He and his wife had seemed resigned, accepting of the inevitable when I met them 4 days ago at his home. Sitting upright in an armchair, hooked up to an oxygen tank, he was having a hard time breathing then, because of the mets to his lungs and the resulting fluid buildup in the pleural space. But he had been at peace, spending his time meeting friends and family who dropped by to say hello, and a final goodbye. The hospice team was wonderful, they said, and couldn't have been kinder. It occurred to me that Charlie was lucky in a way, because he had had a chance to say goodbye to those nearest and dearest to him before he died. How many people, I wondered, got a chance to do that?
That day I explained again the information I had found about the clinical trials on pancreatic cancer, and encouraged him to enroll in the study. Also, I told them that I had ordered a bottle of enzymes for him to try, but unfortunately it was "out of stock" and wouldn't arrive until the day after Thanksgiving. Charlie and his wife were very appreciative of my concern and efforts on his behalf, even though I wasn't his doctor, or even his friend. I just wanted to help him buy a little time, and have a little hope when there was little chance of either. I guess I didn't know it at the time, but I was trying to practice "chivalrous medicine". Coincidentally, the current issue of Family Practice Management has an article on this subject:
Chivalry is not merely a civil duty meant for young men of yesteryear. Rather, it is a lost art that physicians - both male and female - can practice today. Being chivalrous requires effort, self-sacrifice and giving of oneself without expectation. A chivalrous physician respectfully places patients' concerns before his or her own (within reason). Fundamentally, being chivalrous demonstrates to others that you are a person who actively pursues the moral high road and realizes your character, perpetually evolving, is linked to your deeds. Chivalry is simply acting with kindness.
I brought the bottle of enzymes by two days later, on Friday evening. Charlie had had a rough day and could barely speak because he was so short of breath. As I handed the bottle to his wife, she asked me, "What do you think?" And I said, "You've got nothing to lose." She nodded her head with a hopeful smile. "What do I owe you for this?" she asked. "Nothing," I said, and I meant it. "Thank you so much," she said as I left. "It's my pleasure." And it was. The next night, he passed away.
It occurred to me that I might have done a disservice to Charlie and his family by offering false hope when there was none, instead of allowing him to accept his eventual death without a fight. Normally, I don't believe in futile treatments. But there was something about Charlie's situation that made me want to try to help him no matter what. Probably because he was so young, a few years older than me, and I could identify with him more than usual.
I believe that even though I didn't help Charlie live one second longer, I still helped him with the only treatment I had left: Hope. As Orisen Swett Marden said, "There is no medicine like hope, no incentive so great, no tonic so powerful as expectation of something tomorrow."
This website on bladder cancer discusses end of life care and the value of hope as a treatment option:
Some practicing oncologists consciously uses hope as a treatment tool. In ancient times, when medical technologies were more limited, the physician's appreciation of the therapeutic uses of hope was much more refined than it is today.
Even if one has no difficulty accepting the prospect of death, human beings need hope. To hope for a miracle is something we are capable of doing until the very end. There is no such thing as false hope.
This is the kind of medicine I want to practice, medicine that doesn't end when pills and drugs and knives can't do any more good.
Charlie, I hope you're doing fine.
Countdown: 36 days until target start date