To choose what is difficult all one's days, as if it were easy, that is faith. -W. H. Auden
"They want to operate on your grandmother."
Dad was shook. I shuddered. This was one of those dreaded moments when my family looked to me for medical advice.
“What should we do? What should I tell them?” I was still in training. I tried as best I could to think objectively.
“Who wants to operate?” I asked.
“What did they tell you?” My dad had received a phone call. My grandmother was in her 90s and confined to a healthcare facility six hundred miles away. For years, she had adamantly insisted that her boys never put her in “one of those places.” However, after a rapid deterioration in mental and physical status, she had passively allowed herself to be moved to the local nursing home. For two years, she had shared a room with a woman who had spent her entire life on a neighboring farm. Although they had known each other for decades, my grandmother no longer recognized her old friend.
“What surgery are they suggesting?” I asked.
“Her foot is turning black. They say she needs an amputation soon.”
We had visited the family farm just a few months before. When we spent time at the nursing home, my grandmother had not recognized us even once. She had smiled pleasantly when we spoke to her but the vigorous farmer’s wife of the past had long since faded away. This remarkable woman who had weathered the Great Depression saving pennies, selling eggs, worrying about rain, raising cattle, and butchering chickens no longer knew who anyone was. Her eyes were empty.
“Why do they want to operate? Will it make her better?”
“No. They said the foot is getting infected. They said surgery might help her live longer.”
Dad and I talked about our visits to the farm. In my memory, I could taste the home-cooked meals around the kitchen table, gaze at the sunsets from the front porch, smell the fresh-plowed Ozark soil, and feel the clean sheets of the upstairs bedroom. I could hear the boards creak beneath my feet and touch the bare plaster as I climbed the stairs.
“I don’t think surgery will make her feel better, Dad.” There was a long pause.
“Could you talk to the doctor?” “Sure.” A few minutes later, as I hung up the phone after talking to my grandmother’s physician, I felt an unfamiliar heaviness in my chest. To this day, that heaviness returns whenever one of my patients presents me with a choice that I would rather not have to make.