THE SYMPATHIZER

In recent years, the Vietnamese-American writer Viet Thanh-Nguyen has written several wonderful books about his experiences in Vietnam and coming to America during the war, including The Sympathizer and The Refugees. The former is about a Vietnamese General who is caught between two worlds, and I could not help thinking about this book when I meet Mr. D, who was a former Vietnamese General, himself.

The General was in his mid-60s and had been living in America with his son for several years when he was first diagnosed with prostate cancer about 5 years ago. Despite surgery, his cancer had returned, and he was referred to my care. He spoke very little English, and so we always arranged for a translator at his visits. However, at the end of each visit, the General always said, "You are MY doctor. Thank you, MY doctor." It was his way of showing me his gratitude and the respect that he thought I deserved.

Unfortunately, Mr. D's cancer was quite resistant to treatment, and it morphed into an even more aggressive form called neuroendocrine prostate cancer. Despite our best efforts to slow the cancer down with chemo, it continued to grow and left him weak and in pain.

Because of his deterioration, I asked him to bring his son, who worked as a mechanic and who had not attended previous appointments, the next time he came in. It was at this visit, that I gave them both the bad news that his cancer was no longer treatable and that I thought we should focus on maximizing his comfort and quality of life at home with hospice.

The General was obviously upset about this, but not for the reasons you might have suspected. He said he had lived a long life for which he was thankful, but he also recounted many of the hardships from that life including a gun shot wound during the war and seeing his country come apart. He fanned his arms to describe how we are all connected and said he had one final wish - to go home again to Vietnam.

I sympathized with him and his son and explained that I was concerned about his ability to make it home to Vietnam safely. He was insistent, however, and I said I would do anything I could to help him. For his pain, we called in strong narcotics, and we arranged for equipment at home.

The day of his trip, I received an urgent page from my nurse. The General had arrived at the airport, and his weak and cachectic appearance had startled the airline staff at the check-in desk. They were concerned that the General might not make it to Vietnam without experiencing a medical emergency - a concern I, too, shared. However, I knew that getting home was the General's final wish - a wish I knew I had to do everything in my power to help grant.

My nurse Pam helped to draft a letter to the airline, to which I affixed my signature. Pam somehow got the letter into the right hands at the airport, and the General was permitted to fly home.

Last week, Pam reached out the General's son to see how he was doing. His son said that they had made it to Vietnam two months ago without needing to divert the plane. Upon landing in Vietnam, the General was taken directly to the hospital to treat his uncontrolled pain. He died there in the hospital a few days later.

There are many definitions of home. Certainly, a sterile hospital bed does not generally meet that definition. However, the General was no usual man. It was home that we were able to get him and where he took his last breath.