to do no harm

My patient is dying, and he doesn't believe us. Nine months ago, he was a successful business man, training for sport competitions in his free time. The kind of guy who ran through the pain, never took an aspirin in his life, never drank, never smoked, went to church regularly. Now, his organs are all failing him. He lies in the hospital in pain all day, refusing palliative care, insisting on the impossible cure.

He was diagnosed seven months ago. Told that he had a randomly acquired disease that hits you in the prime of your life and that has been, until recently, completely incurable. They told him he had a chance, because some people indeed did recover after nearly a year of chemotherapy, and his doctors started him on the difficult treatment regiments. His disease didn't respond, and his organs, one by one, began to fail.

Two months ago he was admitted to the hospital. He was thin, with a massively swollen belly, and thickly edematous legs and thighs. He was exquisitively sensitive to touch. He was treated intensively, spent nearly two weeks getting that fluid removed, and was sent home in slightly better shape. He came back three weeks later, and then again, three weeks after that. Each time, the treatment was less effective. Each time, he was determined to beat his disease; to get his organs impossibly back to the shape they had once been in so that he would qualify for the chemotherapy.

He is our patient now, and nothing we do is helping him. His family, who have been been at his side and protective of his determination for months, are all starting to realize that a cure is no longer an option. They say that he is realizing this and knows that he would need a miracle to survive, but he is a very religous man, and he believes in miracles. He wants us to keep him alive, as long as we can, however we can, in case that miracle comes, in case his faith is being tested.

Our team is at a loss. We all react differently to this. Everyone is compassionate of course, but the more experienced members, seem -- at least to me -- a bit impatient. They are frustrated and say that he should have had months to come to terms with his death, and instead this is all going to be messy because his denial is getting in the way of him achieving that perfect ending, where he says everything he needs to say and makes his peace with the world. They want to stop the treatments that are prolonging his life and switch to palliative care. I find myself admiring him - despite his uncomfortable denial - as he alone continues to fight for his life. I don't see how the athlete, the competitive boxer, the man who used to run stairs in his building before work and who now sticks to his prescribed diet like a hawk, how he could possibly just stop fighting. Mabye if he had more time, maybe if he had a chance to try those treatments that he thinks will help him, maybe if he was given back some of that control...but even then, in the end, that control will not be his and he will die.

In the meantime, our team debates his care every day. We waffle and consult out to various specialty teams who approach his one organ system at a time, and provide us with distracting options. He gets worse, then better, then worse again. If we stopped everything, he would live for days, if we treated everything, he might have months. I feel like he has decided what he wants, but in providing his care, in trying to achieve that perfect death, we seem to be resistant to giving him that. He may be terminally ill, but he is not allowed to be in denial, and I'm not quite sure if I agree with that.