For those of you hoping for a happy ending to this piece, I apologize in advance. I bring it forward though because it struck me to the core and it may inspire us to frame our lives in a way to avoid this tragedy.
My first patient this morning was a pretty, fragile, slight woman, age 55, who has lived with metastatic breast cancer for eight years. She finds it harder to be optimistic as the disease becomes recalcitrant to therapy and she perceives the certainty that her life is destined to be cut short by the disease. Even so, at the moment she is in a steady state and functioning well except for the loss of function of her left arm and hand by disease in the nerves that control the arm. Treatment has been successful in arresting the damage but the arm remains useless and she lives daily with this reminder that her cancer can wreak further damage to her vitality at any moment. It frightens her a lot.
Today’s visit was a crying session that ran well beyond her allotted 15 minutes. She required my empathic attention and even after 30 minutes I could not improve her spirits, in large part because of what I will describe now. Parenthetically, keep this story in mind when your doctor is running late because it is possible his/her attention and expertise was required for someone else’s emergency.
I knew Judy had a difficult life despite her innate intelligence and good looks. She married wrong twice and and had a daughter with each husband. The older daughter has accompanied her mother to the office at times and clearly has been supportive.
But is was the younger daughter that brought out the tears. Judy was so upset because she felt her time was short, again based on the daily reminder of her arm not working. She knew her cancer could not be eradicated. She was estranged from her daughter and she described a horrific set of circumstances that led her to conclude she could never rescue her daughter from the grips of her ex husband who had convinced the daughter that Judy had no interest in her welfare. It was heartbreaking and the saga she described was punctuated by family members and her ex-husband trying over the past eight years to hasten her acceptance of the cancer while at the same time dissuading her from chemotherapy. She had the pernicious feeling that they wanted her to die. They were reluctant to help her with transportation to the doctor when her arm stopped working. They wanted to put her in a nursing home although she is fully functional and actually now has engineered her car so she can drive. There is an undercurrent of cultural and economic dissonance, of a woman who never quite found her way in life and who made some poor social decisions and now is suffering immensely.
At her core, Judy loves her daughter. She is desperate as any good parent is, to rescue her from the father who is poisoning her mind, reconcile with her, heal any wounds and leave her daughter in a better place when she passes away.
It was a heart rending beginning to my day and I had no words to comfort her except to encourage her to reconcile with her daughter. I felt completely inadequate. I know I can still find medical therapies to curtail cancer growth for a while longer but I have no capacity to fix a deep seated social problem that is tearing the heart out of my patient. And I know that it is not likely to be solved in Judy’s life time. As Thoreau said, “Men (and women) lead lives of quiet desperation and go to the grave with the song still in them.” In Judy’s case her desperation was palpable and not quiet. The song in her life will never be sung. It broke my heart to hear her story.
It did remind me that we should not let problems with family and other loved ones fester like this. We all should work hard to heal wounds before it is too late to do it. I fear it is too late for Judy and for this reason, I share her story so others can work to avoid this deep heartache and tragedy.
Pear Martini Broadside 