Sacred Farewell BY MICHAEL CAÇOILO, MD
“Before we go in, I want to let you know that your father seems tired today. He is weak, and he may not be able to say much. But he is really looking forward to seeing you.� I hoped these words of warning would help prepare the family members as they visited their loved one as he neared the end of his life. We admitted Mr. M. from clinic because his liver function tests had reached dangerous levels, a sign that his aggressive liver cancer was progressing. When he learned of the advanced stage of his disease, his options for medical intervention were limited. Knowing his diagnosis was terminal, his plan was to work a little longer while he still had his strength, get his affairs in order and then fly home to Mexico to be with his family. He had moved to the U.S. years ago on his own, working to provide for his loved ones. Because of his documentation status, he was not able to travel freely back home, and it had been a long time since he had seen his family. When he was first hospitalized, he was feeling intense nausea and could barely tolerate food. I recall how alarmed
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MDADVISOR | Winter 2020
I was when I first placed my hand on his belly and noted his liver was three times the normal size, taking up most of his abdomen. No wonder he could barely eat. Our interventions were mostly supportive. We provided anti-emetic medications to help keep the nausea at bay. We offered fluids and eventually artificial nutrition through his IV. Our hope was that we could help him gain enough strength to get on a plane back home. After a few days, we saw that he was continuing to decline. He was growing more tired and more uncomfortable. His daughter called us every day to ask how he was doing. She was applying for an emergency visa in hopes she could come to the United States to be with him. As the prospect of their reunion grew more unlikely, our team felt increasingly desperate to bring Mr. M. and his family some peace as he entered his final days. We coordinated a time to call his family through video chat so they could see each other.
