One of the privileges of medicine is the chance to meet people from every walk of life—many of whom you might never get a chance to know otherwise. Of course, such meetings are never spontaneous. In medicine, we are brought together by illness, and the people coming to see me are seeking advice on treatment for cancer. With new therapies, fortunately, oncologists are now seeing patients over the span of years, and we get to know the person who is the patient beyond their illness. Many also bring along others on visit after visit, and we get to know each of them too.
Such was the case with Alice*. I had met her two years earlier after a diagnosis of advanced ovarian cancer. She came with John*, her husband, and Lauren*, her younger sister. All three listened intently as we spoke of her diagnosis and my recommendation for treatment. John took notes while Lauren listened and asked questions. Alice was silent and, in retrospect, the most frightened. Over the next year, she underwent adjuvant treatment and entered follow-up. John and Lauren always came with her.
I had learned that Alice taught music in middle school—a job she loved. I learned that John had proposed marriage to Alice right out of college and that they had been inseparable over the next 2 decades. I learned about their two children who lived far from them, but called every night to see how mom was doing. I learned that Lauren was a successful entrepreneur and that she and Alice were the only family they had left. There was a time when Lauren stopped coming to the visits; it must’ve been as Alice entered her second year of remission. I had gotten so used to seeing all three that I asked why she hadn’t been coming.
“Lauren was in a car accident,” Alice told me. “She almost died, but thank God, she made it. She’s in a rehabilitation center getting stronger.”
“Oh no,” I responded, “How awful. I am so sorry!”
“It could’ve been worse,” Alice replied. “I don’t know what I’d do if we had lost her.”
As we entered the third year of follow-up, Lauren started to join them again. She looked great, and I made it a point to tell her.
“Thank you for saying that, Dr. Dizon,” Lauren responded. “I am fine, out of rehabilitation and will get back to work next week. I can’t wait, actually!”
Six months later, Alice became bloated and experienced worsening abdominal pain. An exam suggested ascites, a sign of relapse, supported by a marked rise in her tumor markers. I ordered a scan then, and the results confirmed relapse. They had waited in my office for the scan results, too anxious to return home.
“It’s back,” I said to all three of them. John was the first to cry. Lauren asked questions. I made arrangements for a paracentesis to improve her comfort and allow her to eat, and then recommended chemotherapy.
Over the following months she cycled through many different treatments, each less effective than the previous line. She also began to show signs of the advanced cancer within her—she lost her appetite, grew more tired, and experienced worsening of nausea first, later accompanied by pain. Each time I saw her, her sister and husband were with her. They had tried to remain optimistic, but with each passing month, the look of worry on their faces became more evident.
One late evening in December, I received a page that she had been taken to the emergency room. She had had an acute onset of severe abdominal pain and nausea, and had started to vomit. A work-up revealed a bowel obstruction and evidence of free air within her abdomen—a sure sign of a bowel perforation. She was immediately started on pain medication which helped her get more comfortable. She was offered surgery, but she opted against it. She felt her time had come.
The next day I made my way to the floor to see them. It was early, so I quietly entered the room. Alice had her eyes closed, a grimace still visible on her face. John was seated by her side, looking at her intently, eyes wet. He was caressing her arm. I know it was meant to comfort, but I could not figure out if it was to comfort her, or him.
“Hi,” I said. At the time, it was all I could think of.
Alice opened her eyes and smiled. “Hi Dr. Dizon. It is nice to see you.” John too greeted me warmly.
“You too. Both of you. I am so sorry this happened. I had hoped you would have more time.” We talked some more, making sure her pain was better controlled, and that any questions John had were answered. As we spoke Lauren also came in. She looked exhausted, eyes puffed from crying. We spoke as well, and she seemed resigned to the fact her only sister was at the end of her life. The sadness was made even harder by the fact it had happened around the holidays. I tried to find a silver lining in this very dark cloud, but I could not.
Ultimately, I sat with them in silence for a few minutes and it dawned on me once more what an incredible privilege it is to be a doctor. Because of Alice’s cancer, I had gotten to know her, John, and Lauren, and her entire family. I had seen her enter remission, diagnosed her relapse, and had treated her with the best therapies I could think of. And now, I was here, with her, at the end.
I got up then to give them privacy. I walked up to her bed for what I expected would be the last time. “Alice, thank you for letting me in to your life. It’s been an honor to get to know you and John, and Lauren, as well as your kids. I promised you that I wouldn’t let you suffer, and I promise you won’t.”
She looked at me and smiled. “Thank you for everything, Dr. Dizon. And Merry Christmas to you and your family.”
“You too,” I said. It was all I could think of.
*Names and identifying details have been changed.