La médicine,
c’est guérir parfois,
soulager souvent
et consoler toujours.
Medicine is sometimes healed,
often illuminate,
but always … offer comfort.
This classic statement in medicine
is attributed to Ambroise Paré,
a French surgeon from the 16th century.
And although the quote is 450 years old,
it is still very current.
Because how can we,
healthcare providers and society,
focus on that first piece.
How is it that we look much less often
to that last line of the quote?
I will explain it with an example.
I am a lung doctor.
I treat patients with lung cancer
and that – we know – dies 85% of all patients.
That was 90% 20 years ago.
So in the past two decades
we have been able to achieve a survival advantage of only 5%.
Of course,
all that innovative medication is incredibly important,
I do not dispute that either.
But I think that’s a patient,
that a man who has an incurable disease,
much more than just medication.
I specialize in palliative care;
I am particularly fascinated by palliative care,
because palliative care is the care for the whole person,
for the incurably sick person.
It is not only the relief of physical suffering,
such as pain and tightness,
but above all also the elimination of psychological suffering –
anxiety and depression.
And I think especially existential suffering,
because every patient who is incurably ill,
will have to deal with life questions to a greater or lesser extent.
Questions like ‘Why does this disease affect me?’
or ‘How can I still color
to the months or weeks or maybe days that I still have? “
I once researched how often I am a doctor in training
education on palliative care.
In the first six years of my study that was …
half a week.
In my further training as a lung doctor, also six years,
I only had two hours of lessons
about palliative care and about dealing with death.
I think that compassion and empathy
basic characteristics are from every healthcare provider.
I think that palliative care in particular focuses on compassion and empathy
and it is incredibly important
that we develop well as care providers.
We must stand next to the patient.
We have to give them attention, we have to listen
and above all: we have to be there.
One day you too will die.
And answer the following question honestly:
do you want us to treat your illness,
or do you want us to treat you?
In the summer,
2009,
early August.
The Netherlands celebrates holidays.
We are in the soft pink morning light
in his room in a back corner of the nursing ward.
He is very ill and just 32 years old.
I sit next to his mother and girlfriend
and behind me, with bated breath, the assistant and nurse.
The man is turned away from us at his table.
He has put his hands before his eyes.
He is extremely stuffy.
I look at his bent back and count his breathing frequency:
30, 35 times per minute.
A window is open.
A sweet summer fragrance falls inside.
The contrast
between that beautiful outside and the raw reality within me.
We had known to him before that I liked him
and I had not found it that professional afterwards.
But he really appreciated it.
It is a charming type.
He has a large tumor in his lung
with metastases in his bones, liver and brain.
“Also in my head?”
he had wondered in despair.
Death is always raw.
But the death of someone who is so young and in the middle of life,
is an atrocity of nature.
“Of course I take this home”,
I had answered the internship in all honesty.
In recent months we have tried chemotherapy on chemotherapy,
but nothing helps.
The fear of his death is constantly being felt.
Dexamethasone, Pemetrexed, etoposide and Erlotinib
and some exotic names.
It all turns out to be pointless.
The cancer continues without mercy
and has taken his once-imposing body down to the man who now sits before us.
The last few weeks he has become very stuffy.
He has refused the morphine we offered him countless times.
It could well combat his distress.
“I stay with my girlfriend
until the last moment, in my full consciousness. “
The last days he has settled on a dining room table
and there he is now, 24 hours a day.
He can not and will not lie anymore,
because then he gets the feeling to suffocate.
It is due to the metastases in his pericardium
who take care of it relentlessly
that a decent return of blood to the heart is impossible.
Decency,
a word that is missing in the vocabulary of cancer.
The diagnosis is: pericarditis carcinomatosa.
It is Latin for ‘horrible’.
And there we are.
His girlfriend looks at me – she is late 20, a beautiful woman.
And she asks the question why this conversation actually started:
“Can it still be a doctor, can we still marry?”
We talk about the end in minutes, about his end.
“The thunderous final cup is imminent”,
he had summarized it visually, but above all painfully.
I look at the strap around his wrist.
1977 insists;
he has the same birth year as me.
“Of course you can still get married,” I said, but it must be quick.
Actually very quickly: today, not a day later.
There we are, in the corridor.
The co-assistant calls immediately
the town hall of a nearby village.
We get civil affairs on the line
and I brace myself for all the red tape
and god knows what ridiculous questions.
The reality is completely different.
After we have done the whole story, it turns out that all doors open immediately.
The mayor becomes the necessary signatures
called from an important council meeting;
an army of civil servants is acutely available for advice and action;
“Passports not present?” asks a woman from the municipality –
“Fetters”, she says in the same breath.
Wow.
Within less than 50 minutes we arrange an entire wedding ceremony,
including official and witnesses.
It certainly does not belong to my job description,
but ‘what the heck’.
They can get married that same evening.
Half of the facility staff of the hospital is expanding
to turn a quiet room into a complete wedding chapel.
The kitchen makes a cake …
This is concern.
This is what concerns.
In the distance the sun sinks behind the trees.
She is standing in the soft light next to him.
He is – terribly stuffy, but intensely happy.
Their hands are folded.
It makes an indelible impression on everyone in the room.
These two people have been in recent months
reached an impressive level of unification
and full of strength and love they agree with the marriage promises
and swear faithfully to far …
far after his death.
At the end of his life there is nothing left but love.
The assistant will beckon me.
Together we walk away.
We’re going to the hallway.
We are crying.
Of course, that is of course not allowed as a professional,
but it does not interest me a flute.
That same night he dies –
at the table, but next to his wife.
Thank you.
(Applause)
”
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