The battle

“I don’t think your wife wants any more cornflakes, Mr. Johnson. ” He pretended not to hear me. He didn’t turn around. He remained sitting on the edge of the hospital bed, gathered another spoonful, and inserted it delicately into her half-open mouth. She chewed slowly, and swallowed with difficulty. He gathered another spoonful. “Mr. Johnson,” I said more emphatically. He paused. “When people are dying, they’re not interested in food. ” He bristled. His eyes showed determination. “You don’t know anything,” he said. “She is not dying, there is no cancer, her blood pressure is not as low as you say. ” “As a matter of fact . ” I started to correct him, but he kept talking. “Every morning you barge in here, you listen to her lungs, you talk about tests, and specialists, and second opinions, and she doesn’t get any better. Yesterday you had that woman doctor examine her . she has had radiation ‘down there’; it hurt her and accomplished nothing. ” “She specializes in cancers of the . ” I couldn’t interrupt him. “When someone brings a car to my shop, I figure out what is wrong and I fix it. I give them back their car, and everybody is happy, and life goes on. I have brought you my wife, and you offer only tests. You don’t know what you’re doing. ” I straightened, and locked my knees. I drew back my white coat at the waist, placing both hands on my hips. I felt like a sheriff in the Old West. Instead of a badge and a revolver, I had a white coat embroidered with my degree, my department, my authority. I knew all the test results, and I knew why there was no curative option. I was prepared to defend the treatment plan. He wore a coat too. It was camouflage—Vietnam era I guessed. The sergeant stripes suggested he spent many years as a soldier. He knew all about fighting. The ribbons on his jacket spoke to his courage. I saw a purple heart—he knew what it was to be wounded. At one point, he must have been an imposing soldier, but now his coat was baggy, he walked with a cane, and he squinted through large round spectacles. He was an old man. I exhaled, and said nothing. I was tired, and fighting would not change anything. “I know what my wife needs,” he continued. “She must eat. Then she will regain her strength. Then she will recover. ” Mrs. Johnson was motionless in her bed. She was emaciated, worn out from her long battle with cancer. She wore a wig with thick luscious brown curls, which seemed out of place against her wrinkled forehead and wasted temples. She wore pink toenail polish—unevenly applied, but fresh. Above the bed were several pictures of her and her husband: at the beach, at the ballpark, barbecuing by the river. Every picture was local, and included only the two of them. He often carried a bag of supplies, and she often wore t-shirts with sarcastic slogans. They had big smiles. Her infection was causing her blood pressure to drop, but mentally she stayed attentive to the conversations around her. Throughout her weeklong hospitalization she had seen every specialist in the hospital, patiently allowing each to examine her, review her diagnoses, and explain that nothing more could be done. She listened politely to what they said, but she obviously cared most about what her Address correspondence and reprint requests to: Ryan E. Lawrence, Department of Psychiatry, New York–Presbyterian Hospital, Columbia University Medical Center, New York, New York. E-Mail: re12137@columbia.edu Palliative and Supportive Care (2015), 13, 1487–1488. # Cambridge University Press, 2015 1478-9515/15 doi:10.1017/S1478951515000115