GRATITUDE

Being grateful is an acquired taste for many people. That is because so much of our world and our lives does not conform to our notions of how we wish things were. However, sometimes gratitude sneaks up on you and shakes you awake, recalibrating your expectations and resetting your world view. That was the gift the family of one of my patients gave to me this week.

I first met Dr. P two years ago when he was diagnosed with metastatic prostate cancer. He was weak and felt ill most likely due to the renal failure his obstructive cancer was causing. We started treatment, admitted him to the hospital, and stabilized his kidney function. We were able to improve his symptoms for a few months, but then the cancer began to grow. Despite multiple additional therapies- new hormonal pills, immunotherapy, chemotherapy, injectable radiation, his cancer marched on. I had discussed experimental therapies, but he declined these because of the time commitment that was involved. It was not that he was worried about the inconvenience of additional study-related visits. He was concerned because he was the primary caregiver for his wife, who had had a stroke several years back. He was unwilling to sign up for anything that might interfere with his ability to get home to her every weekend by 3 PM, so he might relieve her in-home nurse.

A few weeks back, I met with him in clinic with his brother, sister-in-law, and son. I explained that we did not have any safe options left and that I recommended hospice. Dr. P said he understood and thanked me for all my efforts. As I stood to leave, I gave him a hug and did not hold back my emotions or my tears. 

Indeed, hardly felt I had done much for him, especially since most of the treatments I had recommended had not worked at all to slow down his disease.

A few weeks later, his sister-in-law emailed me letting me know there would be a visitation and funeral the next day. She said, "I thought you would want to know." 

I cleared some time in the morning and headed over to the visitation. There, I met his two sons again and other family members. I told this sons how proud he was of them and how he always talked about them. I thanked his brother and sister-in-law for being there for him on hospice. They, in turn, thanked me for what I had done. When I lamented that I was not able to do as much as I would have liked, his daughter-in-law interjected, "Dr. P had one goal - outlive his wife so he could remain his caregiver. You helped him achieve that!"

I am not sure I have ever been given a greater gift from a patient's family than the knowledge of what his goals were and how I helped to make that goal a reality. It reminded me of the importance of asking patient's what they hope to achieve and to not overestimate what they expect when faced with a terrible diagnosis. It was also a reminder of all the things to be grateful for in my life - my family, my health, my work.

I left the church that day in a new frame of mind - a more grateful frame of mind. I pray that the lesson I learned there persists. What a life.