One cold February morning during my third year of medical school, I walked through the entrance of the rural hospital where I was doing a nine-month rotation and made my way to the nurses’ station. Feeling the warmth return to my face, I set down my coat and bag and hung my stethoscope around my neck.
The charge nurse, Barb, waved me to her computer.
“Kristie, you have a patient.”
She shuffled through papers, grabbed a blank chart and placed the patient’s admission note on top. When she saw the name, her face fell.
“Ah, it’s Peggy.”
I sighed. I met Peggy three weeks earlier when she’d come to our urgent-care clinic. A sturdy woman of sixty with a broad, smiling face and a stoic air, she complained of severe abdominal pain.
The pain was diagnosed as metastatic pancreatic cancer.
“She was admitted through the ER this morning,” Barb said. “She’s got cellulitis in both legs.” A glance through the chart told me that the ER physicians attributed this cellulitis, a skin infection, to undernourishment and edema.
Feeling a sense of foreboding, I walked down the hall to Peggy’s room.
I had three months left in my rotation. I feared that Peggy wouldn’t survive that long.
Entering the room, I was shocked at how much she’d changed. Three weeks ago, she was a vibrant, bright-eyed woman with a hearty laugh. Today, her face was pale and thin and her eyes were lifeless. Her legs were swollen, red and weeping pus. A small tube in one nostril snaked down to a bag of liquid nutrition at the bedside.
Trying to hide my dismay, I greeted Peggy with a hug. She showed me a funny video on her phone. I examined her, doing my best to act calm and to keep my voice from betraying my distress.
A quiet, pleasant-faced man came into the room — Peggy’s husband Jack.
“Cold enough for you?” he said.
“Thirty below yesterday,” I answered with a sigh. “Every morning, I’m grateful when my car starts.”
“You’re young — you don’t remember the cold winters we used to have,” Peggy said.
Our pleasantries were shallow but comforting. It was, indeed, one of the coldest winters on record. Here was one thing that we could talk about without having to pick and choose our words.
With the exam complete, I walked back to the nursing station to dictate my notes. As I did so, I overheard one nurse telling another about a camping trip she was planning for the spring.
The tears that I’d kept in check crept to the surface, and I blinked them back. I knew there might not be a spring for Peggy.
That afternoon, my pager beeped. A patient was in labor at our hospital. Her physician called from a clinic twenty minutes away. She asked me to notify her when the patient’s cervix was completely dilated.
I examined the patient, then conveyed the message that she would be ready to push soon.
Back at the nursing station, Barb flagged me down.
“Peggy’s feeding tube is clogged,” she said. “Her nurse is in her room. Could you go down there and see how they’re doing?”
I went back to Peggy’s room and joined her nurse and Jack in manipulating a small brush that was inserted into the tubing to break up the obstruction. Peggy watched in silence. We made little progress and the mood was dismal. We all tried to stay positive and come up with suggestions for unclogging the tube. There was nothing else to do.
The intercom on the wall beeped loudly, and we all jumped.
“Kristie — we need you in OB right away,” Barb said over the speaker.
I handed the tubing to Jack.
“I’ll get back as soon as I can,” I said, then rushed down the hall to the OB department.
The patient was ready to push, and the doctor arrived. Ten minutes later, I helped deliver a beautiful baby girl.
After mom and baby were stable and comfortable, I went to complete my notes.
“Dr. Brown is in Peggy’s room, helping to unclog her feeding tube,” Barb said.
I returned to Peggy’s room. She stared blankly out of the window as her doctor worked the small brush.
Seeing me, he paused.
“The tube will probably need to be replaced,” he said. “But there’s no rush to do it this evening. We’ll have all of her medicines held, unless…”
“Did someone have a baby?” Peggy interrupted, looking at me expectantly.
“Yes.” I smiled at her. “All went well.”
“Boy or girl?”
“A perfect girl,” I said quietly.
Dr. Brown and I waited, but she didn’t speak again, just smiled thinly. Perhaps, she wished she could be the mother down the hall, just starting out with a new baby, rather than a woman suffering from terminal cancer and an obstructed feeding tube.
I wished that she would talk — maybe reminisce about when her children or grandchildren were born. A few birth stories would have been a welcome distraction.
I hoped that Peggy would somehow find comfort within herself. But she seemed far from resigned to the reality of her illness and impending death.
I need to accept where she is, I reminded myself. Her life is her own, and she needs to grieve in her own time. But her time was slipping away so quickly.
Before leaving for home, I went to Peggy’s room to say good night.
She glanced at me, then looked down at her hands and mumbled something. It might have been, “I’m ready to die.”
“What was that, Peggy?” I said, taking her hand in my own.
“I’m afraid to die,” she said distinctly.
She looked straight at me, her eyes were clear.
“I am too,” I said quietly. The words left my lips before I knew it — before I realized just how true they were.
I sat with her and held her hand a while longer. We looked out the window at the cold, snowy world outside.
Kristie Johnson is a medical student. This piece was originally published in Pulse — voices from the heart of medicine.
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