Medicine For People!
- Letter to Our Readers
- A Lesson in Acceptance
Letter to Our Readers
I spent my free time last month hiking in the Olympics instead of sitting at this computer studying medical research. So this month, instead of the usual medical updates, health advice and Rant O' the Month, I want to tell you a story about a patient who affected me deeply. I'd also like to offer you this prescription for September: enjoy the clear, warm days of autumn. Eat some good local, organically grown produce. Go outside, get some exercise, and watch the leaves change colors, the birds flock and fly, and the last of the flowers bloom as the seasons change and the earth prepares to rest. -- Douwe Rienstra, M.D.
A Lesson in Acceptance
I first met Mildred on a house call when I worked in Wauwatosa, Wisconsin, many years ago. Her husband was recovering from a serious illness. Mildred, who was in her seventies, bustled around smoking her cigarette, as bright and cheery as a newly hatched chick.
I was so charmed by her upbeat personality that it came as an unpleasant surprise, some time later, when I received a telephone call from the Emergency Room telling me that she was inexplicably ill. She was so groggy she didn't know where she was, but otherwise her exam proved normal. As I arrived, the X-ray returned. The news was dismal: snowballs in the lung fields. In a smoker, these pretty much spell cancer. It wasn't too hard to speculate that the cancer had spread to her brain, and that was why she was groggy. We tested that hypothesis by giving her some high-dose corticosteroid to reduce the swelling such brain tumors cause. Sure enough, she woke right up.
I sought a second opinion from the oncologist. He agreed with my assessment and pointed out the obvious. Although there was almost no likelihood a biopsy would show some other diagnosis, without it we couldn't be sure. As it was, there was precious little we could offer apart from chemotherapy and radiation, which might or might not extend her life span but would be sure to make miserable whatever time she had left.
I reviewed these facts with Mildred. Now, most people have a hard time hearing that kind of news. They don't want to die. They hope and believe that because sometimes we doctors can make a big difference, we always can. I wish that were true but it is not. The amazing thing was that Mildred listened carefully to me and understood that we really had little to offer but risky tests, risky treatments, and little prospect of helping her. She replied in a very matter of fact way that she would be happier without the danger of chest surgery to remove a piece of lung tissue. She said she wasn't going to argue with Mother Nature about the cancer. She just wanted us to help her be comfortable. My sadness at our inability to treat her disease was mixed with relief -- relief that she understood her situation clearly and we wouldn't have to pretend; relief that she chose not to spend her final days undergoing useless surgery, chemo, and radiation.
It had taken several days to get through all this. We were about to send Mildred home when she began bleeding from the colon. It took us a couple of days to determine that the cause was the high dose cortisone. Then we spent another several days trying to find a dose that would keep her brain swelling under control and yet minimize the bleeding. In the meantime I visited her once or twice a day. There was nothing I could do to make her cancer go away, so we would talk about this and that. I enjoyed her lively company and was nourished by her contentment even in the face of her impending death. She told me some sweet stories about her family and her life. One day, as I left the room, I bent down and, without thinking,kissed her on the forehead.
As the days went on with bleeding on and off, we touched on other subjects. I asked if she had any concerns about dying. She looked at me a little coyly, I thought, and chuckled "no". She'd been raised in a church, which, I knew, taught that if we died without the proper beliefs, we would spend eternity in hell. Since then she had left the church. Curious, I asked if her current agnosticism concerned her as she looked death in the face. Again, she laughed quietly and said no. She wasn't worried about any such thing.
Mildred had lost so much blood she was in danger of dying from blood loss.She made what I thought was the best but most difficult decision -- not to postpone the inevitable by blood transfusions. One day we were reviewing her hospital course so far, and I told her I wasn't used to doing so little for someone so ill. As I was rising to leave, I asked, "Isn't there anything I can do for you?" She looked at me with a sweet smile and pointed to her forehead.
One night at 2:00 a.m. the hospital nurse called me to report that Mildred was bleeding so heavily that she might not live 'til morning. However, she was sleeping quietly, so nothing needed to be done for her comfort. To my surprise, when I arrived the next day, she was alert and smiling, though she moved slowly. "Do you want to hear the dream I had last night?" she asked. I told her I did.
"In my dream," she said, "I saw this beautiful white church. It was luminous. Light just came through the windows and walls and everywhere. As I looked at this church I felt more calm and happy than I'd ever felt in my entire life." Her face mirrored the peace she reported.
A day or two later she died quietly in her sleep.
I've never forgotten Mildred, or the other woman staying just down the hall, another doctor's cancer patient, for whom I was on call. This woman chose to undergo chemotherapy and spent her last days throwing up and complaining of her pain and discomfort. She died quickly, while Mildred lived on peacefully in a nearby room, a pleasure to the nurses and everyone who took care of her.
In a sense, Mildred was lucky. In two or three weeks, she went from being fully functional to dying. She had a chance to exit the stage purposefully and gracefully, and she did so. Not everyone has it this easy or this quick. But for me she remains an inspiration, an example of what is possible when a person is content with life as it is.
Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.