A letter to a cancer patient in palliative care

I heard about you a few times before I ever met you in person. It was my first day on the palliative care service — a week that felt like a relaxing break from the sixteen-hour days I was used to on surgery. Many people don’t know what palliative care is. But I suspect these days if you are still living that you know it well.

I first heard of you during rounds that morning. Palliative care rounds look different than surgical ones. Instead of rushing around the hospital at 4 a.m., we leisurely discussed our patients over coffee, huddled around a tiny wooden table in the team room. Most everyone is a sad story on palliative care, but you were especially so. I’m sorry to tell you this, but when my attending introduced your “case,” or introduced you, I should say, his opening line went something like, “This guy is so f**ked.”

We talked about how much weight you had lost, how young you were, how you had six children at home. We also talked about your PET scan, biopsy results, and the dread of not knowing what you had, but knowing that whatever it was, it was bad-bad-bad.

I wonder now if you knew how dire things were during those days in the hospital when no one could tell you what was going on. But you were sick. You must have known that — with your weight loss, weakness, all the tubes, and machines. I mean, you knew it was bad, right?

The next time I heard about you was outside your hospital room on my way to visit. Your nurse told me in a hushed voice that you were such a “sad case.” She told me you were tough.

I admit, what came to mind when she said that was that you were the “tough-eager-and-ready-to-fight-cancer” kind of tough. When we finally met in person, though, I realized you were more “tough” — as in, impenetrably so — to the point where we don’t know what you’re thinking or how to help you or what to say. Palliative care doctors are good at these things, but I suspect you remained a “difficult case.”

I tell you, working in health care is strange. We acquire this new dialect that consists of calling people, including you, “cases.”

You were a sad case, a difficult case, an interesting case, a tough case … of what, we didn’t even know. We couldn’t give you a specific diagnosis, but we knew you were a 30-year-old man with six young children. We knew you had a wife you hoped to celebrate five years of marriage with soon. We knew that you were scared and were dying. You were in a situation so painful the nurses whispered when they spoke of you. I suppose “case” was just a little shorthand for all of those things.

I’m tempted to say that when we finally met that we connected on some kind of deep level, but I don’t really believe that to be true.

I think you just enjoyed the company. And I got to be one of the people entering your room that didn’t need anything from you. I didn’t poke you, examine you, ask you to rate your pain, nothing like that. In all honesty, I don’t remember much about our conversation. I remember how angular you looked. I remember you telling me you just got back from smoking weed outside, which was, of course, fine with me. You told me a little about your kids and how your wife worked two jobs to take care of them. Now she bent over backward to take care of you, too.

You had flowers in your room. They were from the hospital. You won the award for being sick enough to receive hospital flowers.

(There’s a very limited supply, you know.)

We talked a while longer. You smiled easily and had a big old gap in your front teeth. Your family was coming tomorrow, we planned to re-convene then.

My attending and I continued on with the rest of our rounds, seeing dying people in the hospital, trying to make them feel better while they died. As I trailed behind him up the concrete stairwell, I remember saying, more to myself than anything, “Hmm, that’s sad. I like that guy.”

(I was talking about you.)

He craned his neck back toward me and kept walking. “I know, sad, isn’t it?” he replied. That was that.

I often think about what drives us in the healing professions to write about patients so repeatedly. I suppose it feels good to say thank you, or to express gratitude for letting us share in your stories, for letting us be with you, for giving us a place in the world. I’m not sure if I can say thank you this time, though. Because you didn’t find yourself here, in your hospital bed, to teach any lessons to young medical students about life, or impermanence, or love, or anything like that. So, I wasn’t sure what to say — I just thought I’d say something.

Alison Vasa is a medical student. 

Image credit: Shutterstock.com

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