"the eagle has landed"

He was disabled from his illness for many years. Now on a ventilator with failing kidneys."I'm going to die, you know", he stated to me in greeting. I wondered was that the declaration or just a reminder."Yes,we all gonna die at some point in time",I replied.

The patient had been quite successful in his life, providing well for himself and his family. He vented his sadness and frustration of slowly losing his capacities over the years, and now being in a failing body of which he had no control. I told him,I thought he was brave to consider things in this way He told me that he was not brave, he was scared, but he was doing it for his wife. "I can't stand to see the pain in her eyes anymore", he explained.

His eyes sparkled as he talked about his "wonderful lady" and "the love of his life", noting how he could no longer be there for her in any substantial way. As I put the phone to his ear. "The eagle has landed", he said to his wife, communicating to her that he had arrived at what would be his final destination here on earth.

How someone can come to such a difficult decision out of love that most of us could not even bring ourselves to think is simply amazing.

I wonder how one can be fearful and brave at the same time.Perhaps being in love makes it easy.

"she wanted to go home"

She had this look of grandmother,and I was her physician.She had her fair share of health related issues,aging was certainly not one of them.She was 91 and she was keep going.

She had bounced back to her baseline after many episodes of pneumonias,urinary tract infections and skin break downs.Even she came off of ventilator to her credit. One of her hallmark was her being a yankee fan in the hardcore redsox nation.

The other day in my daily rounds,I was told that she looked somewhat upset.I tried to ask her few questions,there were limited answers,due to limitations of tracheostomy.Finally,it was narrowed down to one answer as a tear drop rolled down on her cheeks.It was known to all that she wanted to go home.What a heartbreak,as she could not. No one can take her home as her daughter had her own issues.

How this intense desire of going home lives on in some people's mind is truly heart breaking.On one hand their souls are trapped in an aging body which does not want to just give up.On the other hand their mind keep pushing their desire to go home.This might be the struggle of a mind and a soul carried on at the expence of a decaying body.I guess this playground is just way beyond our immagination of living a life as we know.

To some,I wonder,dementia might be a blessing,offcourse in case by case basis !

"from your loving son"

One day I entered this patent's room,his eyes were close,he was coughing with phlegm at the tracheotomy tube,he just needed suction.I did suction and he looked better.His parents were there and they told me," their son had been challenged since birth but he always had the best smile in the whole world".

This was their way of loving,dealing with the ultimate sadness of living through ones child suffering.To be there then and now,to defend and protect their bundle of joy.

I saw a statement on the notice board,and I asked politely,who wrote this;

"#1 dad,from your loving son".His father read with a smile in his voice.
Yes,when we treasure someone our voice has an expression of love,a joy we can't hide.

I knew that patient can't read,write,talk but yes he can communicate in ways only a parent and child can do.If doing so made them happy,I was happy for them.

How some people accept their situations,and struggle at the same time is striking.To some this is the way of living when one is a parent who takes care of a child in the struggle of a life time.

Let's salute to their beautiful hearts.

"let her die"

She was a special patient,an earthquake survivor,now a cardiac arrest survivor with a residual stroke.On a lighter note,what else she needed to prove that she was here to survive,until she had to deal with this tumor in her abdomen which was growing,bleeding and killing her.This tumor was now her survival challenge. As I took care of her,I noticed an enlarging tumor which was bleeding inside and she was dying now.

She was followed up by specialists,who made their final verdict.Let her die comfortably, put her on morphine drip.I had discussions about that and her final preparations with her daughter,who showed her firm belief and faith in God Almighty,and she took it as it was with hope for a miracle.

In matter of days her tumor got complicated with growth which no one can see and the bleeding which everyone can see.Surprisingly she became more interactive with signs of improvement.Then what happened which only happens in movies,a physician offer to intervene and over a matter of days a surgeon agreed to operate and finally removed the tumor.That made her a tumor survivor.

How some people die while other survive is fascinating.Who make those decisions. Whether living or dying is a free will or predestined domain is open for discussion.The concept of code status and subject of comfortably dying looks like all cursory. We relate death with pain.May be it is disease which is painful but death,who knows what it is like to go through except to those dying now and all of us at some point in time,just not yet.

"God's way of her promotion"

As I was discussing the poor prognosis of her husband,who was on a ventilator with high grade fever,I was doing the most difficult task of saying the most unpleasant truth about life.He was dying.The wife took a sigh and said,"do what you can,and I trust you".Then she continued,"for the last many days I am asking God to keep him safe in His Hands,I don't know what to do?"

She told me that when she lost her 6 years old daughter,she could not speak a single word.Now she can and probably this is a God's way of her promotion to deal with this situation.

How do people comprehend God's way of doing things is amazingly insightful.

"she had 18 dolls"

The first time I entered into this patient’s room, I got scared. There was a doll in bed beside her that was starring at me. I could not have eye to eye contact,off course with the doll.

She was a patient who could not breathe,talk without assistance and ambulate so was the doll.Later I was told that she had 18 dolls and the stories at nursing station were as imaginative as nurses from different parts of world.

One day one of her favorite physician assistant visited her, and the very next day to our surprise, like we needed one, there was an additional doll,a black doll was in her bed. It freaked out all of us.

As times goes on, nothing happened and my patient took care of her dolls like a live object. We watched as other patients did, but no one said a single word.

How someone can get so deeply attached to an inanimate object is a question for a curious mind. I wonder that her doll collection was something deeper than we will ever know. It may just be a reminder that we can give meaning to any object of our desire. The more I thought about it,I was not so surprised.

Yes, dolls are part of human tradition whether it is in the form of gods, money, power or our egos. It is just we all have dolls with different faces and different names. To be honest we all do love our dolls.

"broken bones and more"

He broke his ribs, scapula and clavicle while saving a deer on road. That motor cycle accident had taken away a lot from him,including his spleen.

On his first day at the hospital,as I introduced myself to him,he had this look of a hero,70 years old and just too well preserved for his age.

The other day I asked him, why he did so?
His reply was a smile with a sparkle in his eyes. He could not say a word. He had then a tracheotomy and was on a ventilator.

How some people put their lives before their safety to save others is a striking human attribute.It does not matter whether the life they save is a man or an animal. To some this may be the highest calling, a life worth living in and a life worth dying for.

"he is a good man"

I got him as a patient with a challenge.The wife wanted him to get better so that she can take him home.In usual situation it was not a big deal.But in this case,the odds were desperately odd. He was on mechanical ventilator with multitude of problems..

How humans love and keep loving is beyond imagination.
One day she showed me their wedding pictures,nicely saved as a treasure.It was time captured in moments of joy.Sometimes I wish,"lets just freeze in happy times".A smile,cheese,here it is moment.The forever 'aha moment.

Then she kissed her husband,and told me that "he is a good man,he took good care of her when he was healthy".
I saw a glow on her face with a deep shade of sorrow in her eyes.That was love in action:smile,joy,sparkle,tears;all components of being in love.

In the coming days,I saw her involved,caring,maintaining the fine line not to offend egos of doctors and nurses She was there just to have the best out of a sad situation she was in. Every day she had the same goal of taking her husband back to their home. May be some day,but there and then,it was a sad love story.A princess was losing her prince in every passing by moment.

How some people try to make the best out of their worst life situations is really amazing.Can that be a simple blessing or is that a wise choice.What ever is the reason,their ways of dealing with their lives make them living a life full of human experiences.

To some living the fullest human experience is the ultimate spiritual experience of all times.

"he is a broken man"

The other day I went to visit this patient.A very proud,self made,professional gentleman whose pride was a little skewed in terms of having a killer instinct.
He had a stroke which made him dependent on others but I saw enthusiasm of a conqueror in his eyes. I saw struggles.His struggle to survive and learn basic daily living skills and his family's struggle to see this proud man's daily losing battle.

One day his wife told me that a health care provider had made a comment that made her very upset.
"He is a broken man",those were the words.
Those words had echoed day in and day out in her mind.Those were the words which torn apart whatever strength left in this wife to care for a stroke survivor,her husband.

How our words can affect family members is a serious awareness issue in medical community. What we say,how we say,our words make or break people.

Words can have life of there own.Words can cause an invisible sharp razor cut or be an invisible soothing angel touch.The words,verbal or nonverbal, have lasting impact upon the morale and coping of families in a stressful time of their lives.

I wonder when will we treat all our patients like our own parents,brothers, sisters, wives,husbands,children,uncles,aunts and grandparents. Perhaps only then we will mind our own words to heal and keep our words like first do no harm !

"smiling and dying"

I was out the day she was admitted on my service. In my sign out I was told that she needed hospice care and she was dying.

When I met her; she greeted me with a smile. She was on high flow oxygen, she could not breathe well but she had this angelic smile. I discussed the overall prognosis that she was dying fast. I was proud of myself that I did communicate well, until later it fall upon me that it was her not me who was communicating at all.

The very next day and over few days later, in my interactions with her, I never noticed even a glimpse of fear. She was the same smiling, greeting face, wanting to go home. Not a word uttered about scare, fear, guilt, regret, blame.

How a person can keep smiling while knowingly dying is really a privileged experience for a few. I wonder is it extreme fear of death which makes one numbed-in-smile or those are a few lucky ones who embrace their forward journey with a no-fear-smile.