The familial covenant between a doctor and his patient

She was my patient for more than 30 years. Among my first patients when I entered my practice of Obstetrics and Gynecology, she and her family and I “grew up” together as I witnessed her life unfold and shared in her blessings and adversities.

As a young woman, she was afflicted with a curable cancer for which she was treated and cured. Forewarned about the adverse effects of her radiation and chemotherapy on future pregnancies and desirous of a child, she nonetheless conceived and delivered a healthy son. Shortly thereafter, she developed a cardiomyopathy. Her heart remained in failure as she awaited a heart transplant for two years.

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On the day of her heart transplant, I came to the operating room with her and held her hand as she drifted asleep. I was a surrogate for her family who could not be at her side at that moment. I have acted as surrogate and advocate countless times for my critically ill and most vulnerable patients, but this was different. She knew her heart was to be removed, her life to be supported by machines until her new heart was sewn in place. She knew she might not awaken from the surgery. I knew that too but as our hands clasped, we silently shared a common hope. Together, we trusted in faith and in the doctors caring for her.

I have attended in the operating room nearly daily for my entire career, but I had never been in the operating room to participate in or witness a heart transplant. I watched with trepidation as her cardiac surgeon, skilled and experienced, removed her enlarged and failing heart from her body and placed it on the operating table’s instrument stand. Her new heart, 20 years younger than hers, was then meticulously transplanted into her body. After multiple attempts to initiate a spontaneous heartbeat her new heart beat and her pulse resumed.

Next: A fateful visit

A fateful visit

In the years following her surgery, she went on to meet the donor’s family. I went with her and her family. Her life seemed to return to normalcy. But then, yet again, she was stricken. She developed a virulent form of post transplant Lymphoma that, despite heroic efforts to cure, ultimately took her life.

She spent her last days in hospice. The hospice facility was located near my office and each day, without exception, I would visit her either on my way to the office or on my leaving.

On one particular day, I left my office early to attend a lecture at the Yale Humanities in Medicine Program entitled “The Doctor-Patient Relationship,” to be given by a renowned ethicist, Dr. Eric Cassell. I wanted very much to attend this lecture and I was not planning to visit her on this day. I explained this to her and her family, now accustomed to expecting me each day.

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But when I passed by the exit to hospice, I was compelled to visit her. When I reached her room, her husband, her son and her mother were sitting beside her, somber, crying. She was now comatose. I sat at her bedside with her mother, while her husband and son took a short break. She was unconscious but I believe she was aware we were there. She took her last breath with me and her mother holding her hands.

Next: The differences we can make

The differences we can make

I was told later she wanted to die absent the presence of her loving husband and son to spare them the pain. She directed her death as she did her life. I was asked by her family to give her eulogy, telling me she considered me a part of her family. Yet I knew she considered the world a part of her family. Her life affected everyone she knew and those whom she did not know. Her family was the “family of man.”

She possessed a silent gravity that drew us into her life. I have always been compelled by virtuous persons, those who place wholesome values and selflessness on their daily agendas, and needn’t struggle to carry them out.

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By simply being, she taught me what is truly important in our lives. Though sometimes in pain and sometimes dependent, often afflicted and confined, her life was saintly. She put others’ concerns before her own. Their afflictions became her afflictions; her cause to live. She cared and was caring; she loved and was loving. She lived as she was dying.

From her, I learned what is absolute: that our hearts grant us life, but our souls render love. Science and skills of devoted physicians could not keep her alive any longer. This was her time to leave us. She chose her moment. She was ready: unafraid, serene, at peace. Her memory would continue to render love to us all.

I eulogized that with her death, we feel as if a part of our own humanity was lost, never to be found, and that our tears could not justly portray our grief as we begin the search for reason and comfort. In remembering her, I spoke that hope must prevail for she was driven by hope. She believed that hope is a singular gift we must never destroy in ourselves; that hope is an endless song in an endless concert; a nocturne bright in the darkest of nights.

Next: Affirmation of our responsibility and privilege

Being her physician during her short life was an affirmation of the responsibility and privilege we have as health professionals and what differences we can make in the lives of our patients-even with death as an endpoint.

Michael R. Berman, MD is an OB/GYN at Mount Sinai Beth Israel Medical Center in New York, New York.