Through the Valley of the Shadow of Death

The Valley of the Shadow of Death by Frederic Edwin Church — **The Valley of the Shadow of Death** by Frederic Edwin Church

““I declare I hold [physicians] to be true heroes, when I regard their hard existence, their pure pathetic lives; when I recall their cheerfulness and manliness; when I see them, generously forgetful of self, answering every call with alacrity; when I think of the warm heart that beats so steadfastly under the fuzzy damp coat; when I know that the lantern that guides them in a dark night to the house of distress is but like their own calm purpose and resolve shining forth to guide and comfort others.”

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— –Dr. Jacob Mendes Da Costa, The Higher Professional Life: Valedictory Address to the Graduating Class of Jefferson Medical College, 1883.

There are certain individuals that people put immense trust in during their lives. Whether it’s a sprained ankle or life and death hanging in the balance, doctors are those people that are relied on for health. Even before the Hippocratic oath was first taken over 2000 years ago, people were trusting doctors with their lives and doctors have been serving their patients health needs ever since. It seems appropriate to recognize the efforts and personal sacrifices of those who treated Ulysses S. Grant during his final illness on this National Doctors Day.

When Grant first noticed a stinging throat pain in June of 1884 he was at his summer home in Long Branch, NJ. Grant’s neighbor and friend George Childs asked Dr. Jacob M. Da Costa, who was visiting Childs at the time, to examine the General’s throat. Da Costa seeing the seriousness of the condition advised Grant to consult his regular physician as soon as possible but Grant could not as his physician Dr. Fordyce Barker was in Europe at the time. Grant, preoccupied at the time with his writing, did ask Childs a few times if Dr. Da Costa was available or if he would accompany him to Philadelphia to find out more about the condition but another consultation never occurred.

Jacob Mendes Da Costa was born in 1833 on the Caribbean island of St. Thomas and received his early education in Europe. His family later settled in Philadelphia where he would graduate Jefferson Medical College in 1852 and then both practice and teach medicine there. During the Civil War Da Costa served as a surgeon in Philadelphia’s military hospitals treating and studying hundreds of patients. It would be this experience that would lead to his work on the heart condition known as “Da Costa’s Syndrome” or “soldiers heart.” He continued his career as a respected physician and instructor, publishing numerous medical works before his death in 1900 of heart failure.

After a summer of intermittent pain, the Grant family moved back to their New York City home for the winter. On October 22 Grant went to see Dr. Barker who immediately referred his patient to the premiere throat specialist Dr. John H. Douglas. Grant visited Dr. Douglas and after an examination asked the doctor plainly “Is it cancer?” Douglas, who knew how important it was to retain the trust of a patient, replied “General the disease is serious, epithelial in character” but added a ray of hope stating it was “sometimes capable of being cured.” Grant would return to Dr. Douglas’ office for treatments until February of 1885 when Grant’s deteriorating condition forced the physician to treat him at his home.

Benjamin Fordyce Barker was born in Maine in 1818. Barker’s father was a physician and the son followed the same career graduating from Bowdoin College in 1841. Eventually moving to New York City by the 1850’s Barker would make annual trips to Europe for the rest of his life for learning and lecturing. Throughout his career, he published medical works, held positions in medical societies, was awarded multiple honorary degrees and helped establish the use of the hypodermic syringe in America. Barker would pass away from a cerebral hemorrhage in 1891.

A formal consultation between physicians on Grant’s condition would take place on February 19, 1885. A biopsy by Dr. George B. Elliot confirmed the cancer diagnosis and it was determined a fatal case. The doctors present were Dr. Barker along with Doctors Henry B. Sands and Thomas M. Markoe, who had served as a surgeon during the Civil War. They discussed the situation and concluded that Grant’s case was beyond surgery. All that was left was to keep the patient as comfortable as possible during his final months.

John Hancock Douglas was born in Waterford, NY in 1824. After graduating with a Doctor of Medicine degree from the University of Pennsylvania in 1847 he studied in Europe for a couple of years. Returning to the United States Douglas eventually settled in New York City. During the Civil War Douglas was appointed Associate Secretary of the United States Sanitary Commission and in that capacity would meet General Grant. After being Grant’s lead physician for nine months, Douglas’ health and his medical practice in New York suffered greatly. Douglas's decline in health and finances ended with his death in 1892. He truly gave all that he had to care for another in need. The book General Grant’s Last Stand would be written using Douglas’s diary.

Henry Berton Sands was born in New York City in 1830. After graduating from the College of Physicians and Surgeons in 1854, Sands studied abroad and became a preeminent surgeon in New York City. He was involved in numerous medical societies, had multiple degrees and was said to have the largest consulting surgical practice in New York City before his death in 1888.

In early March, Dr. George F. Shrady would be added to the medical team for the General. Shrady became a close friend and confidant to Grant in his final months drawing forth Grant’s sense of humor to help distract from his physical struggle. After Grant survived a near-death choking episode on March 30th Dr. Douglas reassured him of his commitment by using Grant’s phrase “General, we propose to keep to this line if it takes all summer.”

George Frederick Shrady Sr. was born in New York City in 1830. He graduated a Doctor of Medicine from the College of Physicians and Surgeons in 1858 and began his practice in New York City. During the Civil War Shrady was an Assistant Surgeon in the Army working at both hospitals in New York City and at the warfront. Dr. Shrady became a revered surgeon and contributed to such famous cases as President Garfield and Emperor Frederick III and attended the first criminal execution by electrocution. He was active in numerous medical societies, received honorary degrees, did extensive editorial work and advocated for the advancement of medical instruction and licensing. Shrady would author General Grant’s Last Days and Shrady’s son Henry would design and build the Grant Memorial on the National Mall in Washington D.C.

In March the doctors who had up to that time been reticent to give out the condition of their patient to the press were forced by circumstances to start giving updates to the reporters. The physicians were wary of the public scrutiny of their work and wanted to issue clear and accurate bulletins, especially after the controversy over President Garfield’s death a few years earlier. The bulletins were designed to counteract the misinformation being published and to feed the appetite of a concerned public while maintaining the trust of their patient. Even the bulletins did not end the misinformation though and the press began to question the care Grant was receiving. Grant responded by defending his physicians, “I… have… faith in the four doctors attending me… they are all distinguished in their profession.”

Dr. Barker would leave the medical team in May to make his annual pilgrimage to Europe. Grant remarked to his physician “I suppose you never expect to see me again.” To which Barker replied, “I hope I may.” The patient reading through the lines then said “You do not say ‘expect’ but ‘hope.’” Grant’s medical team now consisted of Dr’s Douglas, Shrady and Sands.

After some characteristic ups and downs in his disease by May, the doctors agreed their patient needed to be removed to a better climate for the summer. A seasonal cottage on Mt. McGregor near Saratoga Springs, NY was chosen for its coolness and pure dry air.

After arriving at Mt. McGregor on June 16, 1885 Grant, his voice failing, gave Dr. Douglas a note. Grant had always been straightforward and honest with his physicians throughout his illness and they, in turn, held nothing back from their patient.

“Since coming to this beautiful climate and getting a rest of about ten hours, I have watched my pains and compared them with the last few weeks. I can feel plainly that my system is preparing for dissolution… There cannot be a hope of going far beyond this time. All any physician, or any number of them can do for me now is to make my burden of pain as light as possible. I do not want any physician but yourself but I tell you so that if you are unwilling to have me go without consultation with other professional men, you can send for them. I dread them however, knowing that it means another desperate effort to save me, and more suffering.”

Grant’s internal resolve impressed his doctors but he did have moments where hopelessness overcame him. It was at these times that the doctors had to treat not just the physical man, but the psychological man as best they could. Dr. Shrady was a favorite of Grant’s due to his great bedside manner. He would hold conversations on non-medical topics and trade jokes with his patient, giving him crucial distraction from his condition. Dr. Shrady recalled an amusing note given to him by Grant “I said if you wanted anything larger in the way of a spatula [tongue depressor] I saw a man behind the house here a few days ago filling a ditch with a hoe, and I think it can be borrowed.” Grant became so close with Dr. Shrady that he checked with him to ensure the doctor could reach the mountain to be with him when the final moments came.

Grant was the ideal patient but he was torn between two extremes. He desperately wanted the time to finish his book, but he also wanted a speedier end to the suffering if there was to be no recovery. He expressed both positions at various moments during his illness. He confided to George Childs:

“I have been twice within half a minute of death. I realize it fully, and my life was only preserved by the skill and attention of my physicians. I have told them the next time to let me go."

In the end, despite the prolonged pain and agony Grant appreciated the care he received from his doctors writing to Dr. Douglas:

“I will be the happiest the most pain I can avoid… I would say therefore to you and your colleagues to make me as comfortable as you can. If it is within God’s providence that I should go now I am ready to obey His call without a murmur. I should prefer going now to enduring my present suffering for a single day without hope of recovery… I am thankful for the providential extension of my time to enable me to continue my work… to hear the kind expressions towards me in person from all parts of our country… They have brought a joy to my heart if they have not effected a cure. To you and your colleagues, I acknowledge my indebtedness for having brought me through the “valley of the shadow of death” to enable me to witness these things.”

After enduring months of tortuous pain the rapidly failing patient wrote on July 16th to Dr. Douglas that his final task was now done:

“My life is precious of course to my family and would be to me if I could recover entirely. There never was one more willing to go than I am… There is nothing more I should do to [the book] now, and therefore I am not likely to be more ready to go than at this moment.”

Grant died a week later surrounded by his faithful physicians having formed a powerful bond with them they would remember the rest of their lives. Grant in his openness as a patient had given his physicians valuable information in treating his disease while they had given him the support he needed to soldier on. Dr. Douglas soon after wrote to his sister describing the exhausting efforts he put into caring for his patient and the admiration he developed for Grant:

“This is the first day I have felt able to write for a long time. I have had a long and trying time and was on the edge of an abrupt break when the death of my patient ended my vigils. It is three full months since I had a continuous night's sleep. My head was dizzy and my step very faltering. My work is ended and I have now only to follow to the grave the man I loved and for whom I have devoted my life these many months. I could not cure him but I could by close and continuous care alleviate his sufferings and possibly prolong his life. That I think I have done. I am contented I go from here on Tuesday with all that remains of my patient and my friend and expect to keep close to him until he is deposited in his tomb. Nine months of close attention to him have only endeared him to me I have learned to know him as few only can know him. The world can know him as a great general as a successful politician but I know him as a patient self-sacrificing gentle quiet uncomplaining sufferer looking death calmly in the face and counting almost the hours he had to live and those hours were studied by him that he might contribute something of benefit to some other fellow sufferer. If he was great in his life he was even greater in his death. Not a murmur not a moan nor a sigh from first to last. He died as he had lived a true man.”

It seems too easy a thing to take a doctors care for granted. Though they are paid for their services, there is a deep commitment shared by most in the profession that transcends monetary profit. An inner desire to aid their fellow human regardless of their own safety. It is this selfless service that provided a dying man not only with critical time to complete a final task but comfort and care and a dignified passing. In the end, for most, it will be a doctor who will take the lead role in helping them pass through the valley of the shadow of death.