"Our painful experiences become the passages that open our hearts to empathy."
The Rude Awakening
"Please help me die, Dr Ohno! Please help me die! I know you can help me, Dr. Ohno. Please show mercy and help me ! Stop this pain I am going through ! I beg of you, Dr.Ohno, be merciful and help me die. send me to heaven and relieve me of my pain ! "
She stunned me with her outburst. I responded. "I know you are in a state of intense pain and you are not able to think straight! Please understand that what you ask of me is unthinkable and I cannot help you die. I am a doctor! "
She took deep and deliberate breaths. It was obvious that she was in a tremendous amount of pain because of the anticancer medication in her body system. I wondered if it was the pain that had taken over her senses, affecting her sanity. But her eyes told me that she was not insane, quite the opposite. In fact, she was quite rational, and her intention was very clear.
"Dr. Ohno, please understand, I am asking you to do this out of mercy for me! I am asking the 'unthinkable' because you are my doctor , and I trust that you will help me. If you were not my doctor, and if I felt you did not care for me, I would never think of requesting such a thing.
"I have been waiting for the right time to approach you. I have been praying to God to give me the chance to talk to you. It is at this moment that I am telling you that I have decided to die. I have hesitated because I knew, of course, how you would react to my request to die. Your reaction is not a surprise to me. I would not have requested you to react in any other way !"
She looked at me carefully and calmly. She as almost too calm. She had surrendered herself totally to this decision to die. There was no fear in her voice or in her eyes. She got up out of her bed and closed the door quietly, wanting privacy in the room so no one else would hear our conversation.
"Dr. Ohno, I have asked you before to stop giving me the anticancer drug ! The side effects are to strong and I know you don't want to watch me suffer 1 Every time you inject me with this drug, I know you, too , are suffering as you watch me suffer.
"I have lost over 25 pounds since I have been here. Iweighed 100 pounds when I was first admitted here and now I weigh only 75 pounds. Look at me ! I look like a living skeleton! Nobody recognizes me anymore, because I am only a shadow of the person I used to be!
"Putting food into my mouth is a nightmare because I know I will vomit up everything I eat . When there is no food in my stomach, then I experience the dry heaves. Right now I am also suffering from bleeding of my gums. It looks like I never clean or brush my teeth."
Her eyes were filling with tears again. She suddenly held her hand out from underneath her bed sheet and said, "Look! Look at my finger!" When she showed me her finger, I noticed that the fingernail had fallen off and the skin under the nail had turned black.
"Look at my finger. it looks like a dead person's!" She waved her finger in front of me to see. Sobbing, she lifted off her wig . "My hair has completely fallen out! I am completely bald! I can tolerate my hair loss, but I have no energy left to stand the continuous nausea and vomiting and chills ! The chills that take over my body after you inject me with the anticancer drug are terrible. It doesn't matter how many blankets I use to cover myself with, the chills are so intense that nothing makes me warm !
"After the chills subside, I have another severe attack of abdominal pain. The pain is so strong that I have to take another drug to ease the pain. After the abdominal cramps, I can't move my arms or legs. When I go to pick up something , I have no feeling. Even if I prick myself with a needle, I am numb and feel nothing. After the paralysis, I have nausea again with more vomiting.
"Dr. Ohno, even though I am a strong and patient person, I cannot tolerate these strong side effects. I am reaching the end of my limit ! Dr. Ohno, I beg you, please stop giving me the anticancer drug! I have experience strong side effects before from anticancer drugs, but this new anticancer drugs, but this new anticancer drug has worse side effects. They are unbearable for me to tolerate. I know I do not have the strength to handle the pain anymore!"
Her words lingered in the room, hovering over me like a thick, dark cloud. It was very clear that she was nearing the end of her pain tolerance. She was getting weaker every time I saw her. Her voice was very strained now. Simple conversation was very difficult for her. But she found energy to make an appeal to me.
I sat there in the room with her, struggling for something to say. At that moment, there was nothing I could tell her, no words I could find to say to her , to give her any comfort. Although I felt compassion for her, a part of me wanted to get up and leave the room. I wanted to process what was happening, not only to her, but to me as well. Just as I thought of leaving the room, she instinctively reached over and grabbed my hand. I remember how the strength in her frail and lifeless hand amazed me. I felt the inner strength of her soul at that moment. As I hesitated, searching for a way to bring comfort to her, she continued . . .
"Dr. Ohno . . . from the first time I met you, and looked into your caring eyes, I knew you were a person who would understand. I sensed that you were completely different from the other doctors who had treated me before. I felt this way because I watched how truly sincere and empathic you were with your patients.
"The other doctors have always ignored me while I have struggled with the agony of my pain. But your eyes have always shown me your genuine concern. I have never found another doctor who has demonstrated compassion the way you do.
"I am aware that you do not agree with the hospital professor and you want to stop giving me the anticancer drug. I know that you suffer from being embarrassed about this situation and that you are deeply troubled because of your disagreement with the professor on how I should be treated. I know that if it were up to you, you would be taking care of me in a completely different way."
Again, het statement caught me totally by surprise , I responded, "What?" I suddenly raised my voice to her. "How do you know such things? Who has spoken to you about this?"
She reached over and gently patted my hand. It seemed so strange to watch her comfort me while I was searching for a way to bring comfort to her. Then she said, " No one has had to tell me anything. I know of your personal struggle because your face is always pale and drawn. I have been watching you and I have recognized your personal battle. Your work is depressing and you are aging and looking older and tired from the struggle."
She was talking to me with concern in her voice as though I were her son. Her insights were amazingly accurate. She stopped and took a sip of tea. During the silence, I started thinking about what she had just said.
It was true that I was struggling and my physical state was showing the fatigue from my internal battle. I was not sleeping well. I would not go to bed until after 1:00 in the morning every night/early morning. As tired as I was, I would lie in my bed unable to sleep. Since I could not sleep, I would usually get up and sit at my desk. I would think about her and if there were possibly different ways of helping her. I often thought to myself , "Why did I become a doctor?"
When I first became a doctor, I thought that I would find ways to help my patients. But instead of a healer, I felt more like a murderer. i was aware that the struggle would continue for me if I didn't find a better way to help my patients. I realized that I must decide whether I could continue being a doctor. I knew I would not remain the kind of doctor who could not effectively care for his patients. Nearly every night I would lose sleep over my preoccupation with this concern. During the day, my eyes were red and weary from lack of proper sleep, and I was being emotionally drained.
She finished her tea and continued, "Since I have been here, I have become very fond of you because you remind me of my son. I always think to myself that if I die, Dr. Ohno will be with me at my deathbed. This thought gives me a feeling of comfort.
"I have tried my best to be a good patient. I have never complained or refused your help because I have believed in you with all of my being. I have trusted you with my life. However, I cannot tolerate taking this new anticancer drug anymore, because the side effects are too strong for me to handle ."
She held my hands and looked directly into my eyes. then she continued to speak . . . . .
"I have talked to my family about my decision to ask you to help me die. I have made them promise me that they will not see you or bother you after my death. I am trying to make this easy for you to do. All I want you to do is to put another drug in the tube. That is all you have to do and then walk away. or, you can just leave the drug on the table and I will pick it up and swallow it. You can leave the room and leave me to die in peace and my pain will be over. If you are a humanitarian doctor, you will obey your patient's last wish. You are the only doctor who can help me! My family will not blame you ; they will be appreciative because they know of my wish to die.
"Please sent me to heaven right now! "Please, Dr. Ohno, please send me to heaven!"
She was convulsing and weeping. her frail and lifeless body shook with her sobs. I immediately answered, "I cannot help you die! I am a doctor, not a murderer! I have taken an oath to help keep people alive. I know you are in a tremendous amount of pain, but I cannot help you die!
"Please don't ask me again! I cannot help you. Not in that way!"
A part of me died that day, watching this woman collapsing in sobs and begging me to release her from her misery. This incident I just described happened shortly after I graduated from medical school and was interning in Orthopedics at the University of Osaka, in Osaka, Japan. When I first met her, she was a 62-year-old breast cancer patient, being treated in the outpatient clinic. I saw her husband first and I thought he was my patient because he looked as though he had no energy, and he was so thin.
The nurse accompanied the couple into the examination room. When they entered the room I realized that I had misunderstood who the real patient was. I asked her to give me a brief description of her medical history and she began,
"I was found to have breast cancer five years ago. I was operated on at a different hospital and at first, it seemed that the operation had been successful and that all the cancer had been removed. However, one year after the operation, the cancer reappeared again, so I was put on the anticancer drug. The anticancer drug worked for awhile, but then the cancer reappeared.
"The last doctor I had did not care about terminally ill cancer patients. The doctor and his staff encouraged me to be discharged from the hospital and they suggested that I go to a hospice. I o not want to go hospice because I have not lost my will to live. I have decided to fight the cancer and fight for my life!
"This is why I have come to your hospital."
As she talked about the details of her breast cancer, her X-rays were delivered to the examination room. As I reviewed her x-rays, I was shocked to see that the cancer had metastasized to her pelvis and to her brain. I thought to myself, it is impossible to help her at this stage of the cancer. Al she can do now is try to be as comfortable as possible and wait for her inevitable death.
Then I spoke to her as honestly as I could. "Your cancer has already metastasized to your pelvis bone. And it has als metastasized to your brain.
"Unfortunately, i am also recommending that you go to the hospice because we can do nothing for you now. It is too late to try alternative measures because your cancer has already spread to the extent that there is no therapy that can help you at the stage of your cancer. The damage is irreversible.
"I realize this sounds cruel to you, but the more chemotherapy you are given, the sooner you will die. You see,the anticancer drug kills not only cancer cells in your body , but destroys even healthy cells. It cannot distinguish between a cancerous cell and a healthy cell. As a result healthy cells are destroyed. Your body loses its immune ability and death results soon afterward.
"The anticancer drug is generally successful when only a small part of the body has been affected by cancer. But your case isa completely different situation because the cancer has spread throughout your body.
"I don't recommend chemotherapy because it is too hard on patients. The side effects are too strong and counteract what the chemotherapy is designed to do. I suggest that you should consider an alternative measure."
Objecting to my recommendations, she said, "It doesn't matter to me what the painful side effects are from the anticancer drug, because I have to get well so that I can take care of my husband! That is why I will keep trying to fight the cancer !
"Please admit me right now so that you can begin to help me! If I go to the hospice, then I am surrendering myself to death. I refuse to surrender my life until I know within my heart that I have no choice!"
"I know how difficult this must be for you and I do understand how you must feel, but right now our hospital is full. Even if there was something we could do for you, we don't have a bed for you at this time. Please understand that although I wish I could , there is nothing that I can do to help you. I am suggesting that you go home."
"No! I can't go home ! My husband is not healthy. He is very weak and I need to look after him. If something were to happen to me, he would surely die very soon because he is not able to care for himself.
"Please, Dr. Ohno, admit me into the hospital now ! Please find a way, any way, to cure my cancer!"
The scene in the clinic was a heartbreaking one. This sweet and loving couple had obviously been together and devoted to one another for many years. Although she was literally dying from the cancer that had taken over her body, she was more concerned in her husband and her responsibility to take care of him. I so desperately wanted to be able to give them both some kind of hope. But the facts were on the X-rays, and there wasn't anything I could do at this point in time to help her.
"As I have already told you, the hospital is full. If you decide you want to come back, you will need to wait until we have the room to admit you."
"You don't understand, Dr. Ohno ! I don't have time ! I only have now and I need a miracle ! Please reconsider and admit me ! Can't you make a special provision for me, because I am an end-stage cancer patient?"
At that moment, the hospital medical professor, who was my superior, stepped into the examination room and interrupted the conversation, "Dr. Ohno, I will take care of this patient. I will be able to help her. You should take care of another patient."
He continue, " I am sorry to interrupt your conversation. let me introduce myself, I am the main professor of the hospital. My name is Doctor 'A'.
"I have had the opportunity to look at your X-rays. Because your cancer has metastasized to you pelvic bone and to your brain, I agree with Dr. Ohno that it is not going to be easy at tis stage of your cancer. The cure rate is only five percent for end-stage cancer, and unfortunately in you case, I don't see any hope."
He watched her face intently. The colour in her face turned completely pale. He waited for the impact of the news for her chances of survival to set in. Once he saw the couple's reaction and how discourage she and her husband were, he then continued, " I think I can save you with a new drug I have developed.
"This new drug only destroys the cancer cells and it has no side effects, based upon animal testing. It is true that this drug is in the experimental stages, but the data from the testing has shown that there is a definite decline in the cancer, as well as showing not to have any side effects. I can offer you this opportunity for a possible cure for your cancer!
"This new anticancer drug had never been used in another hospital. If more cancer patients knew about this special drug, the response would be tremendous! You are very fortunate that you have come to our hospital and met me."
The professor's words were totally unexpected by her. her expression changed from one of despair to an expression of hope. She and her husband began to cry with tears of joy and relief.
She grasped the professor's hand and said, "Oh, thank you so very much! I never expected a miracle like this from your hospital! You have given me hope again!"
The couple held each other and cried from the good news. The scene touched everyone in the room. The professor was very pleased with himself. As I watched this dramatic scene, it seemed as though I were watching a scene out of a movie. However, despite the deep emotion of the event that had just taken place, I felt completely separated from the joy that everyone else was experiencing. I knew that the anticancer drug the professor was talking about absolutely had very strong side effects.
I wondered why the professor insisted on using the anticancer drug on this woman. I internally questioned his decision and I felt very uncomfortable for this patient because I suspected that his recommendation was not in the patient's best interest.
This was the first of what was to prove to be many rude awakenings for me. After years of medical school, of learning how to help people, I was now coming face to face with the grim reality of obeying a hospital staff professor, who was testing patients as though they were experimental animals. There was no empathy for people who were terminally ill. I wanted desperately to disagree with the professor, but I was only an intern in this hospital.
The Japanese medical system is very conservative. The professors on staff are upheld as though they were royalty , and the interns are looked upon as nothing more than slaves. I knew if I said anything to question him I would probably be fired on the spot.
The professor ordered the breast cancer patient to be admitted into our hospital. Immediately after being admitted, she received the 'new' anticancer drug twice a week. Then a course of agony began for this patient. The new anticancer drug had devastating side effects. It took hold of its victim with a force so intense that the agony of the pain was unbearable.
"Please stop giving me this drug, Dr. Ohno, I beg of you! Please help to take the pain in my stomach away! The professor told me that there would be no side effects from this drug and I am in agony !"
"Please stop this pain! Please stop it!"
The tragedy of this scene would repeat itself over and over , becoming my ongoing personal nightmare. The anticancer drug was given to the patient, and after each injection her life energy to withstand the trauma declined. Even though I knew I was not responsible for causing her pain, I was in fact the doctor who administered the injection. I watched as other interns around me were able to go about their daily routine. I noticed that they were able to set themselves apart from the pain their patients were experiencing. However, this was impossible for me to do.
I felt so much empathy for my patients that it was very difficult for me to stand by and do nothing, especially when I knew in my heart that some of these patients were not receiving the right kind of care. But again, I kept reminding myself that I was only an intern and perhaps this was something I needed to work through so that I could eventually become the kind of doctor I knew I could be. I was determined to become a doctor who healed people and a doctor who was able to make a positive change in people's lives.
Dr. Yoshitaka Ohno,
Intern.
