My father was diagnosed with stage IV adenocarcinoma of the lungs when I was a third-year medical student. He was a healthy, non-smoking 52-year-old when he noticed a painful lump over his right clavicle.
“The biopsy result is bad news,” my dad said. It was even more devastating as my med student brain calculated his prognosis.
I watched him endure cycle after cycle of chemotherapy over the next two years. I watched as my strong and healthy father began to break down under the misery of cancer. I can only thank the good people at Memorial Sloan Kettering Cancer Center for supporting our family through it. The frequent hour-long drives into New York City for treatment are sad recollections and fond memories of my last years with him.
My dad was able to see me graduate from medical school. I remember looking out into the crowd, seeing him sitting near the back, too weak to stand on his own and barely recognizable, but the look of pride in his eyes was so strong that it felt like he carried me in his arms to receive my diploma.
It was a few months into my internship that I had to step out of clinical rounds to take a call from his oncologist. The cancer was no longer responding to the chemotherapy and was advancing rapidly. There were only a few months left, at best. I remember hanging up the phone as I sat on the ground outside the hospital. A lot of people must have seen me there, dressed in my white coat with my head buried in my arms, crying.
One week later, we brought him to the hospital when he became too weak and frail even to breathe on his own. It felt surreal to watch the most important person in my life get triaged among the general populace of the emergency department. I felt the swirl of chaos in the ED that night: the drunk patients, the drug seekers, the MVCs. There my dad sat in the midst of it all. We looked at each other, both realizing what was happening. He was going to die.
The ED staff must have realized it before I did as the full fury of emergency medicine whooshed past me, scurrying my dad off into the horrors of the resuscitation bay.
“No,” I said out loud to myself.
Choosing a Peaceful End
I broke free of my frozen state, and I pushed into the room. My dad was held down by burly male nurses as he reached at the BiPap, wide-eyed and terrified. The residents looked at him hungrily like they would a steak dinner as they prepared to intubate, as the nurses shoved needles into every limb, as they shouted at him to stop fighting.
“Stop,” I said. Ironically, this would be the first time in my career that I would command a room during a critical emergency.
I thought about all the patients I had seen throughout medical school and internship. The nameless patients that interns and residents looked at as practice for procedures. All at once, I saw all the patients I had witnessed butchered and prodded, sometimes futilely, and then stuck forever on ventilators while their bodies rotted away into lifeless husks.
No, I would not let that happen to my dad. No intubation. No central lines. No torture. This is my dad.
That night, we started him on a morphine drip as he lay in the ICU on BiPap. The hospital staff was astounded as dozens upon dozens of family and friends arrived overnight to visit him in his final hours.
I sat with him and was fortunate to share a last conversation. He told me he was proud of me, that he always would be. That was all I needed. That is all I will ever need. After we said our goodbyes, I held his hand as he drifted away.
I will always be thankful for how he experienced his final hours. Surrounded by dozens of his friends and family, he was able to tell them all goodbye individually. For all he had given me in life, I gave my greatest gift to him. The culmination of his support and my medical education, I had made the eternally difficult decision simply to let him die.
Painless and peaceful, Reynaldo Cruz, 53 years old, passed away the morning of Dec. 6, 2012.
I miss you and love you, Dad.Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.