Friday, October 30, 2009

It Lasted Until the End

I always looked forward to Harold's visits. Harold knew that he had life threatening pulmonary fibrosis. He also knew that doctor's didn't have the faintest idea as to what was causing it and used quite toxic medications to try to keep it under control. Prednisone seemed to work the best for him.

Somehow he forgave me for all the shortcomings of medical science. He liked to chat about his life during office visits: how his grandson was playing football at Notre Dame; how a granddaughter was loving soccer; how the holiday celebrations were special with his family. Over time I thought I had gotten to know Harold pretty well. But did I really?

He would come in cheerful and bubbling with a tendency to minimize his shortness of breath. His lungs were progressively filling up with scar tissue thus blocking the oxygen in the air from effectively getting through into his blood. An oxygen tank helped and he actually accepted it with grace. We did have some serious discussions with his wife present and he had completed an advance directive stating that he wouldn't want to ever be placed on a breathing machine unless he could rapidly return to meaningful existence. His wife would be in charge if he couldn't make the decision.

One day, during a routine follow up visit in the office, I noted that his severe lung dysfunction had been quite stable for over a year. In the conversation I said, "Harold, you know you're really lucky to still be alive." I was referring to his tests and it was meant to be encouraging, but the result stunned me.

Harold burst into tears and started shaking. I rather helplessly said, "What's going on, did I say something?"

"You don't know how lucky I really am to be alive."

"What do you mean?"

"I was a paratrooper on D-Day. I came down behind the German lines like all my buddies. I didn't know where I was or where they were. It was pure terror. I saw a lot of terrible things and did a lot of shooting. It's never out of my mind."

I immediately understood how wrong I was. I really didn't know Harold well. Here was a true WWII hero, trying to live a normal family life, trying to fight a serious illness, yet suffering from disabling post traumatic stress disorder from 50 years ago!

Harold's defenses took hold fairly rapidly and he actually apologized! I tried to reach out and refer him for counseling but he would have none of it. In future office visits he would deflect questions about his WWII experiences, though he wife would confide to me that he would have night terrors with shouting and waking with drenching sweats.

Harold survived two more years until his pulmonary fibrosis finally caused his demise. I wish I could say that his death was peaceful, but as he weakened his terrors took hold. Our palliative care team fortunately used enough sedation and narcotics to take the edge off. But his PTSD didn't really die until he did.

1 comment:

  1. Jim, I've read all the current posts and found them thought-provoking and very useful. Please continue...