David's head was literally stuffed with lung cancer. I was called in to take care of his hip and pelvic bones broken by the growing metastases. His seeming nonchalance about the pain and the surgery was clearly out of concern for his beautiful, young family--his wife Carol, a nurse, and his three kids, who were there every night. He couldn't keep up the carefree charade over the next two weeks, though, as his speech slurred, then became incoherent. He stopped speaking, then moving.
I dreaded making rounds on a patient for whom there was no good news, no good plan. When his doctors rescanned his head, there was barely any brain left. The cerebral machine that talked and wondered, winked and sang, the machine that remembered jokes and birthdays and where the big fish hid on hot days, was nearly gone, replaced by lumps of haphazardly growing gray stuff. Gone with that machine seemed David as well. No expression, no response to anything we did to him. As far as I could tell, he was just not there.
It was particularly bad in the room that Friday when I made evening rounds. The family was there, sad, crying faces on all of them. I fussed with the hip a bit. His respirations had become agonal--the gulping kind of breathing movement that immediately precedes death. I knew Carol had seen this and that she knew what it meant. I said something inane and slid out the door fast, looking importantly at the papers in my hand, striving for the nice, empty corridor. But Carol came after me, needing to catch me away from the kids. Her eyes red-rimmed, she asked me where her husband was. I had noticed the cross around her neck. I said I wasn't sure where he was, but I was pretty sure where he was going. She wanted to believe me, and I think she did.
Saturday morning the sun poured in as I checked the room. The bed was at chest height, made up and empty, with clean, fresh sheets over the vinyl mattress. As I turned to leave, I was blocked by a nurse, an older Irish lady with a doleful look on her face. She had taken care of David last night.
"He woke up, you know, doctor--just after you left--and said goodbye to them all. Like I'm talkin' to you right here. Like a miracle. He talked to them and patted them and smiled for about five minutes. Then he went out again, and he passed in the hour." My eyebrows went up.
Two weeks later I saw Carol in the lobby. It was busy and very public. But before her last "God bless you," I couldn't help asking, "Uh. Carol, did ...?"
She knew my question. With a wide, knowing smile, she nodded and said, "Oh, yes, he sure did." And I believed her.
But it wasn't David's brain that woke him up to say goodbye that Friday. His brain had already been destroyed. Tumor metastases don't simply occupy space and press on things, leaving a whole brain. The metastases actually replace tissue. Where that gray stuff grows, the brain is just not there.