(From Connexion Newsletter Spring/Summer 2024)

I first met him in the middle of the pandemic. He is gaunt, older than his stated age, and has the collapsed jitteriness of a man beaten down by life. He has complex chronic pain and a history of substance use disorder. Most recently, he was diagnosed with recurrent lung cancer and lytic metastases to ribs and pelvis.

He is here because of pain. I do the usual, set up the ground rules, calculate morphine equivalents, and organize close follow-up.

He visits diligently. His only vices are cigarettes and hydromorphone. He is clean and sober. As his disease progresses, I finally have to prepare him for the end. Not surprisingly, his pain goes through the roof, and he starts to drink again.

He is weeping in agony. The pain is too much to bear. He tells me he would end it all, but he can’t.

“I am a believer, doc. Please promise me you would never let me choose euthanasia.”

I was not prepared for the intensity of this conversation.

He sees my hesitation, and he launches his full assault on my heart: He and his wife had gotten into a bad situation with an evil person, and things got ugly. He got away. His wife did not. His daughter blames him for his wife’s murder, and he has been estranged from his daughter ever since. This is how he became an addict.

“Please, doc, promise me. God let me live for a reason. Please don’t let me choose euthanasia. I need to make things right with my daughter,” he begs me.

In a moment of weakness, I relent.

By grace, there is a hospice bed, and he is admitted for pain control and end-of-life care. I thought he was close to the finish line but in an ironic twist of events, he improves, becomes belligerent, and demands to leave. He gets himself blackballed from hospice. I get a bed at tertiary psychiatry. He declines, leaves AMA, and shows up in ER in agony.

He goes to the ward for pain control. One day several months later, a courtesy fax informs me that he had chosen MAiD (Medical Assistance in Dying) and it was provided. My knees wobble and I sit down, my grief and an unkept promise both suspended in mid-air.

— Dr. Allison Chung