Monday, May 12, 2008

The Closer

Today I was the Closer.

In baseball the Closer is called in to clean up the mess of a game or to keep any gains from being lost. In medicine, the Closer’s job is similar—smoothing over sticky situations or tying up loose ends and saying good-bye. This can happen before a patient is discharged home to get well or before they are discharged home to die.

In the latter case, the Closer is not necessarily the doctor. It turns out to be the person who has the closest relationship, the most credibility with the patient. And sometimes the Closer is me, the chaplain.

The doctor, the nurse and the social worker had all told the patient she was going home to die but she didn’t believe them. I ran into her family in the waiting room.

“You have to tell her there is no more treatment left,” her daughter said. “Tell her the cancer has spread everywhere.”

But I knew that is not what I needed to say to make the patient understand she was going home for the last time.

I had known this lovely woman for the six years she had been treated for angiosarcoma, a rare vascular tumor. I never saw her without her wig and make-up. The first couple years it was easy for us to talk about dying and death. But as it happens with many patients, the less hypothetical death gets, the harder it is to talk about.

I sat down next to her bed and took her hand. “I have an agenda,” I said. This is exactly what I was trained not to do. A chaplain should never come in with an agenda and the focus should be on the patient’s needs and not the chaplain’s.

She squeezed my hand and smiled. “You’ve always been honest with me,” she said.

I knew that I didn’t have to talk about the futility of treatment, the extent of her cancer or multiple organ failure. She looked right at me so I seized the moment. “I’ve come to say good-bye.”

She was shocked. “Good-bye?”

“Yes. Years ago you and I talked about this day coming and it’s here now. So I want to thank you for all our wonderful conversations.”

She blinked, still unbelieving. “But I wanted to die vibrant and kicking.” Ball one. This was going to be harder than I thought.

“I know. But people with cancer don’t usually die that way. If you want to go out vibrant and kicking it’s best to have a massive heart attack while doing the cha-cha.”

She smiled. Don’t think it’s easy to say stuff like this. But as the Closer you know what your job is and you have to do it. The only reason I could say it was that it true and not saying it would hurt her even more.

I continued my farewell. “I always looked forward to seeing you in the clinic for chemo. I loved talking with you and your husband. But I know it sucked for you.”

“No, no! It didn’t—it wasn’t bad for me! I looked forward to seeing you too!” In spite of all the pain meds on board, she was still the gracious hostess. “I loved talking about books, and wigs and jewelry and praying with you. Thank you so much for being there for me.” That sounded like a good-bye. Strike one.

For every chemo she received, I had laid my hands on the chemo bag and prayed over it. My prayer was usually something like, “May this chemo help her body remember how to heal itself.” Her body had healed itself for six years, which is pretty good for angiosarcoma.

She adjusted her wig and said, “I just don’t want to give up hope.” Ball two.

What does this mean, “to give up hope?” I hear this all the time, as if accepting reality is some moral failing. As if it’s not possible to both accept the reality while hoping for a miracle healing.

“What are you hoping for?” I asked.

Silence. For a long time. Strike two.

“Perhaps what you’re hoping for has changed,” I said. “Maybe it’s time to hope for a peaceful death, or comfort for your family or hope that you’ll be able to let go gracefully and gently.”

I waited a moment before saying, “I think it takes more courage to let go graciously—“ I opened my palms gently, “than to hold on tightly.” I clenched my fists until my knuckles were white.

She stared at my hands and tears rolled down her face. “All right. But I’d rather be doing the cha-cha.”

Strike three—and my turn to cry.


Robert M. Reeder said...
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Robert M. Reeder said...

When I need a farewell I hope I have the privilege of hearing it from you. That was a very moving article. Bless you.
Bob Reeder