YOLO

Heralded by screaming lights, a man was dropped on our doorstep. Sepsis. Diabetic keto-acidosis. The brink of death.

He was also cachectic from decades of drug abuse and malnutrition, and didn’t have much reserve to fight the illness. He was struggling to breathe. He looked on with hollow eyes. We knew right away he wasn’t going to make it through the night.

Because the foreseeable outcome was so extremely grim, we were upfront in asking this man exactly what he wanted from this hospitalization: How did he want to die? Would he have us pave for him a comfortable end? Or would he have us wring out every last drop of frail existence before throwing in the rag?

To our surprise, he didn’t give us permission to let him go. In previous months, his life had been repeatedly spared in hospitals. But each time, he was restored to lessons unlearned—if he was better, he was better enough to overdose. So said his family, but he didn’t believe it.

So onward we fought.

These are Medicine’s most trying moments. I have sent off many people from this world, now—always when they’re ready, and sometimes when they’re not. It’s humbling and gratifying to be the last friend in a well-lived life, the one to bestow a parting IV and hospital blanket in the final glow of sunset. It’s frantic and dissonant to be the desperate arm over the cliff, the one obliged to hang on until the last futile chest compression. So often I’m assigned the latter role by patients with too many regrets in too little time.

Miracles are doled out too, in small packages of insulin and antibiotics. This man survived to wake up tied to a hospital bed, and—this is the miracle—to think to himself, “This ain’t me.”

The next few days were excruciatingly painful. We gathered everyone—patient, family, and doctors—to have a big heart-to-heart. The man expressed his resolve to come off all narcotics forever. The family had heard it all before. The medical team decided to test his resolve by taking away his pain medications gradually. We had legitimate reason to be skeptical, as he had legitimate reason to be in pain. Every morning, I asked about his pain. The answers went from “Okay” to “It’s 8 out of 10, but I can get used to anything” to “It was more than I could take last night, but I’m bound and determined to do this.” I don’t know how, but every day his smile grew wider and he was able to walk farther. All the while, his severe joint deformities were a constant reminder of his strength in coming face to face with this pain for the first time in so many years.

He later told me of the transformation that came over him. The morning light was breaking through the blinds. He was strapped at his waist. The nurses were eerily quiet in the hallway. He thought of what we had told him, that we expected him to die from the consequences of his habit. “I haven’t been scared since I was in Vietnam crawling through the jungle. But that night, I was ready to put on my street clothes and run!”

I don’t know if all this will last. But thanks to him, I’m willing to give a second chance to many more of my future patients. I wouldn’t have believed that, with either his body or his mind, he would make such a recovery. Now I’m starting to think I’m in Medicine to be proven wrong—and, in the process, to be made better.

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