One Last Visit to See My Patient
The rain was coming down in torrents and my shoes were not up to the job. Nevertheless, I pressed forward along the soggy blocks. My 91-year-old patient and I had been together for some 20 years — honestly I’d lost count — so this was the least I could do.

Still, I was intensely grateful that this patient remained comfortable, happy, pain-free and able to remain in her home with her loving family. Just as the data predicted, she was living far longer than any of us would have expected, given her congestive heart failure and her severe respiratory disease. It was now 18 months since we started the hospice care.

The paradox is that a patient can qualify for hospice care only if he or she has a life expectancy of six months or less, if the disease runs its normal course. My patient certainly fit that definition, but as we focused intensely on making her more comfortable, she was living longer. Every six months I recertified that my patient indeed had end-stage cardiac and respiratory disease. And although she was clearly frailer at each certification, she remained comfortable and pain-free.

Most patients, sadly, get referred to hospice only in the very last days or weeks of their illness, which explains the misperception that “nothing” is done for the patient other than fluff the pillows on the way to death. Even for patients with end-stage cancer, the earlier they are referred to palliative care (care focused on patient comfort), the longer they usually live.

These thoughts circled in my head as I slogged through the torrential rain toward my patient’s home. I’d asked her daughter if maybe we could reschedule for the next day, when it would be less monsoon-like. “I think you should probably come today,” her daughter replied. Her voice was straightforward and unhurried, but as soon as she said that I angled my umbrella into the downpour and didn’t lift it until I arrived at her building, 20 sopping blocks later.

Their apartment was brimming with ferns, vines and succulents. It was almost as if they’d recreated the jungle of their home country in the concrete of New York City. In the midst of this verdant lair, my patient reclined comfortably on the couch, her face radiating warmth and welcome amid the greenery and medical equipment surrounding her. She gave me a big hug and invited me onto the couch next to her. A breathing mask from a nearby BiPAP machine covered her mouth and nose, but she could still talk. It was obvious how proud she was of her two daughters who sat nearby.

Sitting there, it dawned on me that my patient had won the lottery. She’d lived a long and happy life, with a loving extended family in two countries. Her final days were being spent on her own couch, among her plants and family, her favorite TV shows and music.

After 45 minutes visiting, I kissed her goodbye and shared hugs with the daughters. I headed back out into the rain, nursing a sadness and a relief at the same time.