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Voices: Saying Goodbye to a Patient | Larry Puls, MD

Larry Puls
Feb 23, 2018

Saying Goodbye to a Patient | Larry Puls, MD

I stand at the door—afraid. Take a deep breath. Just another room; one I have been in a thousand times before. Inside a bed, a bathroom, an IV pole, a friend. And while I stand there, my angst grows over the unrevealed information. Still frozen in the hallway, I cannot reach out and touch the door handle. You have to go in.

Larry Puls, MD

My conscience compels me across the threshold. There she is on the bed, under the covers. The IV pump making its purring sound. She looks so peaceful. I could not find a more difficult way to start the day. Even now, the important words remain jumbled in my mind. I wish there were another way. But there are no other volunteers. When I look around, pressure mounts, seeing the patient surrounded by an entourage of residents and students begging for some kind of wisdom or insight to do that which screams impossible. Fear overtakes me.

I sit on the side of her bed and touch her on the shoulder. She turns and smiles at me. My friend — this woman who won my heart with her bravery, her kindness, her fortitude. Her sense of humor pops into my mind. All the laughs we had. All the cries we had. They are all in the front of my eyes. You must tell her.

The first words, the easy ones, float delicately from my mouth. I recount all the places we’ve been. Surgery, chemotherapy, surgery again, back to chemo—a game of leap frog… But now, as the hard words are inching up my throat, something unavoidable happens. My eyes speak first—teardrops fall. I see her grasping my anguish, my vacillating heart. I was never good at poker. She knows. The secret has leaked out, albeit unspoken, but audible nonetheless. I see her start to weep. A cancerous checkmate.

I realize this is where life took me as an oncologist. We are not on the sidelines of life, watching everything from afar, but we have been thrust into trenches too often wrought with sorrow. For good or for bad, we are by definition, engaged. And yes, I struggle with that not uncommonly.

Is there a blessing? Our broken hearts remind us of the joy of life, the joy of other souls, even when they are packaged with agonizing pain, carving out deep scars—but healthy and needed ones. Life is a gift and we are blessed to be allowed to savor that gift. Never forget that!

Leaving her room, I reflected on what we do for a living. And I acknowledge yet again that in my own individual life, without my faith, I could not be sustained in such a wrenching moment as this. It upholds me and commands me, to stay in the trenches and pour my heart into the lives of those entrusted to me. So, my encouragement to all of us is that we absorb our fragile emotions, calm our saddened souls, and regroup to serve where we are called.

Larry Puls, MD, is a gynecologic oncologist in Greenville, SC.

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