Helping Patients Fly Into The Sunset At The End Of Life

John H. McCord, DPM

   I have been an unemployed podiatrist for four months since my retirement in December 2008. After almost 34 years of loving my work, I turned the practice over to my partner and a new associate.

   Retirement was the carrot I chased for so many years. The first weeks were like magic and then I got bored.

   I checked the job board at the hospital to see if my skills matched any positions. They did not. There seemed to be no call for used podiatrists.

   There was a job that intrigued me. There was a position open for a music thanatologist. I play the cello so I decided to inquire. I learned that a music thanatologist is generally a harpist who sits at the bedside of a dying patient playing soft music meant to calm the patient and the relatives waiting during the vigil.

   My cello skills would likely have a non-calming effect. I wondered how I would react if I was dying and the music thanatologist played the accordion. I did not apply for the job.

   It did occur to me that as DPMs, we received little or no training regarding end-of-life issues. People who know they will soon die fit into a different niche than a patient who suddenly goes into cardiac arrest and dies.

   Roy was a patient of mine in his mid-70s who was on a downhill path. He had uncontrolled diabetes, heart failure and end stage renal failure. He also had severe peripheral vascular disease and a first toe that had developed wet gangrene.

   Roy had decided to forego dialysis and knew he had about six weeks of life left. He and his wife came to my clinic one day for what I assumed would be his last visit. They had a request.

   He had many family members and friends who came to visit and the smell of his rotting toe caused them to leave quickly. Roy and his wife asked if I could amputate the toe so he could maintain dignity.

   I tried to talk them out of this since there was no chance the wound would heal. I also let them know it would be almost impossible to get medical clearance due to Roy’s renal failure, heart failure and the fact that he was expected to die.

   After much discussion, I talked with his internist, who agreed to give medical clearance. Roy requested DNR status. I had to beg the anesthesiologist just to sit and monitor Roy during the operation.

   I then warned Roy that if he chose that moment to die, I would haunt him in the afterlife.

   The operation went well. Roy survived. I made house calls to change the dressings on the non-healing but non-smelly foot. Roy was slipping toward death but always smiled and thanked me before I left his home. He died five weeks after the operation. His wife came by the office to thank me again.

   Not all end of life issues that I faced were podiatric. A former employee of mine came to the office a few years ago asking for a favor. Her 20-year-old brother had a synovial sarcoma in his hand. The oncologist told him the tumor had spread and there was no hope of survival. He had a prognosis of six more weeks of life.

   His sister knew I was a pilot and owned a plane. She told me her brother’s last goal was to become a pilot and asked for my help. I arranged to have him meet me at the airport that evening. There was no chance that he could take lessons and get a license as the first step is to pass a physical exam.

   I explained to the young man that I was not an instructor but could give him an orientation ride. I let him hold the control yoke as I pushed the throttle full. A smile formed on his pale face as the plane lifted from the runway. We climbed to 5,000 feet and flew to the west toward the Pacific Ocean to watch the sun set. I let him take the controls and explained how to stay on course and maintain proper altitude.

   We landed an hour later. He just kept repeating, “Awesome!” We talked about getting together for another “lesson” but he died a few weeks later. I have a beautiful thank you card that his father sent.

I wish they taught more about the end of life in podiatry school.

Dr. McCord recently retired from practice at the Centralia Medical Center in Centralia, Wash.

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