Issue: BCMJ, vol. 50, No. 9, November 2008, Page 489 Editorials

During one of my recent clinics I saw a patient, “Joe,” in follow-up several months after a lung transplant. I had been involved in his care for the better part of 15 years, watching the inevitable progression of the underlying disease as he made the gradual transition from employed, active individual to oxygen-dependent, severely disabled, respiratory cripple. Several times over the years I had raised the question of transplant only to be told that it “wasn’t my time yet.” Then, after a particularly severe life-threatening exacerbation, Joe agreed to enter the transplant process. The surgery was very complicated and probably contributed to the grey hair count of the surgeons involved, but here we were, several months later, joking about how I found it difficult to recognize him without the nasal prongs! Joe commented that, even several months off oxygen, he would reach up to remove the non-existent prongs prior to wiping his nose!

One of the comments made by Joe was how everyone involved in his post-transplant care invariably included a hug in their greeting. Indeed, I had done so as well, and, in reflection, recognized that my reaction was one of joy. Why was I joyful? I think because, this time, we had beaten death, if only temporarily!

Those of us involved in the practice of medicine have an interesting relationship with death. Most often it is seen as an adversary and we strive to snatch our patients from its jaws, with varying degrees of success. Our successes, especially when they occur against the odds, we remember and bring them to mind when we fail. Joe will serve this purpose for me. In other circumstances, death is an ally, relieving suffering when we no longer can. The death of my 89-year-old mother from pneumonia complicating demen­tia was such a death, bringing relief in addition to the sadness. William Osler, as he so often did, expressed it well: pneumonia is often the “old person’s friend.”

 So I bid farewell to Joe, for I really have no excuse to see him again, leaving his care to my very capable colleagues at BC Transplant. However, the memory of the visit and our departing hug will buoy me in the future when such a lift is needed!


. Joy. BCMJ, Vol. 50, No. 9, November, 2008, Page(s) 489 - Editorials.

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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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