What I Learned From A Dying Patient

On this episode of Our American Stories, Dr. E. Wesley Ely of Vanderbilt University Medical Center shares intensely meaningful experiences, spiritual and all, from a patient's suddenly-shortened last days in this life.

Support the show (https://www.ouramericanstories.com/donate)

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:11):
This is lea have be with our American stories, and
once again we're going to hear from our resident doctor
on the show, doctor E. Wesley Eely, a professor of
medicine at Vanderbilt University. And here's doctor really sharing his
moving story. What I learned from a dying patient.

Speaker 2 (00:33):
I had a patient recently whose death was particularly harrowing.
Thirty nine years old PhD scientist Brilliant. She was sent
to the ICU team as a fascinoma, meaning a person
with a constellation of problems. The doctors couldn't figure out.
This woman had been physically fine until two months earlier,

(00:54):
and now she was growing progressively, short of breath, had
a little blood in her urine, and had pain in
her toes, which were turning blue and red in the cold.
Imaging showed that she had a growth on her aortic
valve and that sections of her kidneys were dying. The
doctors at the outside hospital had diagnosed her with blood

(01:16):
clots in her lungs and started her on a blood thinner,
but her condition kept worsening as the day progressed. We
started all the needed tests and interventions to help sleuth
out the problems and fix them. Hours into my periodic
conversations with her and her mother and sister, her mother

(01:36):
mentioned that my patient was agnostic. I realized that up
to that point, perhaps because of the sheer rapidity of
the way things were unfolding, I had neglected to take
a spiritual history. Since I teach medical students and residents
in physical diagnosis class about the importance of taking a
spiritual history, you'd think that I wouldn't fall prey to
this oversight, but I had. The literature showed that most

(02:01):
patients want to be asked about their spiritual beliefs or
non beliefs, and that many think it rude if healthcare
professionals don't consider this important aspect of their well being.
The question should be asked out of respect and in
a non judgmental manner. Thus, I said to her, do
you have any spiritual values that you want me to

(02:23):
know about that might influence your medical decisions. We'll get
to her answer in a minute. Within twenty four hours
of our meeting, the patient had been checked with an
array of blood tests and imaging studies, and there it
was the bibes. He showed angry cells with too much
nuclear size for healthy cytoplasm and prominent nucleoli. Cancer It

(02:48):
was everywhere. Then it became a whirlwind because she got
shorter of breath by the hour as the cancer and
fluid literally filled up her lungs. We went from her
arrival in the hope of figuring out what was wrong
and seeking a cure, talking about how when she got
back to her lab and students, she'd resume where she'd

(03:08):
left off, to the depths of despair. The patient's conversations
with her sister were difficult, to say the least, and
at times they both got weak. Eventually they affirmed that
they had to pave a way to prevent my patient's
further suffering. With her mother, however, it was much worse.

(03:28):
She looked at me through tears and fear and screamed,
this is not fair. Over and over. Her sister began
printing off her will from an iPad and having things notarized.
It was surreal. I won't forget my patient's look of
shock and surprise, as if she'd heard me wrong when
I told her that the cells we'd seen under the

(03:49):
microscope were cancerous and that the cancer had already spread
throughout her body only eight hours after we'd told her
that she had this incurable illness and that our hope,
which at the time seemed plausible, was to get her
off the ventilator so she could talk to her family,
she stopped breathing and died quietly, without any apparent awareness
of suffering. Throughout the day, I had tried to be

(04:12):
diligent about ensuring that she was able to spend time
with her mother and sister. The initial challenge was to
use a specific approach towards sedation that balanced her comfort
and her clarity of mind so that she could really
engage with the family. My last memory of this young
scientist is that of her breathing, unconscious and unaware of

(04:32):
her surroundings. At this point, she was newly comatose on
the sedation and painkillers. As we removed the breathing tube
and ventilator urged her family nevertheless, tell her what she
want her to know. It helps families to have no
regrets in the days that follow. The story is many things,
and to you, it no doubt means something different than

(04:53):
it does to me, as this woman's physician. I find
that one of the most enduring aspects of the story
was the palpable oneness I felt with her, and in
knowing how in sync we were with everything body and mind,
there was an unusually tight connection, and I sense that
we both knew it. Since antiquity, the greats such as

(05:14):
Plato and Aristotle have taught us the concept of body, mind,
and spirit as the fullness of existence, a triad still
embraced by many today. My patient and I were in
tune after talking about those first two, and then when
I took her spiritual history, she perceived that our beliefs diverged.
She affirmed what her mother had told me, Yes, I

(05:37):
am agnostic, and it's okay that we differ on that.
I nodded and was left to wonder how and why.
Without having talked about this earlier, she had both understood
that we differed in this third piece of the triad
and thought it important to offer me reassurance. An autopsy
will answer many things, like what was growing on her

(05:57):
heart valve and the source of her cancer, which we
think was bowel pancratic or ovarian, But no physical finding,
microscopic sighting, or laboratory test is going to help me
learn any more about her spiritual side. I remember her
loving manner and her inquisitiveness about life. I know that
she was thinking of her estranged father, her students, and

(06:19):
her nieces, whom she'd never see again. She wasn't sure
about the existence of the divine, but her courage, daring
to face what was happening, despite not wanting to hear
the worst possible news, utterly confirmed the human spirit. She
revealed the connectedness we have in all of our imperfect,
vulnerable lives. And I can still feel it now.

Speaker 1 (06:45):
And a terrific job on the production, editing and storytelling
by our own Montay Montgomery doctor E. Wesley Eely. Here
on our American Stories, this is Lee Habib, host of

(07:20):
our American Stories. Every day we set out to tell
the stories of Americans past and present, from small towns
to big cities and from all walks of life doing
extraordinary things. But we truly can't do this show without you.
Our shows are free to listen to, but they're not
free to make. If you love what you hear, go
to our American Stories dot com and make a donation

(07:42):
to keep the stories coming. That's our American Stories dot Com.