Thread by @TheRealDoctorT

(Names and details changed.)

When he was in his 20s, Joe fought in the Battle of Okinawa, during World War 2.

Before he left for the war, he proposed to his high school sweetheart, Lisa.

She said yes.

Then she waited for him to return.

Theirs was an uncertain future. 1/

The elderly couple sitting before me has been married longer than I’ve been alive.

Joe and Lisa.

He is in his late 80s, she’s a few years younger.

I’m a nephrology fellow, in training. It’s the late 2000s.

The world is in an uncertain place, economies collapsing. 2/

Joe is the patient, but Lisa always accompanies him.

There is a soothing rhythm to their pace, their speech. I look forward to seeing them.

Joe is a man of few words. Lisa is a little more talkative, but not by much.

Mostly they seem content to listen, and to be together. 3/

Joe’s kidneys are failing.

I have done everything I can, everything I know, to slow the progression.

It hasn’t worked.

He’s not a transplant candidate for a number of reasons, so that leaves dialysis.

We have spoken about dialysis options.

Today’s the day he decides. 4/

Joe doesn’t look his age. He looks younger. Lisa has shown me old photos and he was remarkably handsome once.

Now, as he contemplates, I notice that square jawline, those blue-gray eyes focusing in the distance on something I can’t see.

His voice is quiet, yet firm. 5/

“Yeah... I don’t think I want to do any of that stuff. If it’s my time, it’s my time.”

He looks to me, then to Lisa.

She is looking down at her feet in her neat little red shoes. She knew in her heart what he was going to say, but words sound so very different out loud. 6/

I reassure him that it’s a perfectly reasonable decision. We have been having an ongoing discussion for months. I had a feeling which way he was leaning.

End-of-life care is woven into the fabric of nephrology.

Death is no stranger here, neither feared nor hated. 7/

As I speak, I observe the most subtle gesture.

Joe takes Lisa’s hand in his.

For a man as closed off to the world as Joe, I understand the depth of the love I’m witnessing.

“How long do we have?” Lisa asks the question, as she looks up at Joe, and then to me. 8/

As I give her the rough estimate (possibly months, perhaps less), it occurs to me how strange the paths of our lives are.

The day I was born, Joe and Lisa were living their lives somewhere in the world, unaware of my existence.

Now, decades later, here we are. 9/

Other people have to talk to them now. My attending. People from the palliative care team, hospice.

My journey with them is coming to an end.

“I reckon this is goodbye.” Joe says.

“Thank you.” Says Lisa.

I feel a lump in my throat.

I’m not sure what to say. 10/

I mumble something about it being a privilege or an honor, and shake their hands awkwardly.

I feel impossibly inexperienced.

The last time I see them, as I leave the room, they are still sitting side by side.

Lisa is saying something. Joe cracks a smile.

Holding hands. 11/

I think about what their love has survived.

The uncertainty of war, of nuclear bombs, of assassinations, of natural disasters, of diseases, of economic crises.

Now one last uncertainty left to face.

Hands clasped together, they face it.

And deep down inside, I feel reassured.