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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  • Kim

    Very touching, honest piece.

  • Mirannda

    Wow. Powerful entry. Left me in tears. RIP Miss Lewis. Dr. Grumet – a very honest and heartfelt farwell. Thank you for sharing.

  • http://www.casahospice.com Carrie Bui

    What a beautifully written, and touching, entry.

  • Francene WIlliams

    Don’t be too hard on yourself, Dr. Grumet. Drs. are people too and can’t be everywhere at once. From the tone of your entry I can tell that you are a very caring person and I’m sure Mrs. Lewis knew that. God bless you as you continue to fulfill all your roles – husband, father, and doctor.

  • http://secondbasedispatch.com Jackie Fox

    What a beautifully written, honest piece. Echoing what Francine said but please don’t beat yourself up.

  • Vincent

    This post is a great portrait of what should be the motivating force for the practice of medicine. What’s notable here is not so much the apology for missing the last day in the life of a patient. With all of the challenges to the practice of medicine today, that you still recognize that your are treating people instead of diseases is remarkable. Here’s to hoping that you can maintain this sense of purpose and to your enjoying a long, happy successful life – both in practice and beyond.

  • Yvonne Torrance

    You may not have been there Dr. Grumet but God was. God is always with us and He was with Ms. Lewis.

  • Suma Achar

    Dear Dr,
    I feel good that there are physicians as caring as you are out there.You and the other doctors did your best.This piece of article brought tears in me.

  • BJ Kim

    Do not blam yourself Dr. Grumet. She already knew your epport for her recovery. It’s a good moral lesson for me, to be a good doctor.

  • http://seaspray-itsawonderfullife.blogspot.com SeaSpray

    Dr Grumet – what a moving post.

    I am sorry about your patient. That must be one of the most difficult parts of the job for docs who’ve trained to heal.

    We are all only human. I am sure she knew how much you cared. It sounds as though you had a solid DR/Pt bond and no doubt you were both blessed by that over time.

    You are obviously a compassionate and thoughtful physician and your patients are blessed to have you.

  • Melissa Lackey

    Thank you for sharing. Your humility, warmth and frustration are commendable. I lost my father to colon cancer 2+ years ago. It’s an awful disease. I’m not a doctor, just a daughter…who like you, let life get in the way. I regret it every day, but hope I’ve made changes to avoid regrets in the future.

  • Ann

    How I ejoyed reading your posting and thank you for your honesty. It sounds to me you were there for your patient. During her visits you said you “often spent her visits joking and laughing” what a gift for you and her.

    You mentioned shile she was in the hospital” I visited her every day”
    Another’s life touched your life, and it was good.
    You are mouring her loss I am sure.
    There are meditations I receive via e-mail and I would like to share one.

    The life of love is one of seasons.
    There are seasons of active growth, and seasons
    of rest and waiting.
    There are also seasons of falling leaves,
    When what has been must take a new form
    and become part of the earth itself.

  • Roberto Santiago

    You should feel no guilt. As life went on for her and she had no time for a colonoscopy you have a life of your own. I feel in her heart she KNEW you did all you did in your specialty. It was neither one of your faults. Based on the relationship you described, you had a special place in her heart and vice versa. You are not a miracle worker, but I would choose you as a physician for your down to earth professional nature. Sometimes we become engulfed in our own lives but that does not make us bad people. I remember crying the first patient who did not like change and wanted to give me problems in my new rank. I got strong and this patient became my favorites and he ONLY wanted to deal with me. He passed when I was on a leave of absence. The guilt I felt was immense that I was not there. I cried. I went through all the psychological changes one goes through. But a doctor put into perspective ALL I did for him, which average people probably would not. We extended his life as best we could with Tier 1 doctors. So pat yourself in the back for all you did and realize we are only human and can do but so much. I give you two thumbs up! You are an outstanding, loving physician, based on what I read, and all I can say is keep up the good work and don’t doubt yourself because you did more than an average doctor. Guilt is a horrible feeling. But when there is no reason for it, it’s even worse. Continue your meticulous ways and I hope my advice helps you find closure as it did with one of my favorite patients.

    I hope we can say RIP cancer at sometime. In the meantime let’s analyze and search while we can to ensure any potential ailment is examined for cancer.

    Again you did good and are a great doctor. The situations were not your fault since all took place so fast. Be strong and rest assured this patient knew you cared about her.

  • Dee

    We need to figure out a way where people dont have to be admitted to get pain control. Who wants to die in an institution number one and number two the beds are needs by people who can recover. I mean no disrespect but wouldn’t pain control at home be the best if the licensing could be worked out?

  • http://www.ccoverwithhislife.wordpress.com his salt

    My husband died young from colon cancer. Thank you for sharing!

  • Denial kills

    Patients let life get in the way – never give them room for denial when delay could be fatal. Blood could have a benign cause? Always emphasize the lethal possibilities and urgency when there is no obvious benign explanation.

    My mom was caught in time, but only because my husband and I brow-beat her into followup.

    We did that because his Dad put it off and died a year before.

  • http://www.sherylawhite.org Sherry White

    Dr. Grumet:
    My 94 year old father was an Internist, and had a couple of patients like your Mrs. Lewis. Although he put up a tough facade to hide his own pain when they passed away, these patients left a imprint on his heart that time would not erase.

    I know he did the best he could for these patients, and they knew that as well, but it still won’t erase that nagging notion that he could of done something different, or more, or less and on and on it goes.

    I don’t know if time heals the pain…but it does lessen it. I’m just thankful that you’re such a caring and compassionate doctor that you cared enough to reflect on this life event and that it’s changed you however it may.

    I just pray that you will continue in your efforts to bring peace, health and healing to those people who are fortunate enough to come into your care. G-d bless you.

  • http://www.elainejesmer.com Elaine Jesmer

    Maybe I’m having “a bad morning”, but I found this self-serving piece nauseating. This doctor’s busy life – what, your nanny was late? – is so out of touch with the real world that it’s amazing he even noticed this woman was dying. But he did know. And he just couldn’t manage to put his life aside for a few hours, to make it to the bedside of his dying patient. I’m touched by this story, but not in a good way. Karma, baby. That’s where the rubber will hit the road.

    And as for the hopes for a cancer cure, it’s not going to happen, folks. There’s too much money invested in “control”. Welcome to the real world.

    • http://LinkedIn Mari-Ann

      Through the years I have learned…..the nagging voices and intuitions is God’s way of helping us priortize. Late one Friday evening I stopped by the PICU to see a fifteen year old in end stage cardiac disease (untreated TOF) and was present with him during his death.

      What a blessing that I didn’t go home, helped him call his mom, and held him until his parents arrived. Life changing and has influenced all aspects of my life now.

  • http://kevinmd.com dkdmd

    In the city that I practice in, it is unheard of for Hospice to readmit a patient for pain control. Hospice here, does a wonderful job with the patients and the families.