LAST CALL | Joseph Zarconi
After a long struggle with bladder cancer and its treatments, after his hair grew back and he started putting on weight, after his doctors told him he was cancer free, Mr. Petruccelli's internist suggested that he see a nephrologist. Bouts of obstruction, cocktails of chemotherapeutic agents and antibiotics, and long periods of poor intake had left him with a significant amount of what was likely to be chronic kidney disease. Glancing through his records, I could hear him and his wife in an animated conversation in the exam room.
They both hastily stood up when I entered, wanting to shake my hand. They quickly reminded me of some of my Italian relatives, talking over each other, both talking to me at the same time, loud and joyful. Over the next half hour or so he shared his cancer story, and his surprise at learning that he now had a kidney problem. After an unremarkable exam, I spoke with them about his diagnosis, its implications and about how we would be getting to know each other as we worked together to delay the possible eventual need for dialysis. Now being in his late 60s, perhaps we could avoid it all together. They appeared relieved as our visit wound down.
After answering their questions I stood up to leave, suggesting that I see him again after some additional testing. With one foot out of the exam room, he exclaimed one last question. "Oh, hey, Doc!" I leaned back into the room. With a guilty smile, he asked, "Can I drink?"
I told him that of course he could drink, that he needed to drink fluids, that we all need to stay hydrated. He smiled further at the diversion, and then clarified that he was referring to alcohol. I asked him what he drinks. "I'm mostly a scotch drinker, Doc! Not every day, and not too much, but I enjoy my scotch," he confessed. I told him I was okay with him drinking scotch, and spoke of moderation, but I told him he ought to limit himself to single malts. His eyes now opened wide. "You're a scotch drinker?" he asked excitedly. I told him I was a bit of a single malt snob, and without knowing why, also made the "not every day" claim.
"I mostly drink Johnnie Walker, Doc! I drink Johnnie Walker Red, sometimes Johnnie Walker Black." I asked him if he had ever tried Johnnie Walker Blue. "No Doc, there's no Johnnie Walker Blue. There's Johnnie Walker Red, and there's Johnnie Walker Black…" Interrupting, I assured him that there was indeed a Blue, and suggested that the reason he may not have been aware of it was that it's usually in a locked cabinet or behind the counter because it's about $185 a bottle!
Starting at his next office visit he began bringing me little bottles of different scotches, excitedly asking me if I had tried them, presenting them as gifts. I knew immediately that we had crossed a boundary that we probably weren't supposed to be crossing, and I hoped he would cease this gift giving on his own. A few more visits (and bottles) later, I expressed my gratitude but shared that we ought not continue this gesture. He took it well.
We continued to see each other over a number of years. I always looked forward to their visits. He brought his wife. They appeared to have a lovely marriage. They told me about their children and grandchildren. We shared Italian family stories. His kidney disease was progressing, but not rapidly. We had serious conversations, but we laughed together as well.
A number of years into our relationship on a cold day in early November, I received a call from a resident in the hospital consulting me to see Mr. Petruccelli who had been admitted with intractable vomiting and some weight loss. He now had severe kidney failure and it appeared to be the result of urinary tract obstruction. Further evaluation documented a pelvis full of tumor with obstruction and widespread metastases. The oncologist thought further treatment of his recurrent and metastatic bladder cancer would be futile. Mr. P agreed, and not surprisingly, accepted his fate fairly joyfully.
For the remainder of his hospital stay, I visited him at the end of every day. I sat in the big soft chair next to his bed and we talked. He told engaging stories of family vacations they had taken. He told hilarious stories about how he and his wife had met, and the crazy things they had done together. He told me how proud he was of his family. We often laughed ourselves into crying, and sometimes it was the other way around. On the evening before he was discharged with a plan for home hospice care, I told him how much I had enjoyed getting to know him and his wife, how much I enjoyed being one of his doctors. I shared my admiration for the husband that he was, and the father, and also acknowledged the grace with which he always faced his health challenges. As hard as it was to say goodbye, I felt extremely privileged to be present with him in his dying.
Nearly two months later, on the first Monday of January, exiting one of my office exam rooms, I found a pink phone message note left for me on the counter by my receptionist. Mr. Petruccelli had called and was requesting a call back. Under "reason for call" she had written "personal." It surprised me that he was still alive. When I finished seeing patients I went into my office, closed the door, and braced myself for the call. He answered quickly and he sounded very much alive. As soon as he heard my voice, in fact, he began shouting. "C, pick up the phone up there, it's Doc calling!" He always called her by her first initial. It occurred to me that I didn't know her first name. I heard her pick up the extension. They were like two children giddy and excited to hear from me.
I asked him how he was doing. "I'm great, Doc! We had the best Christmas this year. All the kids and grandkids came and we had a feast. It was so great to all be together. Probably the best Christmas we've ever had!" I had known that the family would be wanting to make this Christmas a special one. They all knew it was going to be his last. He knew. I shared how happy I was to hear of their family celebration.
"I know, Doc, I know!” he said impatiently. “But that's not why I'm calling. Guess what my son got me for Christmas!" I couldn't imagine the right Christmas gift for a dying man. I told him I had no idea. Now extremely animated, he reported, "my son gave me a bottle of Johnnie Walker Blue!"
I let that sink in.
"And the reason I'm calling is that I want to ask if you would come to my home and have a drink of Johnnie Walker Blue with me before I die."
A few days later, I arrived at his back door in the early evening. His wife greeted me with her usual enthusiasm. There was no sadness. They had moved Mr. P downstairs to the main floor and had him in a hospital bed there. As I entered this room he sat up and shouted, "Doc!" He teared up. He had lost so much weight. He was all cheekbones and Adam's apple. I noted the bedside table covered with what appeared to be a linen tablecloth upon which sat two beautiful crystal whisky glasses and an unopened bottle of Johnnie Walker Blue.
We sat there together for a number of hours telling stories, laughing out loud, and sipping Johnnie Blue. There was no sadness. As I got up to leave, I asked him if the men in his family kissed other men, like they do in my family. He smiled, assenting. I leaned over his bed rail and kissed his forehead and thanked him for the Blue.
In the kitchen on my way out, his wife began to cry and reached out to embrace me. "I can't tell you how honored we are that you came here to this house," she said. Holding her tightly, my mouth to her ear, I replied, "no, no, no, no, Mrs. P, you weren't the ones being honored here tonight.”
At Mr. Petruccelli's calling hours, as I exited the funeral home, his son followed me out to tell me that my conversation with Mr. P had been his last lucid conversation. He had slept that night, never became alert or coherent after that, and died a few days later. His son then stopped and with a sense of urgency, wanting me to know, put his hands on my shoulders and shared, "He waited for you."
Joseph Zarconi is tenured professor of Internal Medicine and clinical director for Health Humanities Education at the Northeast Ohio Medical University (NEOMED) College of Medicine in Rootstown, Ohio. He is a retired nephrologist and has remained active in the teaching of medical students and residents. He has presented at state, national and international meetings and co-authored peer-reviewed journal articles and book chapters on topics relating to medical education, narrative medical practice, narrative ethics, humanism and professionalism, cultural consciousness, close reading and social justice. Zarconi is co-author of two books on narrative in healthcare and a member of the NEOMED Master Teacher Guild; he has been recognized as a Master Teacher by the American College of Physicians.