For Dr.

Sandy Buchman,
a good deathamong
family, the past put to rest,
comfort and acceptance
close at handis something
to strive for

death
By Susan Bourette

P H O T O S : b e n m a r k ho l z b e r g

Its mid-May and Dr. Sandy Buchman sits at

the foot of Lilys* oversized chair in her living

room. His pale blue eyes stare at her over
silver-rimmed glasses. He is that rarest miracle of modern medicine: a doctor who makes
house calls, lots of them, to patients like Lily.
But most of Buchmans patients arent longterm. He didnt know Lily before she was
diagnosed with metastasized lung cancer that
had spread to her bones, before radiation and
*Names have been changed.

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the chemotherapy that caused her

hair to fall out. He never met the successful seamstress with her own businessonly the 56-year-old woman
dying of cancer.
But now, in the course of little
more than a year, theres little about
Lily that Buchman doesnt know.
Are you eating? he asks, just as he
does every week.
Yes, Lily replies, looking out the
window of her two-bedroom condominium in an area on Torontos city
limits.
Hows the pain?
Better, she says, grimacing reflexively as she reaches for the morphine
pump strapped to her hip. Buchman
updates her medical records on a
minicomputer the size of a paperback.
A moment later, the clicking of the
computer keys is interrupted by a
muffled sob. Lily is cupping a hand
over her mouth. Tears slide down her
steroid-swollen cheeks.
Buchman waits.
Im so embarrassed, she says
finally, wiping a hand across the side
of her face. I just dont understand
my son. He yells at me, even though
he knows my condition. Sometimes
I feel like he understands. Sometimes I feel like he doesnt understand at all.
Buchman listens as Lily fills in the
details of whats happened since his
last visit. The fights. The angry si
lences. For months, Buchman has
been trying to heal a rift between Lily
and her 19-year-old son, John.* Johns
father came to Canada to pursue a
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Ph.D. in the late 1980s, but returned

to China when John was just three
years old, abandoning him and Lily.
How can we expect him to understand? Hes still a kid, says Buchman.
We have to help and support him.
Youre still the mom. You have to
guide him.
Ill talk to him. In helping him, Im
helping you, he adds.
It appears to be just the remedy
Lily needs. Her wig shifts slightly forward as she leans her head back in the
chair, calmly inhaling and exhaling as
he listens to her chest and monitors
her breathing.
I feel safe with you, Dr. Buchman,
she says, smiling wanly.
Buchmans patients are running out
of time, but he doesnt rush them. For
many, theres still so much to do. Its
not simply a matter of tying up loose
ends but of taking inventory of their
lives. It can be a painful process.
Above all else, Buchman sees himself
as a doctor who treats his dying patients pain, whatever its nature:
physical, social, even spiritual.
After a few more routine tests, he
schedules his visit to Lily for the following week, before heading for the
door.

uchman doesnt need to consult an agenda to know the

address of the patient hell
see nextor the one after
that. Over the course of weeks, and
sometimes months, he memorizes the
routine and his route.
An 88-year-old Russian immigrant
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with heart problems. An elderly Jewish

woman who has no idea what is making her illand doesnt care to know.
A 30-year-old Russian migr, weak
from radiation treatments for ovarian
cancer.
Family members and friends might
be shaken after encounters with their
loved ones, yet Buchman maintains a
beatific calm, moving from patient to
patient, always carrying his worn

he maintains sympathy for all in his

care. He may seem like a throwback
to the Marcus Welby, M.D., era of
medicine, but his methods and practice are entirely progressive. Many
other doctors, schooled throughout
their careers to avert death at every
pass, may find his techniques mystifying. But Buchman is the vanguard of
a new, still-evolving field in medicine,
working with a small team of doctors

Dr. Buchman
stresses that for
a good death,
a relationship
of trust must
be built with
the patient and
the family.
doctors bagreceived as a gift for
his acceptance to med school in 1978.
I have seen people realize that
some of the things they are angry
about, and have fought over, are
really trivial, he says. Just as I have
seen others swearing from their
deathbeds about this one and that
one, and that they can go to hell.
Death isnt always peaceful. It can be
quite awful.
Buchman, slight of build and with
closely cropped grey hair, is inured to
the harshest realities of lifes end, yet
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out of the Temmy Latner Centre for

Palliative Care in Toronto.
Although his first career aspiration
was to be an architect, Buchman studied arts and then psychology before
applying to medical school. However,
like many doctors who finally choose
to specialize in palliative care, it was
witnessing a particularly painful and
horrible death that helped him make
the decision to focus exclusively on
dying patients.
What really gets me going, he
says, waiting behind a stream of trafreadersdigest.ca 06/10

fic on his way to the next appointment, is being able to help other
people. For me, its knowing that Ive
made an important contribution to
peoples livesboth to the people
who have passed away and to their
loved ones.
His job? Teaching patients how to
dieand their families how to live.
His ultimate goal? The good death.

hile philosophical
and religious scholars have struggled to
make sense of death
for centuries, those who see it regularly and up close have a clear vision
of the good death.
In 2006, a study published in the
Canadian Medical Association Journal
surveyed patients in palliative care

wanted was trusting relationships

with their doctors.
The essence of care is the relationship between the patient and the
physician, says Buchman. If you
dont have trust, you dont have anything.
Ten minutes later, inside a lowslung brick monastery, Buchman
greets a family member of a patient he
first met a week ago. The woman
came from Germany to spend time
with her dying sister, a nun in her 50s
who has a brain tumour and who
hasnt been fully conscious for weeks.
How long? her sister asks, standing outside the room. Two weeks,
Buchman tells her. Maybe three.
He knocks softly before pushing
open the door where his patient is
lying on her side in bed, facing the

Part of Buchmans role

is to help heal rifts
between the dying
patient and family,
as in the case of Lily
and her son, John.
about what mattered most to them at
the end of life. There was remarkable
consensus. Many said they wanted
their symptoms controlled, to be surrounded by their families and to resolve conflicts and say goodbye. But
the number one thing dying patients
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window. Her primary caregiver is another nun who has just returned from
a long-term stay in Africa. Others in
the convent, those who have lived
and shared their entire lives with the
dying nun, are unable to care for her.
They are too shaken by the thought
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of her death. Buchman sits on the

edge of the bed, gently stroking the
nuns arm, speaking quietly. He tells
her that her family is here. And that
hes here, too, to care for her. To
make certain she doesnt suffer. She
stares with wide eyes, unblinking, as
if looking for light through the walls
of the room where she will draw her
last breath.
Its sad, and I often feel sad for
people, says Buchman. But rather
than incorporating it as a kind of depression, it enhances my life. When
you see what ordinary people go
through every day, you cant help but
have a better appreciation for everything. Ive learned we dont have any
time to waste. We need to be mindful
of every moment.

ts now mid-July, two months

since the teary discussion about
Lilys relationship with her son,
and Buchman is flipping through
the pages of a report left by Lilys
home care nurse. Lily is on the other
side of the breakfast nook, starting
the rice cooker. Her son will be hungry when he gets back from classes
later this afternoon.
Navigating an apartment that appears booby-trapped for someone
dragging around an oxygen tank, she
shuffles as she makes her way to the
chair where she spends her days.
Large plastic bins stuffed with drapery material are piled, one on top of
another. Boxes of thread sit beside an
industrial sewing machineremnants
of a former life, before she got sick.
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The phone rings, and Lily greets

the woman on the other end of the
line, a former client. Oh, yes, Tanya.*
Yes, just a little bit of sickness. Ill call
you when Im better.
Theres no hint that she wont be
returning to work designing draperies
and backdrops for the film industry.
I dont want to scare them, Lily
says. People get scared by cancer.
Im not scared. Ive got cancer and I
can handle it.
There are traces of denialshe
keeps her sewing-machine clutter as
though shes going back to workbut
for Lily, mostly there is acceptance.
And in deathjust as in life
theres the inevitable paperwork.
Buchman pulls an official hospital
form from his bag and hands it to Lily.
She reads it for a long while, flipping
from one page to the next.
Remember? We talked about this,
Buchman says, finally. Its a Do Not
Resuscitate order. Buchman asks if
she should be brought back to life
when her body has given out.
What for? Lily answers matter-offactly. Just to live a few more minutes? No. Its not necessary.
Its a good decision, he tells her.

he leaves are beginning to

turn yellow outside Lilys
window. Its a Monday in
late September, and Lily
answers the door carrying a freshly
starched shirt. Shes just finished
ironing it for her son. John is receiving a special scholarship tonight to
study science at York University.
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I feel so dizzy, so sleepy, she says

as she walks in half-steps down the
hall, one hand sliding along the wall
for support. My mind is not so good
today.
The nurse had been called in to see
Lily twice over the weekend, unexpectedly. The pain has suddenly become
intolerable. Her morphine pump isnt
controlling it the way it used to. Still,
Lily doesnt want to sit. It feels better
to lean against a kitchen stool, she says.
Buchman gets straight to work,
checking her blood pressure, her
heart rate, her oxygen levels. Your
vitals are all good, he tells her. Pain
level? Sky-high: five on a scale of ten,
Lily tells him.
Im worried you are developing a
tolerance to the pain medication, he
says. The same medication will work
more effectively, he tells her, if delivered directly into the spine instead of
through the skin.
Lily closes her eyes. Shes doesnt
speak. Her arm shakes.
Lets considerate it. We need to
considerate it, he urges.
Okay, she says finally. Okay, Dr.
Buchman. I trust you. You know I
trust you.
John arrives home. The ceremony
starts soon, and hes in a rush. He
emerges from the bedroom minutes
later, dressed in a dark suit, carrying
a tie. He doesnt know how to tie it,
he announces.

Ive got three sons. I know how to

do this, Buchman tells him. In front
of the closet mirror, standing behind
John, Buchman demonstrates how a
four-in-hand knot is done. They chat
about his studies and the big evening
coming up.
Lily observes from her stool, smiling for the first time that afternoon.
His future is my future, she says,
out of her sons earshot. I want him
to be happy.
I know he loves me. He just
doesnt know how to show it. That
will be his pain when Im gone, and I
feel sorry for that. Maybe it will
change. I hope so. Im happy for the
time I can spend with him now.
Clearly, Lily and John have come
to some sort of understanding over
the past few months, says Buchman
later. Maybe its not perfect, but
there is progress.

good death isnt only about

helping patients manage
their pain but improving
the quality of their lives.
Its not the time you have left. Its
what you do with the time you have
left, says Buchman.
Clearly, its a prescription the good
doctor applies to his own life.
Shortly after this article was written,
Lily moved back to China to be with her
family. There, she passed away.

He that always gives way to others will end in having no principles of

Aesop
his own.
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