In a Eulogy, Finding a Person, Not a Patient

By SANDEEP JAUHAR, M.D
30 oct 2008--Sometimes you learn about a patient only after he dies.
Not long ago, I took care of a young man named Michael with severe congestive heart failure. Michael received the diagnosis when he was 18, but as is so often the case with this disease, we never figured out how he got it. He was a student at a community college in Brooklyn when I met him, though he dropped out when his condition worsened. Despite the setbacks, he was a model patient, coming in diligently with his mother for weekly appointments, eliminating salt from his diet, taking his medications regularly.
Eventually I referred him to a heart-transplant center in Manhattan, where he went for evaluation and frequent follow-up visits. He had to lose weight to qualify for a transplant, and by the time he did, his lungs had become so waterlogged from heart failure that he was suffering from severe fatigue and worsening shortness of breath.
Two weeks before his 20th birthday, Michael went on a weeklong religious retreat with friends in Kentucky. His doctors had strongly discouraged him from going, but he had insisted. He left by car on a Sunday. The following Friday, he died in a Lexington hotel room.
His mother called to tell me the news. Voice breaking, she thanked me and John, the nurse practitioner I work with, for treating him over so many months. She invited us to the funeral; amazed and touched at her grace in the depths of her loss, we accepted.
The church, in Queens, resounded with lilting hymns as we arrived. Inside, men were dressed in cream-colored suits and women in Sunday finery. An organ was playing eerie music in the high-ceilinged chamber. Two men stood in front of the coffin, which carried a portrait of Michael wearing a pinstriped suit, looking debonair, unlike the way I remembered him. As we took our seats, a man got up and started tap dancing, exhorting the crowd to come up and dance with him.
Soon, people were clapping on tambourines and playing harmonicas in fast, crazy rhythms. A few were dancing wildly as Gospels were shouted. Men came up to praise Michael: “He walked with God. ... He is in a better place. ... He never did anything the wrong way.”
His uncle, a bishop, stood up and delivered the main eulogy. In soaring oratory, he declared that Michael had an unshakeable conviction that God would save him. “Even in his worst sickness, when he had to tell his brothers to give him a few minutes because he could not get up from a chair, even then, he had faith.”
“Tick tock!” he screamed into a microphone, which reverberated in dissonant feedback. “Your time is coming, too. Keep on with the insults, the small-minded bruises and disputes. Tick tock! Your time is coming, too.” Murmurings swelled to shouts of support.
The sermon then took on a more subdued tone. The uncle recalled how Michael had been adopted as an infant. (I did not know.) He said Michael had taught himself Hebrew and liked being called “T.R.,” for Temple Rabbi. (Another thing I didn’t know.)
Then he said, “Forgive me, but I want to focus on the lighter side of my nephew.” He told how Michael wore fancy clothes. He recalled Michael’s youthful indiscretions. “Michael loved White Castle cheeseburgers and Chinese food.” Chinese food? I thought. “And chicken rolls with soy sauce.” Michael had always denied such improprieties to us. “Whenever he was with me, we would always stop for takeout.”
I looked at John. He had the same disbelieving look I must have had.
“Michael did not like taking his medications,” his uncle went on. “I’d remind him to do it, force him to, but he would avoid it because they didn’t make him feel good.” I shifted uncomfortably in my seat. “And you all know he never wanted a heart transplant. He never would have accepted one.” (That was news to me, too.)
Afterward, John and I were asked to say a few words. John recalled how much Michael loved pens, how John would always give him a fancy pen when he came to see us. (I had no idea.)
As I walked up, I wasn’t sure what to say. I thought about how easy it is, with the time pressures of medical practice, to ignore social history, habits, the sorts of things that make a patient into a real person — and vice versa. Undoubtedly, such information would have helped me treat Michael.
I told the crowd that Michael was brave and vibrant. I called his death a tragedy. Then I thanked his adoptive mother for inviting me. I had learned so much about her son that day.
Sandeep Jauhar is a cardiologist on Long Island and the author of the new memoir “Intern: A Doctor’s Initiation.”