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| panda-like calm through fiction | |||||||||
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Dante's Infirmity
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I met Dante when he had journeyed most of life’s long way. He was diagnosed with MS, but he ran his own heating supply business, and was fierce and independent, and for a score of years refused treatment. But his wife, who had cared for him, had recently taken ill; with a smile he said: “it’s impractical for both of us to be dying at the same time.”
I came to his home and examined him, and I remember he stood in his own doorway, motioning for me to come to him. It was important that even in this limited sense he not “go” to his doctor. His old dog sat patiently at his feet, and as I drew closer, his old tail waggled sluggishly, until Dante looked down disapprovingly, and the dog’s tail stopped. Dante said he’d been in more pain recently, had less energy. Like he was letting loose a painful secret he told me, “I’m used to doing for myself, with my wife, but with this, I can’t.” We talked, and I checked the normal things, then I drew blood for a work-up, and left. He came to my office to get his results, and that he’d wandered this far spoke to the direness of his situation. The blood work showed he was anemic. I told him there was no other way: he needed further tests, and my humble office couldn’t suffice, he needed to go to a hospital. Reluctantly he agreed. I ordered a CT scan and X-rays; that was when we found the tumor in his kidney. Hmm,” he said gruffly, and I couldn’t be sure if it meant he didn’t believe or didn’t care. “I’d like to go home, now.” I looked at his wife, who looked as desperate as I felt. She leaned over his hospital bed and whispered, “Please, honey, for me. If you love me, you’ll stay until the doctors are done.” He agreed to stay a few days. But I knew that wouldn’t be enough time. I set up a self-administered morphine drip for him, and eased the restricted dose ever so slightly past the protocols. He told me it was the first time in months his sleep wasn’t interrupted by pain. And that bought us another day, maybe two. Then Dante began talking about going home again. “A man ought to be able to die in his own home,” he said. Of course, we weren’t stopping him, but there was just enough old fashioned deference in his character that he wasn’t ready to walk out against his doctors’ wishes. Dr. Rice, head of our oncology department, spoke to him, using all the right words like “aggressive treatment” and “have you out of here as soon as we can.” In my office afterwards Dr. Rice admitted why he had convinced Dante to stay longer. The cancer in his kidneys was likely terminal, but Dante’s insurance covered everything, and would beef up Rice’s numbers at the end of the calendar year- when they mattered most to the administrator. I thought about going to her, or even the medical ethics board, but it bought us another day and a half. Only I couldn’t let it go. I knew what Dante wanted, and I knew that letting Dr. Rice talk him into staying wasn’t right. So I told Dante the truth; he said he didn’t care that Rice had twenty years, myelination and one good kidney on him, he still wanted to punch him in his smug little beard. But his anger was short-lived; “You almost went along with it, because you still think I should stay, don’t you?” He didn’t wait for my answer, but just sighed, and his shoulders shrunk in. After only half a day he’d changed his mind. He was tired of waiting, tired of testing, poking, prodding. He wanted to go home. By God, he didn’t care anymore how many other doctors they presented him with who thought he should get more treatment, he wanted to leave. Only, he was telling this to another doctor, because I had already gone home for the evening; “Oh,” he said, when Dr. Mitchell told him that. He thought he owed me enough to wait until I came back the next morning, to tell it to me himself. Dr. Mitchell talked with him for several hours after his wife fell asleep in a chair at his bedside. “I don’t want to be here. But, if I can’t not be here, then at least I want to be in control of when I leave.” Dr. Mitchell explained that we couldn’t force him to stay, but that we also couldn’t help him leave, either; all we could do was help him with his pain. Dante seemed to understand; “Yeah, of course. It was silly of me to even ask about. Forget it.” Dr. Mitchell stayed there for most of the night, except when she had to make her rounds. Early the next morning, his wife left and came back with paperwork for him to sign. She said it was from the lawyer, the “Do not resuscitate” order he’d requested, as well as some medical proxy documents. He signed them without reading them, because it was his wife, and because he’d misplaced his glasses. By the time I arrived, Dante wasn’t speaking with her. She was now his medical proxy, and in that capacity, had gotten him declared mentally incompetent to make his own medical decisions. “He’s staying,” was the first thing she said to me. We spoke for several minutes; Dante simply glared at both of us, conspiring over his medical care. “I’d rather have him alive and ornery; just so long as he’s still there.” I told her it wouldn’t work that way. His cancer, the MS: her husband was dying, and there was little if anything we could do to prolong his life. What she needed, and what he needed, was for them to be together. Her eyes welled up with tears, “He can’t- I can’t live without him;” she pulled me close to her chest, and I think she realized her only option was to live with him for as long as she could. When Dante saw his wife’s tears he forgot their quarrel. “Come here, Suzanne,” he said, and held her. We took him home shortly after. Standing in his open door, where I had first met Dante, were the rest of his family: his sister, his children, grandchildren, his old dog, his old tail waggling sluggishly from side to side. And Dante smiled; it was the first time I’d seen him smile since the day we met. I realized then that it had always been Dante’s journey, that my place was not as guide, but as companion, that the roads and decisions, taken and not, were his. He died six hours later, and I took some comfort that while I could not prevent his end, at least it was his end as he desired it. |
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