She shook her head. “I don’t need anybody.”
“Mom, you do!” her daughter interjected, eyes welling with tears. “You can’t handle him anymore. He’s too big to lean on you. He’s too sick. He could fall, and you wouldn’t be able to get him off the ground. I have to work during the day, so I can’t be there. Why won’t you let the doctor get you some help?”
She shook her head again, resolute. “I met this man when I was 14 years old. We got married three years later. And I made a promise that I would care for him through sickness and health ’til …” She paused for a moment, choosing her words. “Well, until the end. I am not letting a stranger into my house to help. I made a promise.”
“You have been caring for him,” I said, as gently as I could. “That won’t stop with hospice. “
She crossed her arms and thought about what her daughter and I had said. Then she turned to her husband.
“What do you think? About hospice?” she asked him.
He opened his eyes at the sound of her voice. I wasn’t sure how much of this conversation he had been listening to. “Whatever you say,” he answered, and closed his eyes again. I didn’t know how to interpret that, but his wife did.
“We’ll consider it,” she said to me, in a way that really meant, “We’ll pass on hospice.”
They left the exam room and walked down the hallway slowly, my patient’s wife pushing his wheelchair, his daughter carrying her coat and purse.
It was the last I saw of him. The following week, he had a cardiac arrest at home and died, with only his wife in attendance.
Of all the obstacles to initiating hospice that have been cited, from physician delays to inadequate resources, this one — the devotion of wife to husband, or child to parent, and their reluctance to welcome another into that bond — is the hardest to quantify. She later told me it was about as good a death as they could have hoped for, all things considered.
I think even her husband would have agreed with her on that.
Dr. Mikkael Sekeres (@MikkaelSekeres) is director of the leukemia program at the Cleveland Clinic.