America the Beautiful

yesterday i went to a patient's funeral.  he was a retired ICU physician, in his early 60s when we met.  he had acute myeloid leukemia.  he had gone through multiple treatments, including induction chemotherapy and stem cell transplant, but his disease relapsed and became more aggressive.  nothing was going to work.

he had tolerated his therapy relatively well.  only the last few months, things were catching up to him. his disease was worst. the treatment was harder to tolerate.  he had more fatigue, lower blood counts, more bleeding problems, more infections.

several weeks ago, he had been hospitalized again with fever.  his disease was getting worse.  there was nothing more we could do to treat the leukemia.  and he knew this.  he got everything lined up in his life. he had been prepared for this.  he left the hospital under the care of hospice.

he was always a wonderfully kind man. i really became fond of him and his wife. he was a physician himself and i'm sure had trained many residents and fellows in critical care.  but he was always so respectful towards me. he never once treated me like i was just a fellow - always, i was his doctor and part of his care team.

he was optimistic about his disease and always tried to be cheerful. but there was one occasion, when i was getting up to leave his hospital room, when he reached for my hand and stopped me. he looked scared and that look, coming from another physician, really made an impression on me. he said - "please take care of me. please take care of me". and he started to cry. i had nothing to say at that moment.  i hugged him and he cried briefly. i told him i would do everything i could.

i don't know if it's really ok for doctors to cry with their patients. i'm sure that he could often see in my eyes when i wasn't sure how things were going to turn out.  i'm sure he could see my own fear.  i'm not sure how physicians (or patients) feel about attending funerals.  it is always a little strange. i sit in the church and i feel like i'm responsible for his illness...and ultimately for his death. although i know that nothing could have been done differently to alter the course of his disease. acute leukemia in older patients is a bad disease.

he was Filipino. came over to the US in his early years and worked hard to get accredited as a physician in the US.  at his funeral service, his son went up and spoke of him.  he said that his father wanted "America the Beautiful" to be his processional hymn.  this was truly his land of opportunity.  there was nothing in his life that he was more proud of than being an American. he always impressed this on his children.

his son started crying at that point. he had to stop for several minutes. the church was completely silent.  then, he stepped to his father's covered coffin and stood there.  he bent over and placed a single kiss on the cloth that was covering the coffin.  it was a touching moment.

afterwards, i stood in line waiting to greet my patient's wife. she was standing there and we were all stopping, one by one, to hug her and give our condolences.  she was dressed all in black, as is tradition.  the image of her standing there made me think about her and her husband.  over 40 years ago, when they were married, they both probably stood similarly - at the doorway of the church, she was probably dressed all in white then and he was probably wearing a suit next to her - they were probably greeting people in a similar way, except it would have been a much happier occasion. and he would have been by her side.  that thought made me sad for his wife, who was now alone, and i could feel myself starting to cry.

she saw me, i was several people in line away yet, but as soon as she did - she reached towards me. she had several people to hug before she got to me, but then she hugged me tightly and said - "thank you. thank you for everything you've done".  i hugged her tightly and told her - i wish we could have done more. thank you. it's been my privilege.  it was hard to let go.

rest in peace, dear one.
i will always remember you.
 
and God bless America.