I would not do anything to harm my grandchildren

I met a patient recently.
She is a very sweet elderly woman in her 70's with wide spread cancer head to toe...
She is a retired nurse and quite independent and still takes care of her grandchildren.
As we were discussing her care, we came across the subject of driving.
She was told that day by her neurologist that she cannot drive as she starts radiation therapy to the brain due to possible seizure activity.
We both agreed to it and spoke about it.

Driving is considered one of the respectfully earned privilege we have as we enter teenage years and through adulthood. It is something that is almost sacred that most patients would not give up unless told.
And even after being told to stop driving, some resist. It is their control and freedom.
But this day, she said; " I would not do anything to harm my grandchildren. I will have to stop driving and I will  find rides for them".  She had sad look to her face. She later told me how much she enjoys driving her grand kids to wherever they want to go. She drives them to the mall, movies, etc... She sits in the car and waits for them while listening to the radio. I can only imagine what that feels like and to give that up.

She did not want any chemotherapy or other therapies other than radiation.
She wanted to go back to her local oncologist rather than coming to the city.
She couldn't anyway since she can't drive. 
But she said it was okay. She has a good like and had a good life.
She will enjoy the life she has without struggling to live another day....

A Mother's Eyes

All of my patients have sad stories...
They are facing death everyday or living scan to scan with the fear of cancer coming back.
I came across a sad scene on one of my clinic days recently.

A patient came to see us with his mother and his sister.
Needless to say, it was serious since he never comes with his family and is always "doing well".
He had severe worsening of chronic kidney failure due to tumors in his kidney and now is on dialysis.
He lost significant amount of weight and was in poor condition when I spoke with him on the phone a week ago.
I could not recognize him when I walked into the room.
He was withdrawn, quiet, on the exam table, laying there and breathing softly but shallow.  He had lost so much weight that his face was bony and only his abdomen protruded...
He had difficulty walking and breathing because of the abdominal girth.
Clearly terminal....

We began our visit and stayed in the room for a long time.
As my attending and I explained that he is not a surgical candidate because he may not survive surgery, his mother's eyes started to moisten.  His sister stayed very calm and asked other possible medical interventions. We told her that it is a possibility but he is too weak to receive any medication that will produce negative side effect and that he will likely cannot endure the treatment. Only thing we can do at this point is continuing dialysis and hope that he turns the corner in the next few weeks. He looked sad and did not say or ask anything to us.

I could not take my eyes off of his mother. She was looking at him thoughtfully and lovingly but with such sorrow. Her eyes looked as if she was thinking of him as a boy, not a 40 something year old man who is cachectic and perhaps facing death soon.  It looked as if she was thinking about how he was a young boy, the happy days and how he grew up under her roof. Her eyes were of a mother who cannot understand but is trying to stay strong for her son and trying to not shed a tear in front of her son and daughter. But she did at the end silently while he was not looking....

I think this scene .... this very sad scene was the most saddest encounter I have ever had.
I do not know why but her eyes made me so sad. Perhaps because I have become a mother and I can almost feel the pain she has or imagine it.
Her sorrow filled eyes stayed with me until I was home. I looked at my two children and I again cried for her inside.

Fear that lead to the end

A very gentle soul who struggled decided to take the matter to his own hands.
Just shy of 1 week for the scan to show if the new treatment was working or not.
He was afraid that the treatment was not effective.
Increasing pain and  insurance struggle to get his pain medications did not help but added more pressure.
He felt hopeless.
Then one day, a week after we saw him, we received a call from his wife.
She found him in the garage, in the car, while she went to the store.
It was shocking and tremendously sad.
What made me sadder was that he was all by himself struggling with fear and the fear overtook him finally.
How lonely and scared he would have been to end it all.
No sign, never really told anyone of his fears.
I asked about our responsibility as his nurse practitioner and my attending as his physician.
Nobody could have predicted this and I am sure that he did not either.

From time to time, I think of his fear... His lonely struggles that lead to the end...