LIVING ON HIS OWN TERMS

I saw one of my patients Mr. I. recently for the last time. He was a large man - almost a bear of man - who was straight out of Grizzly Adams, and his appointments can only be described as spectacles.

I first met him over three years ago when he was diagnosed with metastatic prostate cancer. In those three years, I must have treated him with nearly 5-6 therapies. He always agreed to try something new, but he always added his own special brand of humor to the discussions.

One of the more memorable visits involved a discussion of chemotherapy. I listed off the possible side effects, which included alopecia, or hair loss. As I have tried to describe, Mr. I. was a mountain man of sorts with long gray hair. When I mentioned hair loss, he said that might not matter to a "bald motherfucker like you" but that he did not look forward to the hair loss. I could only smile because this was classic Mr. I. - telling it like is without any sugarcoating. One always knew what was on Mr. I's mind because he always told you what he was thinking!

As his disease progressed, we ran out of options. I recommended hospice, but he refused even though he agreed that no further treatments were possible. He said that he did not want to know about prognosis, and I refrained from discussing his projected longevity. At each visit, I saw his symptoms worsen, but he was adamant that he did not want anyone from hospice coming out to his home to bother him.

I saw him for the last time several weeks ago. He was quite weak, and he was relying more on a friend to help him. I again brought up the idea of hospice and said that hospice might allow his friend to go back to being his friend rather than his medical caregiver. It was at this time that I came to fully appreciate Mr. I. and from where he was coming.

He said that he was not sure hospice would be able to make it to his house, which was in a remote, undeveloped area of the state. He also confided that he was not sure that they would think much of where he lived. I reassured him that hospice was able to serve all parts of our state and that they were there to help him rather than judge him or his living quarters.

During that final visit, I noticed how utterly resigned Mr. I. was to his fate for the first time . He did not cry, but I could sense that he had finally come to accept that his end was near. This fighter's loss of hope, his resignation was truly one of the saddest things I have ever experienced in a clinic visit.

A few days later he called the clinic to say goodbye and to thank us for all we had done for him. He even apologized for the way he had behaved at times, which was quite unnecessary. He died shortly thereafter.

Just like there was an ending to Mr. I's story, I am sure there is a story to his ending. For me, though, the moral is simple: one should cherish this life and live it to the fullest on one's own terms until the very end. Is there really any other way to live? I know that's how Mr. I lived it.