There are many different types of heroism.
Don, a marine, was thirty-one-years-old and had been suffering from cancer for eight years. Although he didn’t yet realize it, he had entered the active phase of dying when I met him, returning to the hospital for the second time in two weeks. I was his palliative care physician, brought in to help manage his pain and symptoms.
Cancerous liquid leaked from his lungs into his chest cavity, squeezing down his lungs. Don was now gasping for air. He was also holding a basin up to his mouth to catch the vomit from his constant retching. This tall and broad-shouldered marine, who served two tours of duty in Iraq, had lost all of his bulk; the angel he’d had tattooed on his shoulder to mark his fifth anniversary free of cancer had shriveled. His belly was distended, his face was gray, and his head was bald. His wife was beside him, gently wiping the spittle off his face. His father stood at the foot of his bed, hands thrust deeply into his pockets.
Don had vowed months earlier to “fight till I’m in the grave.” Newly married with a lovely wife, he was willing to do anything to survive. Treatment after invasive treatment had been tried over the previous several months of his rapid decline, but to no avail. And now, Don’s kidneys were beginning to fail. After a few minutes of introduction, Don’s father, a tall and authoritative military professional, pulled me into the hall and asked, “Where are we at this point?”
The question was vague. He might have been wondering what the next treatment would be. But his sad eyes told me the truth. He was starting to doubt that the cancer could be beaten. Until now, he had been supporting his son as he went through the battle, assuming the injuries and casualties were necessary collateral damage. But now I could tell he was starting to question whether there was a benefit to the suffering.
I responded with a series of questions. I didn’t have all of the answers he needed, but I helped him pull together information about his son’s medical status, available treatments, and, most important, about Don himself—his hopes, his plans, his wife. He told me that Don was proud, strong, and a real fighter. But, he said, Don also knew when to retreat. “He wouldn’t stay in a battle if he was losing his men,” he told me quietly. I watched quietly as he put the final piece in this sad puzzle. He drew a deep breath, wiped a tear from his eye, and thanked us for our honesty. The battle was lost, he said, and the time had come to concentrate instead on Don’s comfort and dignity.
But when we talked to Don’s wife, she vehemently disagreed. The oncologist would be back to check on Don’s progress in two days, she said, and she didn’t want to change the plan until she had heard from his lips that there were no other options. But I wasn’t sure Don had two more days, I told her. He was failing rapidly. If the current course was to be maintained, within a day or two he would probably need a ventilator and medication to support his blood pressure. This decision would guarantee that he died hooked up to machines in an ICU. She was quiet. I suggested we call the oncologist in his clinic together, and she agreed. I dialed the number on the telephone speaker.
After ten long minutes on hold, the oncologist picked up. He was in a busy clinic, he said, and didn’t have much time to talk. How could he help?
I explained that the family needed some clarity on Don’s condition immediately, in order to make sure that the current plan was still appropriate. “Is there anything else to try,” I asked him, “anything that will make a significant difference in his clinical course?” The oncologist hesitated. I imagine it was hard for him to acknowledge that there were no further life-prolonging treatments to offer this young man. He slowly began to list a few possible regimens, but then his voice trailed off and he sighed.
This was the moment of truth for Don’s wife. She began to sob and said she didn’t want him to suffer any longer. We began treating his symptoms more aggressively, and by the next day, his pain and vomiting had subsided enough for us to have a conversation. He received the news about his condition with grace. He wanted to go home, he told us, with what sounded to me like relief.
Unfortunately, he never left the hospital. After an unexpected complication, he died at 3:30 the next morning, in the comfort care suite of our hospital. But he was free from pain, at peace, and surrounded by his family. His wife was able to lie next to him for most of the night, her arms around him, feeling for each breath, whispering words of love and support. His mother, at first hysterical with grief, grew calmer knowing that his pain and suffering were under control. And his father sat stoically in a chair next to his son’s bed, watching him with grief and pride.
In our eyes, Don was a hero to the end.