The woman, physically just a shadow of who I’m sure she used to be, looks up at me from her hospital bed and tells me about the age of her children back home, in another country. They are 4 and 2 years old, a boy and a girl, and they are being cared for by extended family while she seeks medical treatment in the US for her advanced stomach cancer. She is 41 years old, just a few years older than me, and her large, brown, beautiful eyes look at me, pleading me to help her. I am not her primary oncologist but simply an oncology hospitalist who is taking care of her, continuing her IV nutrition, correcting her electrolytes and transfusing blood products, if need be. She has swelling in her legs and on some days can barely walk, due to her poor nutritional status. Our rehab team spends their days dressing her legs and walking the halls with her slowly, trying to regain any of her function and mobility. She also has a drain in her abdomen which continuously drains fluid that collects in her abdominal cavity. She weighs about 85 lbs by the time she comes to our hospital.
She has already had two oncologists give her the news she fears most: there is no further treatment for you in this case. She begs me to seek a third opinion before she has to go back home. Her sister, who is with her night and day in her hospital room, and who looks even more exhausted than the patient herself, begs me, “ashan khatir ayalha,” or “for the sake of her children.”
Tears spring up in my eyes immediately, and for a minute, I am not a physician, or someone who has trained in oncology for years, or comforted end of life patients many times throughout my nascent career. I am simply a fellow mother, whose heart is ripped into a million screaming pieces, at the thought of two toddlers being left alone, without a mother. I do not cry easily and I pride myself on that, especially in a field where showing too much emotion can be considered a weakness, and where women are considered much more likely to become more emotional and--therefore, less rational. I pride myself on being “less feminine” in this way. I am empathetic but not too emotional. I can usually keep myself together.
I’m angry with myself for showing this emotion. She is not here for tears; she is here for medical care.
My children are close in age to hers; their laughing faces flash through my mind. I take her hand in both of mine, sit down on the bed near her feet and tell her I will do what I can. I will do the best I can, knowing full well that there will not be another oncologist who will agree to treat her, to give her more medicine that will make her feel sicker than she does now, without any chance of curing her. Sure, there is palliative care to help with her current symptoms, to make her feel less pain, less nausea, less vomiting.
But she is not interested in palliative care. Not really.
What she deeply wants is to live for her children, to watch them grow up, to hold them and hug them when they need their mother. I know exactly what her heart longs for, because mine longs for the same. I promise her I will do what I can, not because I believe I’ll find someone with a cure, but because she needs more time. More time to accept that this is the end of her life. More time to accept what that means for her young family.
In the next few days, I talk to oncologists who specialize in gastric cancer around the city of Boston. I email others in the Northeast. I ask around for clinical trials on which she can be placed. I speak to her oncologist back home. They all agree, there is nothing more to be done, except to make her feel comfortable for the last short months of her life.
At night, I have started dreaming about this patient, her children, her sister. I wake up at night with tightness in my chest that will not dissipate. I pray and quietly cry myself back to sleep, thinking about any child, my children, growing up without a mother. My husband, who worries about me carrying too many emotional burdens, asks if I could be taken off this case, if I could give this case to a colleague. I refuse. I do not want to abandon this patient that is already losing so much. I feel a special bond with her and I am starting to forgive myself for those moments in her room, when I cry.
She and her sister thank me for listening, thank me for trying. After about two weeks, I tell them I have had no luck with a third opinion. They know that this is coming. They only held on to the hope as a mountain climber clings to the rope that is saving her life, knowing that without it she will fall into the deep abyss below.
Our focus starts shifting; she will be going back home soon, to spend her last weeks or months with her family, with her precious children. I assure her that she can and will be comfortable and should try to enjoy these times with them. I imagine her homecoming with her, where she will be embraced by all the people back home that miss her so much. I sense she cannot think too far beyond going home; I do not push it. She will have time for that later.
By now, I am no longer dreaming about her, and I no longer tear up when I enter her room. I don’t know if I have come to peace with her impending death, or if I’m emotionally too weary to carry that weight around with me. On the day she leaves, she and her sister give me a warm embrace, and she cries into my shoulder, thanking me for my help. I think to myself, “I haven’t done anything for you. I haven’t saved you for your children.” I just rub her bony back and tell her I will miss her.
She has taught me something important as well. I’m starting to learn that it is exactly my humanity and my emotional exposure that she appreciates. I realize I am helping her in some small way, not despite my vulnerability but because of it. I realize that it was not a failing on my part to have cried with her. I believe that my emotions became a small part of her grieving process: to have those around her grieve with her. To acknowledge the great sorrow she held was an important step in this process. I believe that it helped her to begin making peace with her death, with this last stage of her life. I could sense a clear difference in her level of acceptance of her prognosis, in the few weeks that she spent with us.
I think that sometimes that is what patients need from their doctor, if they can have nothing else. It is our openness in feeling with our patients, in acknowledging their sorrows, in saying yes, it is not fair, and we are so very sorry for that. I think that this may actually soothe them on their own painful road to coming to terms with their death.
Sometimes this is all we have to give.