The Last Mile
Why is the last mile the hardest mile?
My throat was dry, with the sun in my eyes
And I realised, I realised
I could never
I could never, never, never, go back home again.
“Is It Really So Strange?” The Smiths, 1988
It’s funny how certain song lyrics get stuck in one’s head - I can still recall how many times in college I dashed over to the stereo to turn it off when the first strains of “Feelings” oozed through the speakers like an alien plot to turn all of us into lovesick basset hounds. Now, after decades of downloading tunes both sublime and nauseating into my own personal I-Pod-like noggin I have dozens of song lyrics available for any medical situation that requires muscial inspiration. I’m sure most doctors share the same ability; for example, when working with critically ill heart attack victims in the CCU I used to hum U2’s classic song “Sunday Bloody Sunday“:
And it’s true we are immune
When fact is fiction and TV reality,
And today the millions cry,
We eat and drink and tomorrow they die.
Rather cynical, I might add, but can you blame us when we were young interns working 50 hour shifts?
Now as an oncologist I find myself replaying more poignant ditties, with lyrics that create less gruesome images. This comes with maturity, you know. Lately I have been turning this particular line from The Smiths over and over in my mind, examining it as closely as if it were one of the Amarna letters.
Why is the last mile the hardest mile?
The lyric should have meaning for physicians, who see patients every day struggling to overcome illness, injury or a difficult operation. Patients often become discouraged with their lack of progress and it is up to their doctors to convince them that the finish line is nearer than they think, to cheer them on through the final mile of their journey toward recovery. Their reward is so close, if only they can hang on for a little while longer. Think of the marathon runner who approaches the final stretch, and how wonderful it will be when the race is over.
It is not quite as wonderful in the field of cancer medicine, as many of my patients will never return to good health. What then becomes of those who slowly walk mile after mile, not toward recovery, but toward the end of life?
Why is the last mile the hardest mile?
The end of life shouldn’t be that hard. Using appropriate palliative care we can alleviate many of the symptoms cancer patients might experience during the final leg of their journey, so that their time remaining is as free from suffering as possible. Often they simply drift off to sleep at the end, at which time their pain and nausea are things of the past. As professional or family caregivers we do everything we can to ensure that patients afflicted with terminal illnesses end their life with peace and dignity. We are not just successful in performing this task - we are masters at it. We have to be; the alternative is too horrific to imagine. So what does the phrase actually mean then? The reader may have already surmised the answer, but let me share it anyway. Listen:
“Why is the last mile the hardest mile, when we work so hard at helping those who are dying remain comfortable?”
“The last mile is not the hardest mile for the patient. It is the hardest mile for you, because once the one you care for can go no further, you carry this person upon your back to the end.”
