Fear of Dying Alone

David Green memorialby Danielle Ofri
New York Times

What if a patient dies and nobody is there to mourn? Is it like a tree falling soundlessly in the forest?

These are the questions that tormented me after the death of my patient Edward Isaac. Mr. Isaac was a drifter — estranged from his wife and children even before his prison term and his years-long effort to rid himself of drugs. He died at a hospital I’m not affiliated with, and by the time a social worker tracked me down via his pill bottles, he had been buried with other unclaimed New Yorkers in Potter’s field.

The social worker berated me over the phone for not having documented any next-of-kin, and I was chastened by guilt and grief. But Mr. Isaac had never spoken of friends or family, plus every visit was taken up with his spiraling diabetes, hypertension, hepatitis and kidney failure.

In the six years since Mr. Isaac died, I have become obsessive about next-of-kin, documenting consent from every single patient to call spouses, children, siblings, friends, colleagues if needed, insisting on home phone and cellphone numbers for each. More than once, I have been told it was overkill.

And then, on a Saturday night this past February, a 78-year-old patient of mine who lived alone experienced chest pains. He called 911, but just as the paramedics arrive he collapsed in the doorway. He was whisked, unconscious, to the hospital in the throes of cardiac arrest, without any I.D., and was promptly admitted to the I.C.U. as “unknown white male.”

His name was finally pieced together from the original 911 call: David Greene. When the team hunted through the electronic medical record system, they were relieved to see that he had been a patient at our hospital. Otherwise, his case might have to be referred to the Missing Persons division of the police department. In the middle of the night, after the tumultuous hours spent stabilizing Mr. Greene, they stumbled upon a medical history I had taken three years earlier. There they were — a gift, really, from Edward Isaac — two phone numbers.

Like Mr. Isaac, Mr. Greene was a bit of a solo traveler. A Texan blues singer who had meandered his way from Abilene to Manhattan, he lived alone and had no children. I met him when he was 75, after he suffered a major heart attack that forced him to visit a doctor for the first time in decades. I found him in the waiting room that day, wearing beat-up jeans, aged cowboy boots and brown-tinted sunglasses, reading “A Portrait of the Artist as a Young Man.” Cheerfully sunburned, amiably grouchy, with smooth, still blond hair in a ponytail and harmonica in pocket, he moseyed reluctantly into my office.

Mr. Greene seemed genially unconcerned with the practical concerns of life — phone bills, medications, rent checks, driver’s license — though an ornery streak crackled to life when discussing the evils of corporate capitalism. A few novels were percolating under his bed, he told me, but he wouldn’t dream of submitting them to the publishing-house autocrats. He had a slight “unraveled at the edges” look about him, and freely admitted that his apartment was a hovel. Though his heart had taken a severe hit, he was talking about a jazz festival in Michigan and a trek to Kathmandu.

I have to admit I was surprised when he said that used to write ad copy for Pfizer pharmaceuticals. “I helped launch Lipitor,” he told me in his dry Texan accent, both of us acknowledging the irony as I wrote out the very same prescription for him. I couldn’t quite figure out how someone who had worked on one of the most successful medication launches in history was … well, I couldn’t quite figure out what Mr. Greene was, but I worried that he might be a loner. Maybe not quite as isolated as Mr. Isaac, but concerning enough that I was careful to document emergency phone numbers for his only nearby relative — a niece in the Bronx — and a close friend in Rhode Island.

Meredith — the niece whose number I had scribbled in between Abilene, Pfizer, and Kathmandu — was alerted by a phone call in the middle of the night, as was his friend Monica — and they were at the hospital the next day. Mr. Greene never regained consciousness, and it became clear that he would not survive. But Meredith and Monica could be there to hold his hands when he died peacefully, two days later.

When I heard what had happened, I had chills down my spine. Had Mr. Isaac’s tragic death not prompted me to write down those phone numbers the first day I had met Mr. Greene, he might have died alone, his relatives and friends unaware until after the fact. Mr. Greene was the type of guy who insisted on his own kinetic pace, whose phone was intermittently out of service, who didn’t bother owning or carrying any official I.D. after his Texas driver’s license expired a decade or so ago, so it could have taken some time before his absence was noticed. I closed my eyes at the disturbing thought. All these years I had been dutifully adding in names and phone numbers to the chart in memory of Mr. Isaac — now it had finally served its purpose.

The memorial service was held the following month, at an Irish pub on Sixth Avenue. I had missed being there for Edward Isaac; I wasn’t going to let it happen for David Greene.

I had never been to a memorial service at a bar, but the place was just loosening up at midday when I arrived. Drums, amps, guitars, harmonicas, keyboards and bass were crackling to life. Pints of Guinness stout circulated. Mr. Greene’s cowboy boots sat at the head table next to his sunglasses, cowboy hat, and favorite Chet Baker T-shirt. The jamming went on all afternoon.

As physicians, we get only a tiny window into our patients’ lives. Even when we make an extra effort, it is still hardly a glimpse. It was only as I sat at this pub, steeped in his life, friends and stories, that I got any sense of how richly textured his life was.

David Michael Greene — known to everyone as Mike — kept a “Daily Growler” blog where he ranted against the “ignorant, Confederate-minded, backward-thinking numbskulls” in our chambers of Congress. His creative energy sizzled to life at night and he often wrote, composed and blogged to the wee hours of the morning. I learned that his grandmother and brother were prominent in the Texas literary scene. He lost his parents at 25; their car crashed just after they visited him in New Orleans. His jazz and blues musicianship was respected far and wide, but he was also a keen student of the compositions of Charles Ives. A Texan to the core, he nevertheless grafted seamlessly into the gritty New York music scene. And he was a beloved and cantankerous “Uncle Kitty” to Meredith’s young children, since their grandparents were no longer alive.

Mr. Greene was not quite the loner that Mr. Isaac was, not the loner I had feared might die bereft of human contact. Though he certainly marched to his own drummer, he had quite the ensemble stretched out behind him to trade fours with.

I was never able to track down any relatives of Edward Isaac, despite months of effort. Nobody was there at his bedside or his graveside — perhaps no one who knew him has ever learned that he died. But Mr. Isaac, a Rikers ex-con, an ex-addict drifter from the South Bronx, bequeathed a gift to a craggy bluesman from Texas. When David Michael Greene died, he wasn’t left to play solo.  (from the New York Times)