Sacred Farewell

BY MICHAEL CAÇOILO, MD

“Before we go in, I want to let you know that your father seems tired today. He is weak, and he may not be able to say much. But he is really looking forward to seeing you.”

I hoped these words of warning would help prepare the family members as they visited their loved one as he neared the end of his life. We admitted Mr. M. from clinic because his liver function tests had reached dangerous levels, a sign that his aggressive liver cancer was progressing. When he learned of the advanced stage of his disease, his options for medical intervention were limited. Knowing his diagnosis was terminal, his plan was to work a little longer while he still had his strength, get his affairs in order and then fly home to Mexico to be with his family. He had moved to the U.S. years ago on his own, working to provide for his loved ones. Because of his documentation status, he was not able to travel freely back home, and it had been a long time since he had seen his family. When he was first hospitalized, he was feeling intense nausea and could barely tolerate food. I recall how alarmed

42 MDADVISOR | Winter 2020 I was when I first placed my hand on his belly and noted his liver was three times the normal size, taking up most of his abdomen. No wonder he could barely eat. Our interventions were mostly supportive. We provided anti-emetic medications to help keep the nausea at bay. We offered fluids and eventually artificial nutrition through his IV. Our hope was that we could help him gain enough strength to get on a plane back home. After a few days, we saw that he was continuing to decline. He was growing more tired and more uncomfortable. His daughter called us every day to ask how he was doing. She was applying for an emergency visa in hopes she could come to the United States to be with him. As the prospect of their reunion grew more unlikely, our team felt increasingly desperate to bring Mr. M. and his family some peace as he entered his final days. We coordinated a time to call his family through video chat so they could see each other.

It was a Saturday afternoon, and I was on call with my senior resident. Thankfully, our pagers were quiet and offered us the window of time we needed. We braced ourselves for Mr. M.’s video chat, knowing it was the closest we could get to bringing him home. Mr. M.’s daughter and wife answered the call, greeting us with beaming smiles. They were so grateful for the chance to see him. As I informed them that he was feeling weak and may not be able to communicate very much, their expressions grew somber. We entered the room and sat by Mr. M.’s bedside, holding the phone close to his face, as he was too weak to lift his arm. His breathing was labored, his skin bronze from jaundice, his voice a faint whisper. I imagined he looked so different from how his loved ones remembered him. Over the next 40 minutes, we bore witness to a heartbreaking, sacred farewell. The phone was passed among his wife, his children, his grandchildren, his nieces and his nephews who had gathered in his home. They took turns offering their deepest love and gratitude to the man who had left home years before to provide for them. How desperately they wanted to be there with him to hold his hand, kiss his forehead, keep him company as he died. They relied on us, strangers, who had the privilege of physical proximity to him, to extend their love through our touch, our presence. It was an honor that I cherish to this day. Mr. M died a few days after that phone call. At our next gathering as a team, we paused from our normal routine—as we do every time we have a patient death on service. We lit a candle in honor of Mr. M. and shared reflections from our brief time caring for him. It was healing to process this grief with my coworkers—how we wished we could have honored his desire to go back home, how humbled we were to witness the beauty of his family’s love for him.

Michael Caçoilo is a third-year Family Medicine resident at Swedish Cherry Hill Family Medicine Residency and Sea Mar Community Health Center in Seattle, Washington. He is a graduate of Rutgers New Jersey Medical School and a recipient of an EJI Excellence in Medicine Scholarship in 2017.

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