Quality over quantity in life and care

The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to her room later in the day to find out more about her history. After rounds were over and our cases for the morning were finished, I found my way back. I wanted to know more than a medical history. I felt like I needed to know her as a person.

I reintroduced myself, sat down, and simply asked, “Tell me about you.” She retorted, “Starting where?” with a touch of wit to her tone. I smiled and simply asked, “Where were you born?”

What ensued was like the script of an award-winning movie.

She spoke of her rural Appalachian roots, young love, brutal wars, child rearing, tested faith and growing old. She seemed as if she had been ready to tell her story since the day she came into this world. But this day — the day before major surgery — was closer to the day she would leave this world. As she started her story, all I could see in my mind was her CT scan that I had viewed before coming into her room. I can still see it — a mass in her large intestine with spiky tendrils invading the nearby bladder and abdominal lining. Even as a medical student, I knew this would not end well for her. But as she told me about herself, the CT scan’s image was soon replaced by the beautiful life of the woman in front of me. I sat and listened to every detail of her stories, details that could never be shown with a radiology image. Her daughter sat faithfully by her side, adding details and weaving the story through the generations of their family. Many of the stories had a common theme: faith. Her faith, along with her body, had lasted almost a century.

As her story came close to the present time, she asked if I were going to be a part of her story in the operating room the next day. I told her I would be there. Before I left to see my other patients, she took me by the hand and asked me to pray with her and her daughter. We all joined hands and bowed our heads together. As I finished and headed out the door, I looked back to hear her say, “That was the best part of this whole afternoon.”

The surgery went as expected. The closure went as expected. I waited at the foot of her bed in the recovery unit. When she woke up, she looked around and asked where I was. I stepped to the head of the bed, gently took her hand and told her I’d see her later on when she was back in her hospital room. She nodded at me then nodded back to sleep.

The surgical pathology came back as expected. The team knew what to expect. What we didn’t expect was what the patient would say later when she woke up with a confirmed diagnosis of metastatic cancer. The team came into her room with soft explanations of how bad her cancer was. But she was an otherwise healthy nonagenarian. Chemotherapy, radiation, future surgery — she had options! She took a moment to process all we said.

“Quality over quantity. I want quality of life over quantity of life,” she responded.

I looked into her sunken yet bright eyes and saw she spoke these words from a place of peace. This fragile woman, whose body was invaded by uninvited cancer, chose no further treatment. The team was taken aback but respected her wishes. After we left the room, I told the team how I had listened to the patient and her daughter extensively the day before and how she believed she had lived a full life. She felt that pursuing further cancer treatment would not help her live her final days to the fullest. Armed with this knowledge, the timbre of the conversation was different when we returned to the room. The surgeon’s voice was softer, offering palliative care and assistance with hospice when the time came. We finally saw the patient how she wanted us to see her. The family all smiled with soft eyes as they prepared for the journey back to their home in the Appalachian hills.

I transported the patient down to the main entrance and helped her into her car. She hugged me as tightly as her feeble arms could kissed my cheek, and whispered, “I couldn’t have done this without you,” as a tear fell from both our eyes.

We wouldn’t see each other again in this world, but I see her often in my mind’s eye. And when I think about the time I spent with her, I realize she taught me how to look beyond a patient record, radiology image or pathology report. She taught me to see patients through another set of eyes and hear their heartbeat for what they are truly trying to say.

Just as Henry David Thoreau said: “Could a greater miracle take place than for us to look through each other’s eyes for an instant?” I looked through my patient’s eyes. What I saw was a beautiful life, a loving family, and peace at the end of a road well-traveled. And I am a better human for it.

Jeffrey Cannon is a medical student and can be reached on Twitter @jcannon1993.

Image credit: Shutterstock.com

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