Mortality Bites

I rarely remember my dreams more than a minute or so after I wake up, but last night's dream (more like a nightmare, actually) was on a whole new level. I think it began with me being in the hospital, knowing I was ill (cancer, maybe?) and with a limited time to live. I remember looking in the mirror and seeing my face appear gaunt, with hollow cheeks (which has never happened; I've always had a round face), and having friends and family take me home, asking me what I wanted for "after I go." I distinctly remember being in a room surrounded by familiar things, looking through them, and telling my next door neighbor (whom I've known since he was a baby) I wanted to be buried with my childhood journals. It was around then that I woke up, a good 30 minutes before my alarm was set to go off, and no matter what I did, I couldn't fall back asleep. I just lay in bed, feeling uneasy.

As a hospitalist, I'm no stranger to death. Fortunately my white cloud has prevailed as I've only had to sign 3 death certificates so far since starting my job in September. Even still, I've been working three weeks straight with only 1 day off in the middle, and in these past three weeks I've seen a lot of depressing things. For example, a patient with metastatic esophageal cancer came to the hospital and decided the following day he wanted hospice. He even knew which hospice facility he wanted, and knew he wanted to be comfortable in the end. His oncologist told me 1 week later that he'd died peacefully after several days in hospice; that same oncologist also said he'd lost several patients in the past 2 weeks to terminal cancer. I had another patient with ESLD who got a TIPS in hopes that it could curb his ascites. It didn't; one week after I sent him to rehab, I ran into him in the hall on the way to IR to get a paracentesis. He'd gained 27 lbs in 1 week. "Doc, I can't do this anymore, I want to die," he'd said, "and I don't want to die at that place (rehab), I want to go home." Because we were in the hall, the only thing I could tell him was to get the paracentesis, then talk things over with his gastroenterologist and sisters.

I don't think my dreams are prophetic, but there have been a few instances in life where I had a twinge of deja vu and thought, "I think I dreamed of this before." A few dreams I recall that (fortunately) did not come true include a childhood friend being wheeled into a hospital with a needle in his arm (ironically, he's now working as a nurse in Seattle) or me being pregnant and not knowing who the father is (which will never happen if I can help it). But this dream with me dying of cancer? It could happen. I've seen young people in their 20s and 30s be diagnosed with leukemias, sarcomas, and everything in between. Some (a 31-year-old woman with ALL, a 32-year-old with metastatic rectal cancer) are most likely dead now. I've been extremely fortunate to be healthy all my life, but who knows? That could change in a blink of an eye.

Death is not something I try to think about. I've watched my parents grow older these past few years, and I dread the day I have to bury them. I hate it when my dad makes comments like, "Oh, I've probably got about 10 good years left," but the truth is he might be right. And who knows how many years I have left? Everyone would like to grow old and die peacefully, but those of us in medicine know all too well that it rarely ever ends like that. Anything can happen. I can only hope it won't be anytime soon.