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We are taught in medical school to view death a failure. Yet there comes a time with a patient who has a terminal diagnosis, when as a physician you know there is nothing more you can do. These are the times when a test, a study, a surgical treatment, a medication, or an x-ray no longer make a difference in the disease process. All of the technical skills and modern medicine can only help to make a person more comfortable—Nothing more.

When faced with the terminal diagnosis, many of us will go through a denial and bargaining phase..."If only I had ordered another test. If only I had started a different antibiotic. If only the patient had less extensive injuries. If only they had come in for treatment sooner. If only..."

I was fortunate to realize early on in my health career at age 18, when I was an Emergency Medical Technician, that health care professionals are not invincible, infallible, or omnipotent. Although we may want to we cannot ‘save’ everyone. This lesson was learned on a call for a patient ‘found down.’ On arrival at the scene, we discover a 16-year old with her chest crushed under a boulder. There was nothing we could do. It was a terminal injury. She was dead.

On a different level another important lesson was one that I learned while a resident physician. A very special patient taught me how to ‘let go,’ and just ‘be.’ Perhaps even more important was that this experience taught me how to help others find the strength and the courage to let go. This is a lesson that I have shared many times since with other terminal patients and their family. Often the most difficult role of a physician is knowing when to "let go," and when to just "be."

Sandy was a light. When she was admitted to the hospital for chemotherapy for metastatic lung cancer (at only 37) she would wander the hospital wards looking for people to cheer up. She would come in for her Radiation Treatments dressed to the ‘nines.’ We all had difficulty believing the metastatic disease process taking place inside of her, but it’s destructive growth so clearly evident on the x-ray reports. She had an unquenchable faith that she would beat her cancer, and refused to accept it as a part of her. More times than not, she cheered up this dreary resident physician.

Sandy was one of my inspirations to share poetry with patients, by letting me know how much the poems I had written were helping her. Was it the poetry, or was it a special interaction different than the traditional doctor-patient one? By sharing the poems, she saw a different side of her ‘doctor,’ and that doctor became a person and a friend.

The poem that follows, Healers and Healing, was written during this time. I was struggling to figuring out what I could do for Sandy—the medical treatments had failed. This poem was my answer to myself for what I could do. It was one that I didn’t share with her in writing, rather I it shared with her from my heart--as her friend and her physician.

Several months into the treatment for her cancer, it dawned on me that my role was to support her and her belief that she would beat the disease. When she lost sight of that goal, and admitted this defeat to her physician, she would lose the fight and her will to live. The closest she ever got to acknowledging the severity of her case was a comment she once made looking out her hospital window to the hills of Santa Barbara. She asked me, "Doesn’t it look like you could just walk out this window from here and into the hills?" I realized that in her own way she was starting to let go.

The last time I spoke with her was on a Thursday evening. She was struggling with what it meant to be "on hospice." She asked me, "Wouldn't you want to be doing everything to live?" I didn't know what to say. There was nothing else that medicine could do for her, the disease was so far progressed. I could only be a friend on the other end and listen. She told me she had been reading the poem I wrote ‘Guardian Angel.’ I realized later this was her way of saying good-bye.

I always knew she would make an impression when she left. The following Monday on my last call day as a resident, I was in the emergency room seeing another patient to be admitted when the outside phone call came. The visiting nurse called to let me know Sandy had died. At first I was overwhelmed with tears, then I suddenly realized the irony of the situation. My last call day--another crazy, hectic call day and to have a favorite patient die! I had to laugh when I realized that she would, of course, go out by making an impact and ensure I would remember the date of her death! 

I recognized, sometime later, even though I felt I hadn’t done enough, I had given her the greatest gift that I could—being a friend as well as a physician. By giving her the time to just be, to listen, to hold a hand, to give a hug and emotional support, I was able to give her the strength and the courage to make the transition and let go.

It was in her memory, and those of other patients that I have lost, that we created our website, Journey of Hearts: A Healing Place in CyberSpace, http://www.journeyofhearts.org, as a tribute, a way for me to deal with these losses, and a place to share some of the poetry that had helped her (and is helping others). By sharing her courage and her story, Sandy K. Rogers will continue to be a light and an inspiration for others.

Healing,
the ancient covenant between physician and patient
a promise to cure,
to save,
and to restore.

Healing appears in many forms-
The right antibiotics for an infectious organism
The curative chemotherapy for a malignant tumor
The correct diagnosis in a complex case.

But what of the terminal diagnosis
with no treatment options
when your diagnostic skills are no longer required
your presence will not alter the course?

Then
Healing manifests on the purest level-
an extension of the soul,
aiding in the acceptance of the process
finding peace and serenity
on the path leading to transition.

Healing of
pain,
suffering,
and emotional distress.
No longer with technical devices
and the newest medication.

But just
A cheerful smile
An open ear
A gentle touch
A warm embrace
Taking the time to listen, to be
to share a part of yourself.

Healing becomes an expression of caring and love.
The greatest gift of all
may be the ability
to walk with a person
help provide them with strength
and courage
on their path to transition
and then let go.

This article was originally published on the Death-Dying.com website, in September 1998. The site is now Beyond Indigo and this article is much more difficult to locate since their redesign process.