Tiny threads hold a marriage together

Chains do not hold a marriage together. It is threads, hundreds of tiny threads which sew people together through the years.
- Simone Signoret

Allen’s cancer has continued to grow quickly. He raises his chin so I can see. I check my notes from a month ago and pull out my ruler and make new measurements. I jot down my findings and turn to look him in the eye. We both know this cannot go on much longer.

When he had first come to see me about his newly diagnosed cancer, Allen had been a vigorous, active, enthusiastic man in the prime of life. He was a regular at the gym. He had always been very accomplished, maintaining a wide circle of loyal friends. Despite his failing health, he still keeps his weekends full of activities. His delightful family continues to be his bedrock.

We have known each other for several years now – through his initial cancer treatment and the increasingly aggressive recurrences. His typical reaction at each juncture has been a smile, a shrug, and a “Let’s get going!” Now, things are deteriorating. Treatment options have been exhausted. Active cancer treatment has given way to comfort measures. He is ready to die.

Today, he is weak and, although he insists that he does not really need the wheelchair, he acknowledges that using it makes the visits easier for Therese.

Therese heads out to the waiting room for a moment and Allen looks at me. “Doc, I realize I won’t be here much longer and haven’t finished making all of my preparations yet. It’s just hard.”

I am surprised by Allen’s remark. He has always been completely organized and I assumed that he already had all of his ducks in a row. Everything all set and ready. Color-coded files with instructions. He’s that type of person.

I look at him. “Do you want me to help find someone who can set up your Power of Attorney? Have you worked with a lawyer to get things prepared for after you have died?” ”

Nah. I took care of that years ago. My will and all of the financial planning is complete. I updated it just a couple of weeks ago. No problems there. Doc, It’s the OTHER stuff.” He smiles.

“My Harley, for instance. I love my bike but I know I won’t ride it again. It just sits in the garage looking great. And my sports car. It’s got a touchy clutch and Therese never liked the stick shift. She won’t want either of them after I am gone. They will be a burden to her and I know I should get rid of them. I just haven’t gotten around to it yet.”

He smiles again.

“Doc, I’m sorry. There was no need to burden you with our problems.”

Therese returns and catches the end of the conversation. She shakes her head. “Allen, honey, I’ll take care of it. Don’t worry.”

“I know you will. Just in case, though, I have a list of places in the green file cabinet where you might want to list the car.”

The visit ends and we set up the next appointment, not knowing if he will still be alive. Allen waves as Therese pushes the wheelchair down the hall toward the elevator.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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  • http://twitter.com/cocococo10 Coco Lossil

    I have a question here – what medical value is there in no doubt very expensive and physically highly taxing specialist medical appointments that require a number of people to coordinate when the patient is so weak and in a wheelchair? When treatment options are exhausted and both specialist and patient are clear death is not far away? Measuring the size of cancer growth? Spending an expensively gained specialists time on someone who can no longer benefit from the specialist training? Call me a pragmatist but I can talk to many people about off loading a Harley or my stick shift sports car who do not charge many hundreds of dollars [or more] per appointment. And another appointment is set up, dragging a wheelchair bound dying man and his wife back in the event he is still alive! For whose benefit?

    • http://womanfoodshinyobjects.wordpress.com/ Brian Stephens MD

      Coco, I understand your point and in general I agree.
      But I think Dr Campbell’s blog was about something else, and I felt it was quite touching. As a PCP I often worry that pt’s are “overwhelmed” by specialist. But I think this post reminds me that people can (and often do) have close and meaningful relationships with their specialist. Dr Campbell obviously has a special bond.
      The utilization of care is an important argument, but in this particular case, I see a patient that wants to share the experience of his last days with a physician that has been with him from the beginning.
      I cant speak for Dr Campbell, but I get the sense from this blog that he would happily see this patient for nothing. There is no talk of aggressive treatments or surgery…. simply the time spent and the human touch of a physician and his patient.

      I’m convinced that assisting with birth and death are the two most important jobs a physicians has. They certainly are the most emotionally rewarding and I applaud Dr Campbell for holding on to this relationship with the patient when it would be easier to just tell him, “nothing more can be done” and send him away.

  • http://www.froedtert.com/HealthResources/ReadingRoom/HealthBlogs/Reflections/ bruce

    Coco and Brian, Thank you both for your comments. I chose a cancer-related specialty precisely because I wanted to be part of these families’ lives at critical times. This story is one of many in my practice. Coco: Your comments about cost are very well drawn. It IS an issue. I do try to minimize the billing, although I work in a place that needs to keep the lights on and pay the staff. I pulled out my ruler rather than ordering a CT scan, though…maybe that helps a bit. Brian: I appreciate your insights. It is a privilege to accompany these patients throughout the course of their journeys; not just when we have something we can do.

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