Perspective

Indian chief defeated death

A doctor learns to be a healer by letting an old chief die on his terms, his mission completed.

By LODOVICO BALDUCCI, Special to the Times
Published November 25, 2007

Fifteen years ago, I took care of the last chief of a tribe of American Indians. His hormone refractory prostate cancer had left him with only a few months to live.

He confided to me the final goal of his life: to conclude the history of his tribe, which had never been written before and which would have been all but forgotten after his death. His candor compelled me to level with him: "How much time do you need, chief?"

"At least 6 months."

"Without chemo," I told him, "you have approximately 9 months to live; with chemo you may add 6 months to your life, but you probably won't feel like pursuing this endeavor: I suggest you forgo the chemo and focus on your history!"

He died the day after mailing the corrected galleys of his book back to the publisher. A posthumous note of thanks, almost illegible, is framed on my desk.

The old Indian chief taught me that death is not always a defeat. He conquered death by co-opting it in his own life. He looked at his approaching death as a working deadline. Death became an opportunity to define himself as unique through the history of his tribe that he alone was able to write.

The old Indian chief also taught me the meaning of death with dignity. This expression is frequently misused. Dignity is intended to be synonymous with comfort, as freedom from pain, bed sores and indwelling catheters. In some cases it is a code word for invoking euthanasia that is still socially unacceptable.

Dignity is the opportunity to be oneself. Underlying the idea of dignity is the assumption that each and every one has a unique mission, a unique vocation only that person can carry out. Pain, bedsores and indwelling catheters compromise one's dignity only when they impede one's mission.

The preservation and restoration of quality of life has gained widespread acceptance as a main goal of medical interventions in recent years. The FDA has approved a number of drugs that improve patients' quality of life without prolonging survival. For an old physician like myself this trend could not have been more welcome.

I remember well the old days when patients screamed all the way to death because we were unable and unwilling to relieve their discomfort. Yet even quality of life cannot be considered an end by itself if it is divorced from accomplishing one's mission. If we equate quality of life with comfort, we would pity Teresa of Calcutta for her poor quality of life, and yet I know of no other person with such a sense of mission and achievement in modern times.

The chief indicated the need to go beyond quality of life, to the meaning of life. And he clarified for me my role as a healer. When I have the privilege to be trusted with a person's life, I now try to understand that person's goals in life. I consider it my sacred duty to use my knowledge and expertise to enable that person to fulfill his or her personal mission.

This partnership is essential to answer one of the most vexing questions of medicine: When should a person be allowed to die? That time arrives when the medical conditions prevent that person from pursuing his or her personal mission. When that time is recognized and accepted, death has lost. After having been a physician for 30 years, I had finally become a healer thanks to the old Indian chief.

Dr. Lodovico Balducci is a professor of oncology and medicine at the University of South Florida College of Medicine and is director, Division of Geriatric Oncology, at the H. Lee Moffitt Cancer Center.

[Last modified November 26, 2007, 07:43:35]