Another End of Life Discussion

I take care of people daily that have been diagnosed with Lung and Esophageal Cancer. Thankfully, a good majority of my patient's have a positive response to their cancer treatments. Unfortunately, some of my patients do not have such favorable outcomes. Everyone deals with their own death differently. Some regress, some have anger, cry, get depressed, dive into denial and yet some face it with honesty and acceptance. These patients are the ones that stretch me to my limits and force me to face my own mortality.

I have had the end of life discussion numerous times over the past 14 years. The questions are consistent: How much time do I have left; What do I expect as the Cancer progresses; How do I tell my loved ones and the list goes on. How the patient and the family handles the information and how I present the information, changes each time.

Monday, I started my rounds and headed towards one of my patient's room. Her door was shut with a note on it that said, "Do Not Disturb. I am Disturbed Already". She is in her 60's and her life was turned upside down last week. She thought her health was good up until 2 weeks ago. She started having some symptoms that led her to the hospital. One week later, she is diagnosed with terminal, aggressive Cancer. Of course she is disturbed!! I went in her room to discuss discharging her from the hospital. Her TV was on with the volume down low. Curtains were closed so that the room is as black as it can be. Her and I talk for a few minutes about discharge instructions, then, the questions started. Most of the time, I see this conversation coming and in some cases, I start it. For some reason though, I didn't see it coming with this lady. She began to cry and ask the same questions they all do: How much time ..... I answered her with honestly, the best I could. All of a sudden, I realized that as I am talking with her, I am internally analyzing my mortality and trying to answer, "What would I do if I were in her shoes"? She doesn't have insurance, no money and needs a lot of expensive treatments/medications to keep her at home. I felt her hopelessness and frustration, placing myself in her shoes. Unlike this lady, I questioned the motivation to keep going. Would I keep fighting and dealing with frustrations of signing over my house and getting my finances into order and doing all the necessary things to prepare for my death? I am not so sure I would have the strength to do it. I would be very tempted to relinquish all my responsibilities immediately. This lady has more strength and determination than she should. She is ready to face what is the remainder of her life and do what is expected of her. The last blow that I felt is when I heard myself say, "Most likely, this is your last Christmas"(I am sure some of you just gasped and are thinking how harsh and rude I am for saying those words. I assure you, it was appropriate in this particular conversation). She verbalized she was aware of that and she actually gave me a little smile. I wondered how she is going to prepare differently for this Christmas? How would I? What will be going through her mind on Christmas morning?

I answered all her questions and created many more for myself. Disturbed at how I felt on the inside and the lack of strength that I was exhibiting internally, I said good bye and turned to leave the room. The next words that I heard brought tears to my eyes. As I got to the door, I heard her say, "Thank you for your honesty and ability to discuss this with me". I did my job correctly today!!

On a lighter note, my job is not this depressing; usually. I do have great, light hearted stories that I should share from time to time.