Facing Death, He Found Comfort In A New Suit And Tie
Ed's glasses rest on the bedside table next to a piece of uneaten cherry pie covered with saran wrap and a pocket Bible with an orange vinyl cover. Ed's body lies partially covered with a sheet. His wife Karla rests her head on the pillow. I had pronounced Ed dead several moments before, and now I wait with Karla for her daughters to return from the cafeteria.
A suit, shirt, and tie hang from the closet door. Yesterday afternoon as the resident physician and I examined him, Ed asked me "Ain't it something doc?" The hospice chaplain had purchased the outfit for Ed for $19.50 from the Goodwill Store.
Not a bad price for some measure of peace for a dying man, I think, as I glide my hand across the shiny polyester.
Thirteen weeks before when I recommended hospice care, Ed had stormed out of my office. His lymphoma had recurred for a fourth time. It was not likely that he would tolerate or benefit from further therapy. But Ed pushed back hard on the uncertainty. He was just reading a pamphlet in my waiting room that said his kind of cancer was the "curable" kind. And there were lots of stories in magazines about new treatments. He could not imagine, I suspect, deliberately choosing a plan of care focused on the quality of his final weeks. "What the hell is peaceful about that?" he said as he slammed the door.
Eight weeks before his death, Ed returned. He had received chemotherapy from a different oncologist. Karla had spoken with my nurse every once in awhile. So I knew of the decision and the complications which he experienced. "No hard feelings," Ed said, as I walked into the examination room.
"Ed," I said, "I am happy to care for you, but no more chemotherapy." Karla asked "What'll happen? How's it going to happen, the dying and all?" Before I could reply, Ed said, shaking his head in resignation, "Ugly. Just like I lived. I imagine it'll be ugly."
There is no polite way to summarize Ed's life. We all understood what he meant. Ed accepted hospice eventually but insisted on a weekly office visit with me. He would bring articles about new and promising treatments clipped from magazines. "You think we should try this, doc?" he would ask. "Maybe we don't have to quit after all."
Three weeks before he died, Ed did not bring any articles. He didn't want to answer questions or be examined. He wanted to talk. Ed had concerns. His children from his prior marriages would not visit. Karla's daughters were encouraging her to leave him. He talked about his funeral. Would anyone come? Maybe it would be better if no one came. He didn't want a bunch of people staring at him all skinny and pale and dead. He didn't even have a decent suit to be buried in.
"Ed, have you met the hospice chaplain?" I asked.
"He calls asking to come to the house. Never had much use for religion, doc. Not likely much point in starting this late," he sighed.
With his permission, I shared Ed's concerns with the chaplain. And I know Ed and he met several times before Ed died. I do not know what Ed spoke about with the chaplain. But I also know this: the chaplain collected donations from the hospice staff and bought a suit that hung in Ed's room at home and came with him to the hospital. The night before, as I was preparing to leave, Ed whispered, pointing to the suit, "Ain't it something doc? I'm dying pretty."
I took care of Ed more than ten years ago. I continue to confront the challenge of advising the people for whom I care to forgo further chemotherapy and accept purposeful end of life care. What I learned from Ed sustains me. Not quitting, especially as life ends, is to remain present and to witness--perhaps to foster--the discovery of the so-called little things that may matter most, like a suit to be buried in.
Larry Cripe, MD is a hematologist and oncologist specializing in palliative care at Indiana University Hospital in Indianapolis. This essay originally aired on Sound Medicine on April 19, 2009 as part of Dr. Cripe's "Grace Notes" series.