Canadian Journal of Rural Medicine

: 2021  |  Volume : 26  |  Issue : 4  |  Page : 192--193

Business as usual

Kyle William Carter 
 Western University, Department of Family Medicine, Western Centre for Public Heath and Family Medicine, 1st Floor, London, Ontario Canada, N6G 2M1, Canada

Correspondence Address:
MD, CCFP(EM) Kyle William Carter
Western University, Department of Family Medicine, Western Centre for Public Heath and Family Medicine, 1st Floor, London, Ontario

How to cite this article:
Carter KW. Business as usual.Can J Rural Med 2021;26:192-193

How to cite this URL:
Carter KW. Business as usual. Can J Rural Med [serial online] 2021 [cited 2022 Jan 22 ];26:192-193
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Full Text

My heart sinks as I read the admission history and physical dictated on Mr. F that morning. He was admitted under my care yesterday evening by one of the physicians within my group who has an interest in palliative care. He is under my care for the next 2 weeks awaiting medical assistance in dying (MAID). I do not know why I have a sense of uneasiness and apprehension to care for Mr. F, but I avoid visiting his room until all my other patients have been seen, the nurse's issues have been addressed and I have spent some time teaching the junior residents for the morning.

When I first enter Mr. F's room, he does not appear as I had envisioned in my mind – a man awaiting his death due to agony or suffering. He appears quite well, pleasant and even happy. He is lying in his hospital bed wearing the hospital-required gown. His hair is clean and he is shaven. I notice no evidence of disease, cachexia, wasting, malodour or jaundice. I introduce myself and explain my role as his physician while he is here in the hospital. His handshake is strong and direct. We discuss his cancer that has spread from his prostate to his spine, lungs and liver. His goal is to have no pain and experience no suffering.

'I'm ready to die, can we just get on with it', he says, without missing a step. I can feel the tension in my back as we discuss the process of MAID. I explain that I do not participate in the actual process, but his palliative care physician has made the referral and that there is a 14-day waiting period before the procedure. 'So, you'll keep an eye on me until its time to go eh?', he says. I agree.

Each morning for the next 14 days, I visit Mr. F. He has no complaints during those weeks. I see him up walking in his room, grooming himself and visiting with friends. His spirits always seem high. He very rarely complains of anything, pain, dyspnoea or anxiety. He leaves me with nothing to do and nothing to treat. I am left with the conversation about the world and specifically his life. I wish he had something to treat, something else to focus on or something that helps me understand this part of his life, awaiting death.

What I do learn is that he was never married and has no siblings. He became close with his neighbour over the years who had three kids. His passion was farming and flying. He was the 'cool uncle' to his neighbours' children. 'They would run down the road after school and visit him. Thirty minutes later, the parents would hear the sound of his airplane overhead and knew that he was up there with at least one of the kids.' I learned that he travelled all over the world in a small single-engine airplane, including the West coast of Canada and Central America.

On the morning of his 14th day, I do my rounds as usual. It is a Saturday and the hospital is full. I go in to see Mr. F. I realise that over the weeks, I have really gotten to know him, what his life is about, how he views himself and how he views death. However, I have not obtained clarity regarding his wish to die. This is the dilemma that physicians face caring for those who suffer when suffering is individual. I spend some time with him. I say goodbye. He is alone.

An hour later, I see a physician doing paperwork at the physician's desk. I do not know him but know the physician who completed the MAID travelled from the nearby tertiary centre. I am struck by the business-like regard that this strange physician has completing the paperwork. I realise Mr. F has just died. The medical world has not slowed to reflect or acknowledge the passing of this patient. Nurses continue to nurse, patients continue to be ill and the doctors continue to doctor. I, however, feel the loss of this patient. I question the practice of ending the life of a man who had no external signs of suffering. The stoical do not suffer less and what role should physicians play in judging another's struggle? I contemplate my lack of ability to find or understand his internal suffering. I question the role physicians should play in this and what role I have played in Mr. F's death. I have been left with questions.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.