An apology to a terminal patient with colon cancer

I’m sorry, Mrs. Lewis, for not making it to the hospital to see you yesterday.

Yesterday was one of those days when I felt like I could never catch up. My wife was going downtown for work, and we had to get up early. While she prepared, I helped my two-year-old son get dressed. We walked my wife to the train, then waited for the nanny. She was running late: I finally made it out of the house by 7:20, ten minutes before a meeting at the office. Since I didn’t have any patients in the hospital — or so I thought — I could go directly.

Before the meeting started, I glanced at my office computer and saw that Mrs. Lewis had been admitted to the hospital the night before with worsening abdominal pain. She had terminal colon cancer, and the emergency room had called her oncologist directly without bothering to notify me. Although calling the oncologist was a reasonable choice on their part, I would have stopped by to see Mrs. Lewis if I’d known.

I’d met Mrs. Lewis three years ago, and we’d gotten along well from the beginning. She was a thin, professional, middle aged woman with an open, easy manner. We had similar communication styles and often spent her visits joking and laughing. Her medical problems were serious but under control, and she handled them with humor and determination. I always looked forward to seeing her.

Two years back, she’d mentioned noticing some blood in the toilet after going to the bathroom. Her exam was normal, and we talked about her getting a colonoscopy. I warned that although blood in the stool often has a benign cause, it was important that she follow up so that we could make a proper diagnosis.

As so often happens, Mrs. Lewis’s life got in the way of her medical care. She got busy at work and moved into a new home. Six months later she called me with the same complaint, adding that she hadn’t yet gotten the colonoscopy. I set her up for the test, and a few days later received the results: stage 2 colon cancer.

It took the wind out of me.

The next few months followed a predictable course: Mrs. Lewis had part of her colon removed and started chemotherapy. She saw the oncologist regularly, so didn’t have time to come for office visits with me. Every month I got a note updating me on her progress. Through these, I learned that the cancer had recurred in her liver, and that she wasn’t tolerating chemotherapy well.

Just a week ago, she’d been admitted to the hospital with intractable abdominal pain. I visited her every day and talked to her about going into a hospice program. She was tired of chemotherapy and felt that her chances of survival were minimal. I remember at one point she turned to me with calm eyes and placed her hand in mine: “Dr. Grumet, it’s time to stop this!”

A few days later, she left the hospital, equipped with pain medication and home nursing care. She planned to die at home with her family surrounding her. Unfortunately, as occasionally happens, the amount of stress and physical pain became too much for her to bear. Her hospice nurse suggested readmission for pain control. It wouldn’t be long now.

And of course, yesterday was one of those days. After my 7:30 meeting, I had to see patients in the office starting at 9:00, and I didn’t finish until 5:00. In the back of my mind, a little voice kept telling me to get to the hospital — that Mrs. Lewis was dying, and this would be my last chance. But, like Mrs. Lewis, I kept putting it off. At 5:00 I had to run home to relieve the nanny and make my son dinner. By the time my wife got home, it was too late to go to the hospital. I cleared my schedule to see Mrs. Lewis the first thing the next day.

But when I arrived at the hospital this morning, she was already gone. She’d died a few hours earlier.

Sitting at my desk, writing this, I wish I’d found a way to make it to the hospital.

I’m sorry Mrs. Lewis ….

I’m sorry that you died ….

I’m sorry that as doctors we’re so often there when we think we can help, and so often not there when we’re needed most …

I’m sorry that you got this horrific cancer in the first place …

And I’m sorry that death and sadness have become such a normal part of my life that they’re no longer something I interrupt my schedule for. But that’s more an apology to myself than to you.

 

I will miss you.

Jordan Grumet is an internal medicine physician.  This piece was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.

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