Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Last Inning


Sometimes, patients have the opportunity to write a beautiful concluding chapter to their lives. We can encourage them in this endeavor.  

Mr. L was in the hospital again with nausea and vomiting. He had metastatic gastric cancer with carcinomatosis and the CT showed multiple peritoneal masses with several points of obstruction. This wasn’t going to get better. Only 30% of stomach cancer patients will be cured despite treatment, and he was on the wrong side of that curve.  


I’d been seeing him for a few years. He was on the medicine service, his abdomen was distended and somewhat tympanitic, and an NG tube was in place. Mr. L’s spirits were low.  He asked if there was anything that could be done surgically to relieve his obstruction.  There wasn’t. He nodded, because he knew the answer. We talked about his situation, his cancer, his treatment, and about his family. He asked me how long he had to live. I looked him in the eye and told him I thought it might be a week or two. He nodded again. We talked for a while.  


“What can I do?” he asked.  


“What do you want to do?“ I said.  


“I don’t want to be here.” 


“Then why are you here?” 


He looked at me with a quizzical expression, and raised his hands and pointed to the NG tube, IV tube, pneumatic stockings, hospital gown, and hospital bed.  


“Where would you rather be?” I asked.  


“Doc, I’d rather be watching my grandson play baseball,” he said.  


We talked about his grandson and about baseball. He told stories about his grandson and I shared a story about when I was a catcher as a boy. On the first day of practice, we didn’t have equipment, but played until the sun went down. I was behind the plate looking at the pitcher as the sun set over his shoulder. I never even saw the pitch that broke my nose. Mr. L, with the NG tube in his nose, looked at me sympathetically. I asked when his grandson’s next game was, and he told me it was in two days. 


“Why don’t you go to the game?” I asked.  


“Come on doc, I can’t leave the hospital, I can’t even eat, and I just throw up.”   


“Why can’t you leave the hospital? It’s your choice, you can check out of the hospital.” 


“But what about the NG tube?” 


“Pull it out.” 


“But what if I throw up?” 


“Would it kill you?” 


He laughed. He knew he was dying of cancer and we’d had many honest but caring discussions. And he realized that if he took out his NG tube, nothing dramatic would happen. “Will they let me leave?” 


“It’s your choice. I strongly suggest you go to the game. Be with your family. Watch your grandson play baseball. And if you have to barf, barf and then go right back to watching the game.”  


 “I can do that?” 


“Yes, you can. You’re the author of this last chapter of your life.” 


He left and that was the last time I saw Mr. L. 


A couple of weeks later, his son came to visit me and said that Mr. L went to the baseball game and saw his grandson play. Mr. L died at home several days later. His son warmly shook my hand, and said, “I can’t thank you enough. I’m not sure you know how important that was for our whole family.”  


Mr. L had written a beautiful ending to his life story. 






  This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.