Fumbling Through

Psychiatric TimesVol 33 No 11
Volume 33
Issue 11

This is the story of Peter. I feel chosen to have gotten to know him and to have the memory of what such an experience has carved into me.

This is the story of Peter. He wanted to be chosen.

[[{"type":"media","view_mode":"media_crop","fid":"53619","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6759145452620","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6709","media_crop_rotate":"0","media_crop_scale_h":"123","media_crop_scale_w":"125","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Shutterstock.com","typeof":"foaf:Image"}}]]I first heard about him at the end of my PGY-2 year, during “patient draft,” when the graduating residents present their patients to the incoming PGY-3s for continuation of outpatient treatment. I do not know what it was in me that made me raise my hand when I heard he had advanced lung cancer and AIDS. I had seen patients die during medical school training, but I had never done any kind of end-of-life treatment or therapy with anyone. After I raised my hand, I immediately thought, “Hold on. What did I just do? If he dies during his time with me, this could be too sad.” I basically didn’t know what I was doing.

His outgoing resident later revealed that she had planned to ask me to see him, but Peter had said no-he didn’t want someone to be asked. He wanted someone to hear about him and choose him anyway.

Peter was a big man, with a big, melodious voice. He used a walker and he was always out of breath by the end of our trip from the waiting room to my clinic office. His laugh came from so deep within that if the soul had a geographic location, that’s where it came from. He was always laughing. About something, anything. He used to say, what was the alternative?

We met once a week. I discovered more about Peter-the child he used to be, the man he became, and the stories in between.

Each of his stories carved something different into him-stories of almost impossible sadness and unbelievable disappointment, with occasional glimpses of the warmest, most fleeting light. Peter seemed to be able to see things as they were, no matter how bleak. Yet he also had a way of seeing others with forgiveness. . . not out of any defense, but out of some visceral kindness and generosity he wasn’t even aware he had.

As it turns out, Peter’s big melodious voice escaped very few. He had been a music student at one of the most prestigious performing arts schools in the world. But he had dropped out when he first got severely depressed as a young man. He had a string of relationships where he would give his all, and receive so little in return. When Peter’s cancer was metastasizing, the person he had been with for the past decade began stealing his pain medication. While we explored this, in the midst of his pain both physical and emotional, Peter deadpanned, “Maybe he is in pain and needs pain meds?” And we laughed, knowing full well the high unlikelihood that this was the case.

We only talked about death twice. I had a “treatment plan” in my head of how we would gracefully walk through the valley and look death in the eye. He would find all the answers he was looking for, make amends, and find peace. He would then die painlessly, fully prepared-and panic free. The whole scene would be tragic but beautiful. . . and most of all, neat.

But that is not how it went down at all. Peter actively avoided discussing death. It was the one thing he couldn’t look at straight in the eye-the one thing he couldn’t find funny in some way. He told me one day, “I know I’m dying. I don’t know when, but I don’t want to talk about it. I’m not ready yet.” So we didn’t talk about death. We talked about life. His life. And when you talk about one thing, you discover what is unsaid about the other.

Peter wondered if he had ever found love, if anyone would remember him, what his life was meant for, and what would happen to the people he loved who he would leave behind. We talked about the food he enjoyed, the cute waitress at the casino restaurant who always knew his order, the “booty calls” he’d made when his body was stronger, the music he loved, the irritations of being sick that day . . . we talked about it all. His fears, longings, joys, regrets. Most of all, we talked about his questions. He had many, many questions. He was incredibly honest about everything.

He had asked me to come watch him sing at a little church. I had asked my supervisor if this would be okay, and my supervisor encouraged me. I held back-maybe out of fear. Why would he want me there? What do I do when I’m there? Worst of all, what if I hear him perform and it’s so beautiful that it makes me sad? Horror of horrors, what if I cry!?

I delayed for several weekends, citing all sorts of reasons to myself. I was post-call; there will be another weekend; I’m just exhausted; there is so much I need to do. But the thought never escaped me, like a strong sense that I’m supposed to be doing this.

So on one Sunday morning in early autumn, I took the long winding drive to a little church on top of a hill, and sat at the back. When the church service began, they started by introducing me as Peter’s special guest and asking me to stand up. I nearly died of sheer embarrassment. When Peter began to sing Amazing Grace, his rich voice filled the air as he played the piano. It was one of the loveliest things I had ever heard my whole life. And-horror of horrors-I cried just like I feared I would. But I wasn’t ashamed of it anymore. I just let it be. It was too beautiful. I wish you were there.

A couple of months later, Peter missed our weekly appointment. It turns out he had gotten an infection and was hospitalized over the weekend. I went to visit him, and this was only the second time we talked about death. He told me with panic in his eyes, “I don’t want to die, Dr. Duque.”

I asked, “What are you most afraid of?”

He said, “Not being here, I want to be here. Please stay here for a while.” So I did. He fell back asleep.

He went in and out of the hospital the week that followed. He missed our next appointment. He had been readmitted yet again. I went to see him, and his brother let me know he had been out cold for a while. When I arrived, he woke up for a little bit to motion to me that his mouth was dry. I wet the sponge beside him and wiped his mouth. He nodded, then reached out for my hand and held it. He fell back asleep. He died a few days later.

It was awful when I found out. It was as I had feared it would be when I first signed on-it was too sad. He was such a lovely human being, and he was gone. I guess that will always feel “too sad.” What was the alternative?

His brother came by to give me a simple necklace Peter had asked him to buy. There was an angel on the necklace. His brother mentioned that I had no idea how much it meant to Peter to have me see him sing at church. He was so proud.

Peter allowed me to be with him on his walk to death. I had imagined facing his impending death with him a certain way, with a plan and a list (how I like to do things best). We fumbled through together-through the weight of regret, the vulnerability of longing, the pain of tenderness, the panic of not knowing what “gone” would feel like. We answered some questions, and left others unanswered. Of the questions we did find answers to, some were painful, some were illuminating. All of them meant something real. Something about knowing that time is ticking louder right in front of us, and not in some theoretical distant future, has a way of distilling the truths in our heart of hearts.

This is the story of Peter. I feel chosen to have gotten to know him and to have the memory of what such an experience has carved into me. I am braver with the messiness of it all. All of it is messy, and we fumble through best as we can.

It’s been years since that day I raised my hand. But I can still hear Peter laughing, and I can still hear him singing in that church on that autumn morning.

If I could thank him for choosing me, I would.


Dr. Duque is Clinical Assistant Professor at Loyola University Medical Center in Maywood, IL.

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