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“Where are you from?” This was the first question Ms. Sylvia asked me after we settled down in our chairs where she could hear and see me. She had functional hearing aids that had been recently updated, but due to her sensorineural hearing loss the person she was speaking with needed to sit close by, where she could read lips and hear at the same time. I informed her, “I am from Pakistan.” Then she inquired further, “From where in Pakistan?”
Often many people, including the majority of my patients, ask me about my birth country. Once I tell them the name of the country, they do not ask further questions. Occasionally, a few who know a little bit about other parts of the world will ask me about my city of origin as well. From the way Ms. Sylvia was asking me this direct question so intently and seriously, I had a gut feeling that she was taking me somewhere. So I told her, “I am from Karachi.”
Then she asked, “Do you know Karsaz Road?”
I got excited! I paused for a moment, then told her, “My grandfather built our home on Karsaz Road.” My sweet memories of growing up, teenage years and adulthood, and even going to medical school start from my home located at Karsaz Road.
She went on, “When I went to Karachi, I started driving right away. I thought ‘everyone is going crazy. Why is everyone driving on the wrong side of the road?’ Very soon before I got into an accident, I realized that I was driving on the wrong side of the road.” After this story, she told me that she had lived in Pakistan for approximately two years. In fact, that was where her youngest daughter was born, who is currently acting as her power of attorney.
Ms. Sylvia was a 92-year-old woman in assisted living. She had end-stage congestive heart failure (CHF), atrial fibrillation, hypertension, dyslipidemia, and severe gait impairment. She had been admitted to hospice services a year and a half before my visit. The staff called her noncompliant because she kept refusing her two liters per minute of oxygen, and they had asked me to emphasize to her the importance of using the oxygen because without it her oxygen saturation would drop to 84% or less.
Ms. Sylvia had also been refusing many of the other interventions requested by the team. As I sat next to her trying to listen to her empathically and understand things from her perspective, she placed her hands on my shoulders and said, “The staff wants to do a lot for me, but I am done. I don’t want oxygen even if I am short of breath.”
She said, “My husband suffered at the end of his life, and he was on oxygen. I can’t fathom that feeling. The recollection of those memories makes me feel suffocated.” She told me that she had lost her mother at a very young age, when she was only 16. She had lived with her uncle for approximately three years afterward, and he had advocated for and supported her, especially when she used to do things outside the box.
“My skin color was darker than my two siblings,” she told me. “It was olive green. Growing up, my siblings used to tease me that I was adopted since I have a darker skin color.” Ms. Sylvia sighed, paused for a moment, and then continued, “This difference of my skin color really helped me understand that actual reality is skin deep.”
She shared with me that almost everyone in her family had blonde hair and blue eyes. Despite that, her parents and family had respected and welcomed diversity, even when no one else around them appreciated it. She later married a foreign service officer in what would become the Agency for International Development (AID) in the 1950s; they had five children and traveled to at least 40 countries during her lifetime as her husband’s duties and services changed throughout his career.
Ms. Sylvia said that after traveling across the globe, what she found was that the core of diversity, equity, and inclusion (DEI) is not one’s culture, origin, race, or ethnicity (CORE) — it is the kindness and mutual respect to love and understand each other. We must understand each other as humans first before any other layers of identity are added to the person. Later, she told me that a few of her children’s spouses have a different country of origin and ethnicity, and she had embraced each one of them wholeheartedly.
Afterward, I examined Ms. Sylvia. Her heart rate was in the hundreds, her legs had +3 edema, and she had crackles in the lung bases. She told me that she would never take oxygen, even when the end of her life was imminent. She asked me to promise that I would assist her in making her comfortable when her time comes close. She told me that she was deeply satisfied, had been happy to meet me, and asked me to visit her again.
After my visit, I met the floor nurse and wrote the order to discontinue the order of oxygen and asked the staff to respect her wishes. I wrote the order of routine morphine at night because her CHF had made it difficult for her to sleep. The nursing team then kept a very close eye on her progressive symptoms after I had explained to them what to expect with her declining oxygen. Ms. Sylvia’s power of attorney, the daughter who had been born in Pakistan, respected her mom’s wishes and desired to keep her comfortable.
I was looking forward to meeting her again on my next planned visit in two weeks. However, as I expected, she passed away the same weekend I saw her.
Ms. Sylvia taught me so much in such a short time. Her unique abilities to show her vulnerability, accept anyone despite their appearances, embrace diversity, accept various ethnic backgrounds into her own family, and never-ending urge to learn new things with an open heart made her distinct and unforgettable. Many called her strong willed, but I called her a wise person!
Ms. Sylvia’s next-of-kin reviewed a draft of this article and gave permission to print.