One of the Fallen
Like an officer or firefighter, the sense of loss is magnified when it is one’s own.
It is perhaps one of the most dreaded and challenging tasks of a physician: doctoring a doctor. To witness the fall of a colleague, even when expected, shakes the very foundation of our security in practicing medicine. Like an officer or firefighter, the sense of loss is magnified when it is one’s own. Dr. Z was my first compatriot I laid to rest.
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Four months before he died, Dr. Z, as his family fondly refers to him, is still operating. As a professional, Dr. Z is a highly regarded and respected orthopedic surgeon. As a life-long learner, Dr. Z is a fanatic philosopher. Often performing “think experiments” as his wife explains, it is not uncommon for Dr. Z to be solemn and selective in his communication. But when he wishes to express thoughts, he is as articulate and precise as with his scalpel.
The day I first meet Dr. Z he is sitting in his wheelchair. A very tall back is needed to support his great frame. He is sitting in the sunshine of his backyard as family and friends move in and out of doors to pay homage to this literal giant in their midst. His wife cautions me to be patient. “He really wants to speak with you. He has been asking all day. He wants to make sure you hear it from him. Just please, give him time.”
Dr. Z is experiencing a profound loss of cognitive control that could easily be mistaken for mental decline. Sitting with his head slightly tilted to the right, he jerkily raises his face to make eye contact. The effort required to hold that position is notable. I sit down on a wooden bench, knee-to-knee to his wheelchair. Clasping one of his great hands in both of mine to formally greet him, I place it back on the wheelchair’s armrest with a staccato motion. His voice is deep, and words form at an astonishingly slow pace. It’s as if I am in a soundproof booth of a recording studio, where a record can be slowed or even turned backward. The sounds are hard to interpret, and the shapes his mouth makes are incongruous, making lip-reading unintelligible. Pauses of 10 minutes or more between utterings are not uncommon and are ultimately impossible to distinguish from lapses in thought and generalized fatigue. Yet one thing is certain, Dr. Z is is not demented.
For someone who has devoted much of his life to deep thoughts, the thought of not having any is more terrifying than death itself. Over the two hours I sit before him, his intention is clear: he wants me to inform the medical community at large that while his illness is deforming and disintegrating his body, it is not causing the disintegration of his mind.
Dr. Z is afflicted with an extremely rare hereditary version of an illness usually associated with cannibals: Crutzfeldt-Jacob Disease or CJD. Often highlighted as a prion disease passed from contact with infected brains, CJD causes rapid neurologic collapse and death. Most clinical reports include symptoms of difficulty walking, confusion, speech impairment and dementia. Dr. Z’s dying wish is to make certain that last symptom is not associated with the records of his illness.
“He is desperate to speak with a specific neurologist. An expert on this disease,” Mrs. Z shares at the end of my first visit. “He is determined to make it known he is not demented. We have been trying to get an appointment for weeks. I am afraid now he is too weak to even get to the clinic. We had been hoping perhaps a phone call would suffice, but every day it gets harder for him to express himself in words.”
I catch myself wondering how Mrs. Z is caring for her husband. Providing physical care for a person with progressive functional decline is physically demanding for any person of any size. Mrs. Z’s petite stature exaggerates the growing challenges unique to this rare disease. The patience needed to navigate the growing expressive changes… I struggle to imagine.
“His personality shifted,” Mrs. Z offers as if hearing my imaginings out loud. “It was subtle, but now I can put it all together. But he would never give up the OR. He used to be the speediest surgeon. In the past year, a procedure he could do in his sleep started to take longer and longer. But he never made a mistake. Never dropped an instrument. For him to choose to stop operating was everything.”
Well, not quite.
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