I first met Doug in March 2008. He was a man with alcoholism who had stopped drinking by the time I first met him, but the ravages of alcohol had given him severe cirrhosis. He was disheveled and living in a nursing home facility. Sure, from the time I first saw him as a consultant in the hospital, I looked after him in my professional role over the next several months. I followed all the recommended guidelines in caring for a patient with cirrhosis. But ultimately in my eyes, I labeled him as a decrepit, lost patient unlikely to improve his health. His biggest initial issue was the accumulation of fluid within the abdomen, which at one point required drainage with a needle almost every two weeks. He wouldn’t stick to the recommended low-sodium diet to help prevent reaccumulation of the fluid. Diuretic medications to help release the fluid were resulting in kidney failure. He also had a period of confusion from hepatic encephalopathy. I eventually referred him for a liver transplant evaluation, but he was turned down for various reasons. At one point I didn’t think he would survive long. As time passed, I would let him direct me when he needed fluid removal from his abdomen. And I’d brace myself when he called or visited me in the office because he tended to ramble about his problems.
It was through Doug’s ramblings, though, that he revealed the unique story of his life to me. I learned that he was a gourmet cook who had a selective taste for his meals. He had eclectic artistic tastes as well, which I learned when he started comparing a picture on my office wall to a painting of the Mughal dynasty. Doug made me laugh with his impeccable sense of comedic timing. He was the funniest patient I’ve ever known. And as he held his rosary beads, he would reveal in our conversations glimpses of his Catholic faith.
Over the next few years, Doug’s condition steadily improved. He was able to leave the nursing home and be taken in by a couple who tremendously influenced his improvement in health. We got him through two hernia operations, even as I was concerned how his cirrhosis would affect his surgeries (he insisted on being given the last rites by his priest before each). He stopped needing abdominal fluid removals, and his cirrhosis became quite stable. He resumed living on his own, and he started to drive around a man in his nineties who relied on Doug for his own health. Later he had surgery to remove lung cancer, and he continued to do well after the surgery. Doug liked to share his life with me, and I enjoyed sharing my life with him. We had come to enjoy each other as two persons who just happened to have a patient-doctor relationship. I thought I’d get to enjoy that forever.
Unfortunately, we could not, in the same way. Doug started having pain and atrophy in his right arm. Eventually, we discovered that his lung cancer had unexpectedly metastasized to his spine. I sat with him in the hospital around Christmas time, when he first learned of the test results. Three days after Christmas, he went for surgery to try to debulk the tumor and help with the increasing pain. I shared pictures with him of my son being born three days after his surgery, at the very same hospital. And two weeks later, because his pain wasn’t improving, he elected for hospice care. He died shortly thereafter.
Doug, with all his endearing irascibility, taught me how to see a patient as a person. And he granted me the same grace. I still miss him. His brother has told me recently that Doug’s restless spirit is still haunting his brother’s house. Papers will be blown off the table, with no wind around. And the rosary beads hanging in the house will mysteriously turn backwards.
I have told Doug’s brother this: A beautiful part of his story has been read by people all around the world. He has made an impact, as imperfect as he, we, and all the world have been. And his relationship with me is driving a ripple effect that will evolve health care, forever. I hope, in that understanding, that he can rest.
(1) Janisse T. “Through Conventional Medicine to Integral Medicine: Challenges and Promises,” In Consciousness & Healing: Integral Approaches to Mind-Body Medicine. ed. Marilyn Schlitz et al. St. Louis: Elsevier, Inc., 2005.