The phone rang in that lull of the morning when phone calls usually do not come in. The only calls at 3 am never portend good tidings. This one proved no different. It was a nurse requesting to come evaluate a patient. There was to be no miracle for this patient, no last minute stay from the disease that had carried out its death sentence. The pronouncement of death is one of those duties I hold sacred. I consider it a sacrament to my profession and to my identity. It is the final chapter a doctor can add to the story that is a patient's life. Indeed, the final word, except for the memories that live on within the loved ones. Still, it is rough way to begin a day. I bow my head in reverence as I place my stethoscope upon the chest and listen for silence, bearing witness to the story that has ended.
It is now the end of the day. Despite the fact that I am no longer in the hospital, my mood is somber, colored by the death earlier in the day. But the last patient of the day in clinic knows nothing of this. It is only my second time to see the patient but I remember the first visit well. I only need look at my previous note briefly to refresh my memory. She had come in, like all patients at some level, with a measure of suffering. She had been to several doctors before and still felt no improvement in her suffering. So I started at the beginning of her story. And I did what I always do when unsure how to proceed. I listened. The doctors before had not listened to her story. Instead, they ran up an enormous bill with a shotgun approach. Had they listened, her diagnosis became clear. Textbook, in fact, which is rarely the case for most diseases. I pulled out my pen and added to her story by making changes to her medications. She now sat in front of me with a smile and a thank you. The day began with death, the final word in a story. The day ended with a new chapter, a new sentence for a patient that reclaimed her life.