*All descriptors of this patient interaction have been changed to protect their identity*
When I met Mrs. J we instantly bonded over our sarcastic sense of humor and common heritage. Knowing a few words in her mother-tongue language solidified that doctor-patient relationship almost instantly. Having had a healthcare background herself, she knew all too well what was happening with her breast cancer. She tread that fine line between staying optimistic in the face of dying vs denial. And it didn't help that her husband believed she could still be cured despite CT scan after CT scan showing tumors spreading throughout her body, like lights on a macabre Christmas tree.
Mrs. J had a lot of pain from her metastases that made it hard for her to sit, eat, and drink. Having previously worked as a head nurse, this immense loss of independence troubled her greatly. She had gone from being in charge to needing a two person assist to use the washroom. After several days of following her on another floor I felt it was time for her to be transferred under palliative care.
-------------------------------------------------------
When I went to see her in her room, there were yellow flowers at the bedside. The half eaten remains of her pureed food sat on the tray table to the left of her hospital bed. She sat up and smiled at me. She always found a way of smiling. I asked how she was feeling, how her pain was, and if there was anything she needed that day. With heartbroken acceptance, she opened up woefully about her pain and everything she had lost. She told me everything. Everything but the elephant in the room, the question that has been plaguing her since she was diagnosed. "What will happen next? How will I die?". No words were needed to express what was on her mind, I just knew. I sat with her and we held that fear together.
Apart from adjusting her pain medication, she asked if I could do something for the diarrhea she had been having. When I examined her abdomen, I could feel the rock hard tumor that lay beneath, notably bigger than two weeks ago. I told her I would do what I can and that we might run a few tests. With the guidance of my staff, we adjusted her medication, ordered basic blood work and a CT scan. "To follow up tomorrow" I jotted down on my to do list.
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"How are you feeling today Mrs. J?"
"Oh I feel good, so much better. Whatever you did with my medication has really helped. This is the first day that I am pain free and my appetite is good too!"
She went to hold my hand and I hesitated, blushing with embarrassment. Breakfast was a long way away and my hands were ice cold. Exactly the kind of hands you don't want your doctor to have. She took them none the less and exclaimed:
"My goodness are you alright?!?! Why are your hands so cold??"
I reassured her that I was fine but she insisted that I sit down so she could warm them up. I sat at the edge of her bed and she slowly eased herself towards me. Her grip was firm but gentle. She warmed my hands between hers, her hospital bracelet every so often tickling my wrists. When she was satisfied, she let my hands go and went on to talk about how she used to do the same for her kids. We exchanged a few laughs and I let her know that I would be back later to check on her. As she waved goodbye, she gave me the brightest smile I had seen in nearly two weeks.
-------------------------------------------------------
As I sat at the computer going through my to-do list, I noticed that the results for Mrs. J's CT scan were back. I opened the labs first and they were abysmal. I was surprised she was even conscious with lab results like that. Next I opened the CT results - and just as we had suspected - a bowel obstruction. The tumor had now invaded her bowels. The obstruction was only partial for now which explained why she was having diarrhea. This is something known as overflow incontinence - where not yet fully formed stool passes around the obstruction. But eventually this obstruction would be complete, resulting in intractable vomiting and ultimately palliative sedation during her final days. It broke my heart to know what this sweet, courageous woman might have this in her future. She had survived war, raised a family against all odds, and started her own business. How could I possibly maintain this person's dignity with what lay ahead. In that moment I decided that for as long as I could, I would always make her smile.
My staff and I discussed our approach to management and he got up to go explain to the patient the next steps in her care. I stopped him: "Please, let's not give the results today. She finally feels good. Let her have today". When I went back to check on her she was in her chair enjoying her evening soup. She asked about the test results and I lied, saying that they weren't in yet. She didn't care, she felt good and hummed to herself gleefully between spoonfuls.
-------------------------------------------------------
She had grown substantially weaker and now spent most of the day lying in bed sleeping. She sipped some juice from time to time, but no longer had the energy to sit in her chair and eat meals.
"Mrs J? Good morning, sorry to wake you. I just wanted to see how you were doing."
She gently opened her eyes and looked at me. She shrugged her shoulders.
"Any pain? " She shook her head no.
"Any appetite?" She shook her head no.
"Anything else bothering you?" She shook her head no.
"Ok well I'll let you get back to sleep" I took her hand. She held mine gently, nodded, smiled at me and said "Thank you"
She was already asleep again before I left the room.
-----------------------------------------------------
"Mrs J? Hi, how are you?"
She weakly opened her eyes and held my hand. From her chart I read that she has not eaten in several days, only a few sips of juice here and there. I sat at the edge of the bed and asked the same questions I did each day.
"Mrs.J remember yesterday I told you that today would be my last day?"
She let out a deep sigh and squeezed my hand tightly. I squeezed her hand back and said:
"You are such a strong, wonderful woman. You have done so many great things in your life and you should be proud of that. It was a pleasure to meet you, and I wish you all the peace and comfort you deserve."
She gazed up at me, her eyes filled with tears and she softly whispered "Thank you, thank you for everything". I sat in silence smiling at her, holding her hand for several minutes until I had to leave to go check on another patient. Neither of us wanted to let go but we both sorrowfully accepted that this would be the last time we would see each other. I walked slowly out of the room, her hand lay at the edge of the bed exactly where I left it.
------------------------------------------------
It has been several weeks since I last saw her. I haven't found her obituary but I suspect that she must have passed away by now. I don't know when or how it may have happened, but I hope she suffered no pain. I feel a sense gratitude for having had the privilege to play my part in her dying process. Every so often when a crisp breeze rolls by and my hands grow cold, the thought of her passes briefly through my mind. Her smile and her strong grip still as vivid as the yellow flowers she kept at her bedside.
When I met Mrs. J we instantly bonded over our sarcastic sense of humor and common heritage. Knowing a few words in her mother-tongue language solidified that doctor-patient relationship almost instantly. Having had a healthcare background herself, she knew all too well what was happening with her breast cancer. She tread that fine line between staying optimistic in the face of dying vs denial. And it didn't help that her husband believed she could still be cured despite CT scan after CT scan showing tumors spreading throughout her body, like lights on a macabre Christmas tree.
Mrs. J had a lot of pain from her metastases that made it hard for her to sit, eat, and drink. Having previously worked as a head nurse, this immense loss of independence troubled her greatly. She had gone from being in charge to needing a two person assist to use the washroom. After several days of following her on another floor I felt it was time for her to be transferred under palliative care.
-------------------------------------------------------
When I went to see her in her room, there were yellow flowers at the bedside. The half eaten remains of her pureed food sat on the tray table to the left of her hospital bed. She sat up and smiled at me. She always found a way of smiling. I asked how she was feeling, how her pain was, and if there was anything she needed that day. With heartbroken acceptance, she opened up woefully about her pain and everything she had lost. She told me everything. Everything but the elephant in the room, the question that has been plaguing her since she was diagnosed. "What will happen next? How will I die?". No words were needed to express what was on her mind, I just knew. I sat with her and we held that fear together.
Apart from adjusting her pain medication, she asked if I could do something for the diarrhea she had been having. When I examined her abdomen, I could feel the rock hard tumor that lay beneath, notably bigger than two weeks ago. I told her I would do what I can and that we might run a few tests. With the guidance of my staff, we adjusted her medication, ordered basic blood work and a CT scan. "To follow up tomorrow" I jotted down on my to do list.
--------------------------------------------------------
"How are you feeling today Mrs. J?"
"Oh I feel good, so much better. Whatever you did with my medication has really helped. This is the first day that I am pain free and my appetite is good too!"
She went to hold my hand and I hesitated, blushing with embarrassment. Breakfast was a long way away and my hands were ice cold. Exactly the kind of hands you don't want your doctor to have. She took them none the less and exclaimed:
"My goodness are you alright?!?! Why are your hands so cold??"
I reassured her that I was fine but she insisted that I sit down so she could warm them up. I sat at the edge of her bed and she slowly eased herself towards me. Her grip was firm but gentle. She warmed my hands between hers, her hospital bracelet every so often tickling my wrists. When she was satisfied, she let my hands go and went on to talk about how she used to do the same for her kids. We exchanged a few laughs and I let her know that I would be back later to check on her. As she waved goodbye, she gave me the brightest smile I had seen in nearly two weeks.
-------------------------------------------------------
As I sat at the computer going through my to-do list, I noticed that the results for Mrs. J's CT scan were back. I opened the labs first and they were abysmal. I was surprised she was even conscious with lab results like that. Next I opened the CT results - and just as we had suspected - a bowel obstruction. The tumor had now invaded her bowels. The obstruction was only partial for now which explained why she was having diarrhea. This is something known as overflow incontinence - where not yet fully formed stool passes around the obstruction. But eventually this obstruction would be complete, resulting in intractable vomiting and ultimately palliative sedation during her final days. It broke my heart to know what this sweet, courageous woman might have this in her future. She had survived war, raised a family against all odds, and started her own business. How could I possibly maintain this person's dignity with what lay ahead. In that moment I decided that for as long as I could, I would always make her smile.
My staff and I discussed our approach to management and he got up to go explain to the patient the next steps in her care. I stopped him: "Please, let's not give the results today. She finally feels good. Let her have today". When I went back to check on her she was in her chair enjoying her evening soup. She asked about the test results and I lied, saying that they weren't in yet. She didn't care, she felt good and hummed to herself gleefully between spoonfuls.
-------------------------------------------------------
She had grown substantially weaker and now spent most of the day lying in bed sleeping. She sipped some juice from time to time, but no longer had the energy to sit in her chair and eat meals.
"Mrs J? Good morning, sorry to wake you. I just wanted to see how you were doing."
She gently opened her eyes and looked at me. She shrugged her shoulders.
"Any pain? " She shook her head no.
"Any appetite?" She shook her head no.
"Anything else bothering you?" She shook her head no.
"Ok well I'll let you get back to sleep" I took her hand. She held mine gently, nodded, smiled at me and said "Thank you"
She was already asleep again before I left the room.
-----------------------------------------------------
"Mrs J? Hi, how are you?"
She weakly opened her eyes and held my hand. From her chart I read that she has not eaten in several days, only a few sips of juice here and there. I sat at the edge of the bed and asked the same questions I did each day.
"Mrs.J remember yesterday I told you that today would be my last day?"
She let out a deep sigh and squeezed my hand tightly. I squeezed her hand back and said:
"You are such a strong, wonderful woman. You have done so many great things in your life and you should be proud of that. It was a pleasure to meet you, and I wish you all the peace and comfort you deserve."
She gazed up at me, her eyes filled with tears and she softly whispered "Thank you, thank you for everything". I sat in silence smiling at her, holding her hand for several minutes until I had to leave to go check on another patient. Neither of us wanted to let go but we both sorrowfully accepted that this would be the last time we would see each other. I walked slowly out of the room, her hand lay at the edge of the bed exactly where I left it.
------------------------------------------------
It has been several weeks since I last saw her. I haven't found her obituary but I suspect that she must have passed away by now. I don't know when or how it may have happened, but I hope she suffered no pain. I feel a sense gratitude for having had the privilege to play my part in her dying process. Every so often when a crisp breeze rolls by and my hands grow cold, the thought of her passes briefly through my mind. Her smile and her strong grip still as vivid as the yellow flowers she kept at her bedside.
