My impression from my initial visit 2 months ago was the Mr. J had led a very hard life, had been in jail, had been homeless at one point and had extensive alcohol and drug use in the past. He now had metastatic lung cancer to his brain and I was making a follow up visit.  He’d been drinking 24 ounce beers all day, so my initial expectations for the visit were very low.

I went through the usual stuff, asking about pain, constipation, appetite, sleeping, etc. He was sober enough to answer through the questions, but at times would start to drift off again.  I’d watch him light a cigarette, take a puff then forget it was in his hand. It’d continue to smoke up the room and my lungs, and he’d drift back to sleep.  “Mr. J, you need to be careful when you’re this sleepy and smoking, I’d hate to see this house catch on fire.” He’d wake up, the cigarette now burned to a little nubbin and puff once more before lighting another.

I really wanted to finish up.  It was the last visit on Friday afternoon and I was queasy from the smoke.  I, however, forced myself to be patient.  “Anything else on you mind?”

Mr. J then surprised me.  For the next 15 minutes he began to talk about God.  He spoke of how sad he’s been.  How at first when he was diagnosed he questioned God, “why me, why my family?”  He voluntarily said that he’s come to an acceptance now.  He still prays that God will heal him, but he is at peace with his disease. He said the hardest thing now is that his mom and aunt haven’t accepted it.  He then fell asleep again and even with another question to follow up on his statement, he kept sleeping.  I sensed he had reached his end point.

I went up to him to say goodbye, again having to shake him awake. I asked if there was anything else we could do and he said “just pray for me”.  I went deeper, “How should I pray for you?” He asked for strength, and then just as I was turning to go he chimed in, “one more thing to pray for, pray that I have compassion.”

I was actually moved by his simple requests. A man, dying of cancer, who has had problems sleeping, problems with pain and anxiety, a man who has struggled with things he’s not been proud of in his life.  The two things he wants most are strength and compassion.

When I had word that Mr. J was drunk and emotional, my own prejudices imagined he’d either be riled up,  flirtatious or weeping with self-pity.  I was shocked to find his emotionality was appropriate.  He’s doing the work people are supposed to do, as they get ready for death.  In fact, Mr. J, with his cigarettes and alcohol, his stab wound scars and tattoos, was doing a better job coping than many of my other patients.  More surprising to me than even the work he was doing on death, was that he’s been able to move beyond ego centrism.  When he asks for compassion, he’s thinking about others, and how he acts towards others.  Death and disease are often so inward, focused solely on self and how to feel better, that I rarely find people wanting to improve themselves for the sake of others.

I had to think, when was the last time I asked for compassion?