Your middle initial: The weight of a single letter

You became my patient eight months ago. I asked you many questions, but I never asked you if you would like your middle initial on the last medical documentation that would be completed about you.

When you weren’t too tired, we had candid discussions about your death: your fears about leaving your family without a breadwinner, fears about death and suffering, fears of being in pain and your possible prognosis. You made it clear that you wanted to die at home. Although you shared your innermost thoughts and feelings, somehow asking you about your middle initial felt too intrusive.

The life we were trusted with

You had opted for home hospice. I was the hospice doctor on call that weekend. That meant I was available by phone and email 24 hours a day for any patient issues, including electronic medication prescribing, symptom management, hospice admissions or to complete death certificates. In New York City, death certificates must be completed online.

Most of the weekend, I was glued to my desk in front of a computer. Calls and emails came in from hospice nurses to discuss patients or from funeral homes inquiring about the status of a death certificate. My thoughts and feelings about this are not important right now.

Your hospice team was larger than you and I. Your team included your hospice nurse, your social worker, your spiritual care counselor and your hospice specialty aide. We’d been involved in caring for you and your family since your admission.

Early on, you shared your humanity with us: your joys and triumphs, your regrets and tribulations. One example stood out. It was very important to you that the team knew how you and your wife met. You were not the high school football star, and your bride of 30 years was not a cheerleader. You met her on a stormy day, on another continent, on the worst day of your life: the day your mother died of influenza. The nurse who cared for your mother at home that day later became your wife.

When days became hours

As time went by, you started to experience nausea and pain. I did my best to make you more comfortable using both nonpharmacologic techniques and medicines. In the weeks before your death, you had been an active participant in managing your symptoms. Your family saw how you responded to the medications and interventions I had ordered. Their love for you filled your apartment so entirely, it was almost tangible, and your hospice team was inspired by it.

Your death was getting closer.

In the days before your death, while you still had enough strength to eat, you no longer vomited up the chocolate pudding. You didn’t grimace in pain. Other symptoms were also under control. The hospice team increased the frequency of visits to your home.

Your final days on earth had become hours and your final weekend had come. I spoke to your wife, who told me that you were surrounded by your family.

The question I never asked

At 10 p.m., an email popped up informing me that you had drifted away from this life. My heart was heavy, but I was happy you had been comfortable.

I agonized over whether to include your middle initial on your electronic death certificate. In the end, I decided to include it. I believed it would enhance the majesty of your life. The electronic form became three-dimensional as it filled up the computer screen with your elegance. I took a moment to honor your beautiful life and your soulful energy.

The phone rang. I sighed, and I was off to care for the next patient. 

Wherever you are, I hope that you have found peace. I feel blessed to have been able to care for you.

Related reading:

How poetry helps me process my medical training

Growth, patient openness and free food: What health care workers are grateful for this season