reported his symptoms were much improved with the adjustment in medications. Now I smiled. By the time I finished the consults and follow-ups, 6 hours had passed. It was almost midnight, and I was tired. I headed down the hall to the cafeteria, got a cup of coffee, and began the walk to the parking garage. Soon I was in my house, checking my mail and the news of the day, then heading to bed. The next morning, I awoke to a page for a new consult, and amidst the grogginess of daybreak, remembered I had not gone back to check on Mr Roberts. I called the nursing station, but no one answered, so I showered, grabbed a quick bite to eat, and rushed to the hospital. I hurried from the parking garage up the stairs to the oncology floor. I slowly peered into Mr Robert’s room. Housekeeping was cleaning his bed in anticipation of the next patient. He had died during the night. I sat at the nurses’ station sickened and ashamed. I told both he and his wife I would ‘‘be back,’’ and I had failed them. And with death, there is no second chance, no time to make things right. Our words are our honor to patients and families—and when someone is dying, they may be all that we have. I telephoned Mrs Roberts, and after an awkward hello and a heartfelt condolence, apologized for my absence. Even in the presence of loss, Mrs Roberts was gracious, repeatedly telling me she understood, that I had given her husband a comfortable death, and that was worth everything to her and her children. As I listened to her speak, I was humbled by the kindness of her understanding—a wife, mired in the midst of loss, comforting a physician who failed in his promise to be present. (I want to thank the Roberts for helping me to grow as a young physician. As I look back some 25 years, I understand that such troubling and life-altering ‘‘sentinel events’’ frame our careers, and it is what we do with these events that ultimately define our character.)