"When You Learn How to Die, You Learn How to Live."

Today I had one of those truly almost time-stopping experiences without expecting it. It was like a wrench was thrown into my path on a joyous occasion and I didn't even know what to do with it. I thought about crying, but it wasn't the time for that. I wanted to ask more questions, but it wasn't a time for that either. I felt pensive, I felt lost, but I mostly felt humbled.

It was our end of tutorial dinner. We were sitting down to great food and great company and celebrating what was the culmination of 2 years of clinical education. Tutor group by tutor group we went up to thank our leaders in under 30 seconds and most groups, like ours, just said a little something nice, while some, went the extra mile (and perhaps a little...far?) and broke into limericks or song (Boyz II Men, was, in fact sung). When we all had finished, the head of our preclinical clerkship program told us that someone wanted to speak with us. She said it would be a topic that might be a bit more serious than the ones we had been discussing at our tables, but that "in medicine, that's what we do, we mix the serious, with the funny". While frankly, she had a point there, I thought she probably was just doing what all doctors do, and sucking the life out of the party (and making it serious again--because "that's what medicine is"), but boy--was I wrong.

The man walked up to the microphone. I knew I recognized him, yet I couldn't place him...until he spoke, and placed himself. He said that he had some news to share with us, and that news was that his friend, a patient who had come to speak to us about having (and living with) ALS had passed away. He said that it was a highlight of his friend's life to come and speak to our class and to get thank you notes after, and that he felt he had to share the news with us, even on such a joyous occasion. Suddenly, I remembered.

A flood of emotions and thoughts raced through my head. This was the patient that had moved me so much that for the first time ever I actually cried in class. This was the patient that I went up to after he spoke and told he needed to write/share his story, because he just had to inspire more people (especially future physicians). And this, was the patient whom I had considered writing and talking to about helping to write his story (perhaps as part of a book as it had truly moved me), and now, I would never have that chance.

This patient was no ordinary patient. He was a physician, a prominent one, who had climbed the ranks of academia only to be later diagnosed with one of the most debilitating diseases: ALS (or amytrophic lateral sclerosis to the nerds of the bunch and Lou Gerhig's disease to the popular press). It basically leads to a rapid and progressive muscle atrophy and weakness, and often eventually (in 2-3 years) will lead to respiratory failure and death. He was in the prime of his career, the height of his family life (with weddings and grandchildren on the horizon) when this news arrived. He knew things would change suddenly, he knew medically what the disease entailed, but what impressed me the most, and probably what I most took away from his talk, was his attitude about it. Yes, he was in a wheelchair, and yes, he had to drink water often because his throat was dry and he had trouble talking for long bouts, but he was still living his life to the best of his ability. He still laughed. He still smiled. He was still with his family and his wife the most he could be. And, he was teaching us and we were learning from him.

There is something unique, intriguing almost, about what you can learn from a physician who becomes ill, on how to treat the sick and how to (what its' really like to) be a patient. Its like medical training beats the empathy out of you, but then when you get sick yourself, it all of the sudden returns. But, for me, I did not just learn how to comport myself in a better manner when treating the sick (especially the chronically and terminally ill), I also learned how to better spend my time living. I guess I had always thought of images of ALS, like in movies like "You Don't Know Jack" where the patient wants Jack Kevorkian to help him die, and thought if I was ever that sick, I wouldn't want to live either. But, this patient used his medical knowledge to alter his house so that he could have mechanical aids to use the toilet (like the actual hospital style ceiling ramps), and he had one of the strongest support systems I have ever heard of: his group of friends from college would drive to him weekly and have lunch to just talk. This was a life worth living, even if it was a life that was shortened, painful, and ending.

I felt a little bit like his talk was my own Tuesday's with Morrie...and frankly, I felt blessed just to have met him then...let alone now. Looking back, I am shocked that he deteriorated as quickly as he did, as his motor abilities made me think I had more time to decide if I wanted to contact him to talk with him further. Yet, maybe my own hesitations, complete with deleted drafts of e-mails to deans and course directors, were due to the fact that writing this patient's story down, could never really do it justice. Perhaps the power was in his physicality, in his delivery, in his presence...and not merely just in his story.

Tonight, when this man walked away from the microphone, the entire room was silent. What was once a room full of laughter and celebration, became a room full of awkward reflection. Everyone looked to the person next to them and did not know whether to clap or to sit in silence.There was a slow echo of clapping and so everyone mechanically followed each other. But, you could tell that no one really thought it was right to...clap...about what we just heard, just as no one really knewwhy this was the occasion to bring up the death of this man.

Either way, Morrie said "Death ends a life, not a relationship", and I'd like to think that because I was so moved by his story to begin with, and then his death was mentioned at such a key symbolic moment for my future as a clinician, I will be this...better doctor because of what I felt he taught me (or intended to teach me). My future physician-hood is forever linked to his story and ultimately, I am grateful for that.