Easing the final journey

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HE STRUGGLED for each breath as he lay in the hospital bed. The sound of his breathing was harsh, bubbling, and interrupted by an agonizing cough. His eyes met mine as I entered the room. “I don't think I can do this much longer,” he muttered, closing his eyes.
His breathing stopped for what seemed like an hour, although I know it was only seconds; I realize I'm not breathing either. He takes a quivering breath and the process starts all over again. My patient, Mr. W, has end-stage chronic obstructive pulmonary disease. After a lifetime of working in the coal mines of Virginia and smoking cigarettes, his lungs were giving out.
Mr. W is 68 but looks years older. His skin is gray-blue, nearly matching the color of his eyes. When he smiles, he reminds me of my dad. It's 1973, and not much can be done for him short of a lung transplant. Hospice and palliative care programs aren't yet prevalent at this time in history. He doesn't want heroic measures to be taken, including endotracheal intubation or mechanical ventilation, yet something is holding him back. He fights for each breath, holding on for some unrealized event that will provide him with release. When he looks at me, a single tear rolls down his cheek, and I find that tears are welling up in my eyes, too.
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