Cake with a terminal cancer patient

by Krupali Tejura, MD

A fellow physician called me with a consult this afternoon.

He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn’t show much better. A biopsy was done but the final results were pending. It was cancer.  It smelled like cancer, it looked like cancer per his description, and in my gut I knew it was.

I went upstairs to see the patient. He was sitting in his bed, surrounded by his two daughters and his wife. We chatted for a bit, and I told them I didn’t know the final pathology and that the treatment would depend on what type of cancer or tumor it was. We went over some of the scan results, the cancer had spread to other parts of his body.

His wife’s eyes glistened with tears.

I asked her if I could give her a hug. She crumbled in my arms. As I learned more about him, she told me they had been married 33 years, and she had never spent a day without him. Going home these past few days was hard on her, since it was the first time he wasn’t with her. She started crying, as did one of the daughters.

His breathing was getting worse, so he was transferred to the intensive care unit where he could be monitored more frequently and have other procedures done.

As this was being done, I ran down to pathology to take a look at the slides. I wanted to see what kind of bastardly tumor was ravaging the man’s body. It looked like an anaplastic tumor — a horrible tumor, one that just looked like the meanest, most ugly thing growing at a crazy rate. The CT scans weren’t much better. There were tumors everywhere in his body. This cancer was spreading like wildfire.

I knew the prognosis, and my heart sank. I looked at the pathologist and told him the patients story, how they were married for 33 years, how he has two daughters, and how this news going to devastate them. He looked at me and said, “I don’t know how you do it.”

I don’t know either.

I went to go see him upstairs, after he was transferred to the ICU. He asked me if he knew what type of cancer it was, I told him. He then said the words I dread to hear at times, as I still haven’t perfected the right way to answer the question. “Doctor, am I curable?”

I bit my tongue hard. I said, well the cancer is spreading throughout the body, so that makes you a stage IV the highest stage. Right now we need to put out the main fire and keep you breathing, so let’s think about that battle first. We can talk about the other stuff in a little bit.

I don’t know what else I said, but as I was talking, I was watching the eyes of the family members upon me. They were grasping at every single word — I had to be careful. Their tears and their eyes affect me. Their pain becomes my pain. It is at times hard to pull yourself away from it all and not cry.

I talked to the daughters, and I asked them how old they were (I thought they were 14 and 16). I found out that one was in her mid 20’s and one just turned 30 yesterday. She had turned 30 while taking care of her dad in the hospital. That was not a birthday. No cake was eaten, no food was eaten, but tears were shed, and crying was done.

That hurt me to no end.

I left that room, and by that time I had a lunch break.

I took a few deep breaths and sat outside, needed to get some fresh air, and walk it out. This would be the last birthday that she would share with her father. I started crying.

Then it hit me.

I grabbed my car keys and ran to the grocery store. I aimed for the bakery. I then looked at some cakes … and these exact thoughts ran through my mind.

This patients daughter turned 30, I don’t know her name yet, and I don’t know what flavor cake she likes or dislikes, what do I do? What kind of cake do I get, will I look crazy? Better yet, do I care? She needs to celebrate with cake with her dad. It’s the last one she will have with him.

I picked a chocolate cake (per the bakery worker — which girl doesn’t like chocolate?), and she inscribed Happy 30th Birthday.

The bakery worker asked me if I wanted to put a name down.  I said no. (And then felt like hitting my head on the counter top feeling dumb for not knowing this girls name.)

I bought some plastic silverware, and some plates, and was out the door.

Next stop: Back to the ICU room.

I walked in, but the birthday girl wasn’t there. She had just stepped out. I let her dad and her family in on my plan.  They were stunned, her dad just smiled.  He was beaming. I told him, “I know this is your baby, you want to sing, and celebrate” He just smiled underneath his mask. I held his hand and he squeezed them tightly. I had my phone prepared to take pictures and video. I wanted them to have a special moment, and something that they could think of on the positive side.

She finally arrived.  I could see some tears that had recently been shed from her eyes.  As she stepped in, her mom said, “Happy Birthday, the doctor bought you a cake!” She smiled, and said, “You didn’t have to do this.”  I know I didn’t have to do anything. I wanted to do something.

We sang happy birthday, she cut the cake, and they each ate a piece. They all smiled. Those smiles made me smile. It lessened some of the pain.

It’s not the normal 30th birthday celebration. Not many people have a father in the hospital with a prognosis of cancer which will kill him in 3 months. It’s not normal. It’s not fair, and it just plain sucks.

There are moments where you do happy dances in my field, and there are moments where you just want to vomit. There are moments where you want to scream with glee, and there are moments where you want to hit your head on a wall.

This was a hit my head on the wall kind of day, however the power of a simple cake helped bring some smiles into a family’s life, and hopefully will shed some more strength into them too.

Krupali Tejura is a radiation oncologist who blogs at her self-titled site, Krupali K. Tejura, M.D.

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