WITH KEVIN AWAY LECTURING and one of their nurse-practitioners out sick, Gwen had a busy Friday morning clinic. Though she wasn’t falling behind, each time she looked at her schedule Gwen felt anxious. It was the name at the bottom, the one she had added on late yesterday, that was disturbing her.
At his last appointment, Ed Greames was in the terminal phase of AIDS. Millions of slow-growing mycobacteria were reproducing in his lymph nodes, liver, spleen, and gut, metabolizing their way through his body. His symptoms initially improved on antibiotics, but the mycobacteria were becoming resistant to these drugs, gathering their minions for a final assault.
This week, Greames called complaining of right leg weakness. Gwen sent him to the ER where a brain scan revealed a mass, almost certainly a lymphoma—inoperable, incurable. Before the scan, the best he could anticipate was six months of worsening fevers, diarrhea, and weight loss. In a sense, his death would be caused by starvation. The neurologist who had seen Greames yesterday told Gwen that scenario would be superseded by progressive loss of motor function and speech in weeks with seizures likely along the way. Radiation therapy might prolong the inevitable by a month or two, but the patient would have to undergo a brain biopsy to confirm the diagnosis for any radiation oncologist to treat him. Beyond that, all she could offer was home hospice care from visiting nurses who were savvy in the use of morphine, steroids, creams, and tranquilizers to ease suffering at the end of life.
Ed Greames could still walk into the exam room. A tall, thin, graceful man with graying, jet black hair, he wobbled in on a cane. A proud man, a successful architect prior to his illness, Greames was angry.
“The neurologist explained it all to me,” Greames said, interrupting her greeting. “I’m not interested in radiation. I want it to end, as soon as possible.”
“OK… Can I get a little more information first?”
Greames answered her questions and let her examine him. Gwen’s laying on of hands diffused some of his bitterness.
Five minutes later, he repeated his request. He was lucid, realistic, and hopeless.
It was a snap decision for Gwen. She knew what the risks were, where she would be crossing the line, but she couldn’t refuse to help him. She wrote two prescriptions and gave them to him.
“The morphine is for pain, the phenobarbital to prevent seizures. Be careful with these medications. They’re dangerous. For example, if you were to take an overdose, say the entire contents of both bottles all at once, you’d fall asleep, stop breathing in a few hours, and die.”
Greames’s face softened.
“That is most instructive, Dr. Howard. You’re very kind.”
He gazed at the slips of paper.
“I’ll use these carefully,” he promised.
“I know you will.”
“Though actually, I might need a few weeks to take care of things before I leave.”
“Of course,” said Gwen with relief. “Let me know if there’s anything I can do. There are hospice nurses who do house calls. I can arrange for home attendant help, too.”
“I don’t think so,” said Greames, his voice flat and distant now. “My young friend can take of everything. Thanks anyway.”