conversation.

from where i stood, he looked like an old man. which, in fact, he was. slumped over in his wheelchair, his bright green hat with "Lucky Dad" written across the front was a stark contrast to solemn whispers surrounding his presence at the nurses desk. they had found him in his room--his O2 sat's 86% & quickly dropping, despite increased oxygen through his nasal cannula.

Dr. W: We'd like to send you to the hospital, Mr. Smith

Mr. Smith: I ain't going. If I'm going to die, I'm gonna die right here!! [raising his shaky hand & pointing his finger downward on "here", as if enunciating his point]

Dr. W: Mr. Smith, I think you are sick & we need to get a picture of your chest.

Mr. Smith: Then you bring in the xray...we'll take the picture right here.

Dr. W: Mr. Smith, how to you think James would feel if I just let you die here? If it were James in this position, what would you want us to do for him?

Mr. Smith: Everything you can...

Dr. W: Then how do you think he feels about you?

Mr. Smith: I am 88 years old. I 'dun & lived my life. He still has to live his.

Dr. W: Mr. Smith, I am okay with you dying. But I don't want you to be miserable for a couple of days while your lungs fill up with fluid...and then die.

Mr. Smith: No, doc. I'm ready. I'm waiting. If you have to send me, take me to Dr. Taylor. He'll know what to do.

Dr. W: Well I can't make you go.

Mr. Smith: No you can't...& I'm going to die righ t here.

Dr. W: Okay we'll do what we can.

Tell me, how am I supposed to handle that conversation? How am I supposed to be an innocent bystander & maintain my composure (which I did not--I pretended an eyelash fell in my eye when the waterworks came on)? How am I supposed to be part of medicine, respect patients wishes, learn about the amazing interventions...and then let them ignore something that could save their life??!

And then again, at 88 years, how can I blame him for being ready to go?