In the midst health care cynicism, an affirmation of enduring love

When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.”  Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it.  But just in case — the story is about a young couple, poor and deeply in love.  At Christmas, they have no money to buy each other gifts.  She cuts off her long golden hair, her prized possession, to buy him a watch chain for his own treasure, the pocket watch his grandfather left him.  He sells the watch to buy ornamental combs for her beautiful tresses.  In a classic example of cosmic irony, the two are bereft of everything except their enduring love for one another.

Yesterday, an 85-year-old man was crying in my office.  A month ago, he completed a grueling seven weeks of treatment for head and neck cancer. Otherwise healthy, he endured the side effects of treatment with great equanimity — the loss of taste, the sore throat, the dry mouth, the hoarseness, the skin reaction, the fatigue and the weight loss associated with treatment.  His reward is great — he is free of disease and very likely to remain so.  He drove himself to every treatment, clearly motivated to complete his therapy despite his advanced age.  I never had to cajole him into continuing and finishing the treatment — he was clear that he was doing this for his wife of sixty three years, and for his family.  He wanted more time, and more healthy time with them.

When I saw him in follow up, I asked him how his post-treatment time had been.  Many times for radiation therapy patients, the week or weeks following treatment are even more difficult than the treatments themselves — the side effects may worsen before they improve.  So I was not surprised when he said, “It’s been terrible.”

I patted his arm and said, “Tell me about it.”

He replied, “Right after I finished, my wife was hospitalized and now she is in kidney failure.  She started dialysis on Wednesday.”

Somewhat surprised that an 85-year-old woman would choose to go on dialysis, I asked him, “Do they expect her kidney function to improve?”

He said, “No, the doctors said there is no chance of improvement.  The hospital doctor said that under no circumstances would he recommend dialysis for her.  But the kidney doctor said it was her choice — to have dialysis and live, or to be made comfortable and die.  She chose to live, for me.”

And then he wept.

We can all be cynics or pragmatists if we choose.  We can talk about the escalating cost of healthcare, and the wisdom or folly of treating 85-year-olds with intensity modulated radiation therapy and daily image guidance and their wives with hemodialysis.  But what I saw yesterday was an affirmation of enduring love, in two elderly people, who gave one another a gift not unlike “The Gift of the Magi” — the gift of sacrificing self to continue to live.

It’s hard to be cynical about that.

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries.

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  • a dn

    I think the highest cynicism would be yours here, calling what patients have endured from a corrupt system, and seek to expose and use to warn others…”cynicism”.

    We are the patient whistleblowers. Heroes, when one of your colleagues does it, but shat upon by finger waggers with an overdose of arrogance and holier than thou.

    If O Henry read your post he’d spin. You’ve totally missed his point.

  • a dn

    Those who have survived a corrupt healthcare system and use
    their experience to educate others are not cynical. They are whistleblowers who have made a positive decision to speak out to warn others and change the system.

    • Mengles

      Dr. Fielding has nothing to complain about. She is a radiation oncologist who believes PCPs should make f/u phone calls with patients.

      • Suzi Q 38

        They should. F/U calls should be made if needed.

    • Miranda Fielding

      Are you suggesting I should have blown the whistle on someone? My patient had laryngeal cancer, highly curable in its early stages as he presented. His wife has renal failure. FYI, I looked it up, and even countries with single payer systems like England and Canada do NOT refuse a patient dialysis based on age. I was trying to tell a love story, simple as that.

      • Rob Burnside

        And tell a great love story you did. Thanks!

  • Ron Smith

    I feel for this couple.

    My wife, Stacy and I lost our daughter, Laura, April 24, 2012. She had fetal isotretinoin embryopathy (intrauterine Accutane exposure). We cared for her for 24 years ourselves, in our home. Stacy was there during the day while I saw patients. Laura slept with me during the night so that I would be right next to her and Stacy could rest. The shunt she got at about 1 year of age was the same one she had when she died. Her seizures presented in 2003 and the first one lasted three hours. I controlled the rest at home, but there were at least a half dozen subsequent ones that lasted two hours.

    We remained in the house we had built together to raise Laura and her older sister for not even a year. We would hear sounds that reminded us of her…even sounded to us like it was her. Stacy was constantly looking around the corner from the washer and dryer out of habit at the place where she always lay on our bed. She had never spoken, rolled over, and we weren’t even sure what she could see.

    We have since healed. We sold that house and had just moved into live a small farmhouse in Senoia, GA that was built in 1898 or so. We had become more mindful about each other especially since Andrea has long since left our ‘nest’ and married.

    Then Stacy’s right side just below her rib cage started hurting. A cyst on her liver was found on CT. Of course the gall bladder was a concern, but so was the significant history of a 0.9 cm single breast cancer focus that was treated by a double mastectomy. There were no nodes positive. We thought we got everything. But the new symptoms of the right side pain and the liver cyst overshadowed by our little girl so recently deceased were front and center in our minds. Was the cancer somehow back?

    All the tests only raised more questions as answers seemed to scurry away. One Monday morning, Stacy turned to me out the clear blue and asked me if I could live in the farmhouse by myself.

    I was more than stunned. We have been married for 36 years, ever since I was a junior in college! We’ve practically raised each other…or she raised me! We’ve been together in my practice for thirty years.

    The policeman stopped me for speeding on my 30 minute drive through the backroads to McDonough. All I could say is that I just wasn’t paying attention. If only he could understand why. My insides were crumbling even as I stood there talking to him.

    After thirty years, I’ve seen some rare medical conditions. I’ve walked some children, including my own, right up to the veiled entrance to the beyond that I believe is there. Healthcare will eventually fail us all no matter what. How we choose to live our life until then is everything.

    Stacy’s gallbladder turned out to the be problem. The liver cyst was not a return of the breast cancer. Another much easier surgery down, and all is again well.

    Since that day when I was faced with the real possibility of losing Stacy, it has become just as important to us to be prepared for how we will part as it is to remember how we have lived, loved, laughed and cried. We are both just now qualified for senior citizen coffee, so we could have another 25 years together. Or not.

    We know now, through all this, that we can finish well. When its time to go, we have the necessary courage, and a real hope, just as Peter Marshall who said to his wife before he passed on, “I’ll see you in the morning.”

    Ron Smith, MD

    www (adot) ronsmithmd (adot) com

    • Miranda Fielding

      Thank you so much for telling your story and I am so glad that Stacy’s cancer did not return–as you said, the probability of that happening was low, but it’s never zero.
      I wish we could all be prepared for how we will part. I recently spoke to an insurance salesman who was trying to convince me to buy a long term care policy. I said that I do not want to end up like my mother, with severe progressive dementia such that the last two years of her life she could not feed herself, get out of bed, speak, or recognize her family. He replied, “unfortunately many times we do not have a choice in these matters.” You are so right–it’s very very important to try to establish parameters of what we would find acceptable, long before it happens. Again, thank you for sharing your story.

      • Suzi Q 38

        But the LT care insurance, Dr. Fielding.
        Buy it before you need it. Once you get a bad diagnosis, you can’t get the insurance.
        When you need it, you can’t buy it.

        Thank you for the love story.

    • Suzi Q 38

      Thanks for your story, Dr. Smith.
      I hope you and your wife live many more years together.