My sweaty hand grasped the hospital curtain firmly and with determination. As light as that flowery curtain seemed, it was one of the heaviest curtains I have ever pulled. On the other side, a tall, thin gray‐haired man in his late 50s sat on the stretcher watching videos on his phone tired of waiting to be seen in our emergency department. He looked at me with disappointment when he realized I was not bringing the Jell‐O he had requested. His chief complaint was “unable to swallow solids,” and I had been assigned to find out more. Being one of my first rotations of medical school, the task of interviewing the patient and arriving at a diagnosis was both anxiety provoking and exciting, but mostly anxiety provoking.
I introduced myself to the patient, as I had done countless times in the comfort of my medical school’s objective structured clinical examination (OSCE) rooms and proceeded to obtain a history. My patient was a pleasant Hispanic man who thought about getting his symptoms “checked out” for a while but had been unable to due to lack of insurance. He reported feeling food getting stuck in his throat, vomiting, fatigue, anorexia, and a 40‐pound weight loss very noticeable in his temples over the past few months. The only foods he was able to eat were liquids and soft‐consistency foods, Jell‐O included, hence his initial disappointment. He had been a heavy smoker for many years and had been having persistent acid reflux.
After interviewing him, I closed the curtain, now heavier than ever. Of the few differentials I had thought, the “can’t miss” one sprung to the top. In the setting of dysphagia and inability to tolerate oral intake, he was admitted to the floor for numerous tests. A computed tomography of the chest and abdomen agreed on the one thing that the proceeding fluoroscopic esophagram confirmed. My patient had advanced esophageal cancer. I rounded on him daily during his stay at the county hospital where he was seen by the myriad of specialists who all agreed on his very poor prognosis. Among the options he was offered was an esophagectomy. Being the logical, resourceful, and practical man I had learned he was, he investigated the procedure and the postoperative sequela in depth. When he had gathered all the information and asked the specialists questions, he politely refused it stating “I don’t want to be gutted like a pig.”
His statement resonated in my head for a few days, and I did not understand his reason for refusing a procedure that could potentially save or at least prolong his life. Although his decision early on was final, I still expected him to change his mind and go through the different stages of grief. But he never did, he never wavered. Whenever I approached the subject, he would reiterate that he was ready “to meet his maker” and that he would not change a thing about his life, which he affirmed was “well lived.” By the end of my rotation, he had been scheduled for palliative care on an outpatient basis. On my last day, I thanked him for letting me take care of him and I never saw him again.
To this day, almost halfway through my emergency medicine residency, I think about him. I wonder if he made it, if he somehow survived the odds that were against him. I think about him and his practical view of life whenever I drag my feet to discuss goals of care with a dying patient or when I find myself assessing what my own advance directives would be. With modern medicine, it is difficult to let go at times. We can prolong life beyond what is natural with our advanced technologies, medications, and equipment. Having witnessed the end of life many times as a young physician, I often wonder the cost to one’s quality of life in extending inevitable death. Is it worth it? My patient understood this from the very beginning, and he did not want to compromise living his best life until the end for living his life complicated by chemotherapy or surgical complications.
CONFLICT OF INTEREST
The authors have no potential conflicts to disclose.
AUTHOR CONTRIBUTION
Fabiana Juan Martinuzzi is the first author and thought of the concept for the manuscript. She wrote a draft of the manuscript and critically revised the manuscript. She prepared the manuscript for submission. Ynhi Thomas. is the senior author and refined the concept of the manuscript. She assisted with writing a draft of the manuscript and critically revised the manuscript for important intellectual content.
Juan Martinuzzi F, Thomas YT. The patient behind the curtain: A life well lived. AEM Educ Train. 2022;6:e10730. doi: 10.1002/aet2.10730
Supervising Editor: Susan Promes, MD, MBA.
Funding information
The authors have no financial support.