Physician and patient

by Worthington Hooker

Left the warm precincts of the cheerful day,

Nor cast one longing, ling’ring look behind?”

It is well that the hope of recovery should occasionally light up in cases which are certain to end fatally, especially when the patient is the subject of protracted chronic disease. It breaks in upon that painful monotony of mind, which is otherwise apt to exist. It is not commonly well for any one, in any point of view, to have the certain expectation of death fastened in the mind week after week and month after month, even if he have all the while a clear view with the eye of faith of a glorious immortality beyond. This one unvaried state of thought and feeling, though commonly spoken of as exceedingly to be desired, is ordinarily neither so profitable nor so happy, as that condition of mind, in which the expectation of death is not so constantly present, but occasionally gives way to thoughts and emotions of quite a different character. The keeping the mind strained up to a certain state, and fixed upon one set of thoughts, is never either in sickness or in health profitable to the individual himself, or to others. And aside from this consideration, though the calm and fixed contemplation of approaching death has something noble in it, and challenges our admiration, still the triumph over death may be as signal, when there is occasionally an indulgence of the natural desire of life, and a shrinking back from the encounter with the king of terrors. The destruction of this love of life, and the utter extinction of the hope of a recovery, are by no means essential to perfect resignation. Indeed the highest degree of resignation may exist when the desire to live is so strong as to prompt the sufferer to catch with eagerness at the slightest grounds of hope even to the last. Incidental circumstances have much to do with the manner in which death is met. A cool temperament, the long continued cultivation of a stoical indifference in the midst of change and calamity, a morbid misanthropy, an habitual disposition to fatalism, the breaking up one after another of all the attachments to this world, the benumbing influence of disease or of medicine, long familiarity with suffering, and the consequent capability of enduring it, which is sometimes truly wonderful—some of these various circumstances may conspire to render submission to the necessity of the case easy, and give to the death-hour a calmness that is often erroneously supposed to arise from a true Christian resignation. The calmness thus induced is often an incidental adjunct to resignation, and is sometimes auxiliary to it, imparting to it firmness and steadiness in its manifestations. But it is in no wise essential to it, nor one of its elements.

In chronic cases, which are going on gradually to a fatal termination, there sometimes occurs either a temporary pause in the onward course of the disease, or an alleviation of the symptoms of so decided a character, that the patient and the physician cannot avoid indulging for the moment the hope of a recovery. At such times the bosom of the physician is the seat of conflicting hopes and fears. He hardly dares to hope, when he calmly surveys the whole case from the beginning. And yet he has known, he has himself seen some strange recoveries, perhaps even more strange than such a result would be in the case before him. What now is his duty to his patient? Shall he tell him the worst, as it is expressed, and thus extinguish his rising hopes? Shall he say to him, “This very probably is only a truce for a little while, and then your now dormant disease will renew its attack, and perhaps with more vehemence; and, even at this time, it may be secretly carrying on the work of destruction, while the remedies are merely administering to your comfort, and smoothing your passage to the tomb?” To say nothing of the evil of such a course, if the case be susceptible of a cure, it cannot be an advisable one, if the prolongation of life and the alleviation of suffering be objects worthy of the aim of the physician; for such a course would in most cases have a strong tendency to defeat the attainment of these objects. If the friends of the patient deem it important that such a view of his case should be presented to his mind, let them take the responsibility of doing it themselves, and not call upon the physician to do it. Ask not him to come to his patient with the look and language of despair, and utterly dissever the idea of hope from the efforts which he makes and the remedies which he administers. Put no such unnatural, and cheerless, and, I may add, profitless office upon him.

I remember once being strongly urged to such a course by the friends of a patient. Whilst apparently going steadily down to the grave, his symptoms at length became much relieved, and he took some encouragement from the state of his case. In reply to the inquiry of his friends, whether I had any hope of his recovery, I frankly said that I had not, and that from all I could see I supposed that the relief which he experienced was to last but a short time, and that he must die very soon. They urged me to tell him so, but I declined, for the reasons that I have stated above. The condition of comfort and relief lasted in this case, contrary to my expectation, for several weeks; and they were weeks of delightful intercourse, of affectionate counsel, and of triumphant faith and joy. And I have not a doubt that his life was thus happily prolonged in part by the cordial influence of the hope, that the remedies which relieved his distress might effect a cure.

It seems to be the idea of some, that there is something very salutary in a spiritual point of view in the knowledge of the fact, that death is certain and near. That it is more alarming and awakens more emotion than the mere idea of danger, I allow; but that it is more apt to produce right views and feelings is by no means satisfactorily proved. Even if it be true, that the certainty of death is more likely to secure decisive action in regard to the interests of eternity, a decision under such circumstances is by no means so worthy of confidence as one which is arrived at when the hope of recovery is not wholly extinguished. To test this, take as an example the feeling of resignation. When death is seen to be absolutely certain, its very certainty is apt to induce a sort of calm semi-fatalism, which has the appearance of true submission, and is often mistaken for it through the charity and fondness of friendship. But when the result is seen to be uncertain, if there be amid all the balancing of the mind between hope and fear a willingness to acquiesce in the supreme will, there is good reason to believe that the patient has a true Christian resignation. There was much force in the remark of a patient, who had for some days had the certain expectation of death, but who had at length experienced so much relief, that there was some ground for hope. “I am glad,” said she, “that this relief has occurred, even if I do not recover; for now I can fairly test the reality of my submission. I can put life and death together, and examine my wishes and desires in regard to them.”

There is one disease in which the disposition to hope is so marked, that Dr. Good enumerates it among its symptoms. I refer to consumption. In some cases, it is true, this symptom does not appear, but despondency for the most part prevails. But this arises either from a morbid sensitiveness of the nervous system, or from a diseased condition of the digestive organs. When neither of these circumstances exists, and the disease is uncomplicated with other maladies, the tendency to hope is so strong as often to resist the force of the most decisive evidence. Nothing is more common than to hear a consumptive patient say, “Doctor, if you will only cure this cough, I shall be well,” as if the cough were only a slight matter, and its continuance was rather provoking than dangerous. I once saw a physician deceiving himself to the last week of his life with the idea, that his disease was in the stomach and liver, when there was the most palpable evidence that the lungs, and the lungs only, were diseased.

This tendency to hope is beautifully alluded to in a poetical sketch of consumption by an anonymous author:

“Then came Consumption with her languid moods,

Her soothing whispers, and her dreams that seek