Letting Go

I knock on the door. A male voice responds, “Come on in.” I enter and peer in the kitchen. A bone-skinny woman with errant hair glances in my direction. Her brow is scrunched, her lips grimaced. “Who the hell are you?” I tell her I am her physician. “Get out of here,” she screams. “I don’t know you.” Her head pivots; she glares at her husband. “What the hell are you doing?”

He hobbles to her side. He is exhausted and careworn. “I’m making breakfast. Bacon, eggs, and coffee. Your favorite.” He places a plate in front of her and plops in a chair. He slices the bacon and eggs into small pieces, and blows a cool breath on her coffee. He turns toward me. “I’ll be lucky if she eats a third of that.”

She takes one bite of egg and becomes rattled. She spits it on the table and cocks her head like a bird listening for a worm. Then, she pincers the butter knife in her right hand and slashes the air near her husband. He leans to dodge the knife and tumbles to the floor. “Who the hell are you?” she shrieks. I rush to his side and help him to his feet. “Get the hell out of here,” she barks. “Get out!” She pounds the table and tosses the plate. Her husband grabs her arms and holds her tight. The knife drops to the floor; I scramble to retrieve it.

I inquire if he is hurt. “I’m fine, I’m fine, she didn’t mean it. She’ll calm down in a minute.” She scuffles to free herself. He releases her and offers a sip of coffee; this calms her. “She loves her coffee,” he says. He gathers a new plate and pulls a chair beside her. He tries for twenty minutes to get her to eat. She mutters and whimpers and takes only a few bites. Discouraged, he cleans her face, secures her in her wheelchair, and places her in the living room in front of the television. He and I sit on the couch.

I hesitate a few moments, then broach advance directives. “I know it’s difficult to talk about, but we should address what to do if your wife becomes seriously ill, or her heart stops. I want to be sure we do what she would want done.” I initially refrain from mentioning long term care; he has spurned the suggestion repeatedly. He is of the generation that honors their vows; he reminds me each visit, “In sickness and in health.” However, her outburst prods me to discussion. I advise him it is time to seriously consider nursing home placement; it is their only option. Their lone child is deceased, and their finances depleted from the outlay for private duty nurses. Moreover, he cannot continue the grueling labor of caregiving alone; her physical needs are too great, and her behavior increasingly violent. “I thought she was going to stab you with the butter knife,” I lament.

His eyes travel the room; I notice a glint of tears. “I know, I know,” he sobs, “I need to make some decisions. It’s just so hard.” He is right; it is hard. However, he is eighty-seven, she is eighty-three. His health is burdened by diabetes and heart disease, and her physical and cognitive abilities are rapidly declining. “I just need a little more time,” he says. “I promise next visit I’ll have some answers.” I nod, knowing there will be no resolution next visit. I stretch my arm across his shoulders and hug him. We say nothing at all. Letting go is hard.