By the time most people read this, my surviving patient’s funeral will probably be over.
We first met when I was pregnant and she found out she had cancer. You might think that the combination of life and death makes patients uncomfortable, but children provide a happy connection point.
Children came into our lives together. As I was learning motherhood, she began caring for a grandchild whose mother was not feeling well. Cancer on the one hand, full-time parenthood (as a grandparent) on the other. She took both at her leisure without complaining.
The situation suddenly became worse. Her cancer worsened and the grandchild required permanent care. She had no choice but to do so developing a singular focus during her visits: staying alive for him. She loved him with a burning intensity that made her eyes shine and her voice tremble at the thought of him being left without her.
This expectation weighed heavily on my shoulders, and I suspect this is exactly how she wanted it: to know that the well-being of a small child depended on my every move. As her illness progressed, I read more, listened more, and worried more. I had to keep her alive And Good.
It was a joy to get her out of the waiting room: a petite woman, tucked into a corner, dressed in simple but beautiful clothes. Never on her phone, sometimes with a book, but often content to observe the traffic in a cancer clinic as if she had nowhere else to be.
Her interest in the outside world led to memorable conversations.
Over the years we’ve talked about books, fashion and friends. She silently taught me about the sacrifices of parenthood. Over the years I have told her that I admired her dignity and courage in the face of a terminal illness.
In her most vulnerable moments, when she couldn’t catch her breath, she expressed fear—not of death itself, but of physical suffering. For this, she suggested that, just as she entrusted her life to me, I should ensure her peaceful death. All these years I have shouldered this responsibility with care, because I knew very well how poor end-of-life care is for far too many patients.
When evolutionary biologist Stephen Jay Gould was diagnosed with cancer, his oncologist told him not to read the literature (which he immediately did) only to discover that the average survival for peritoneal mesothelioma was eight months. Three years later he wrote a striking essay entitled The median is not the message in which he explained that statistical averages are at best abstractions that do not take reality into account.
Twenty productive years after his initial diagnosis, Gould died of another form of cancer. When it comes to forecasting, I know what he meant by appealing to “our real world of variation, shades and continua”.
When my patient’s cancer returned, she got five years. Five stretched to seven, and then ten, and then she was a statistical anomaly. This was satisfying enough, but of course something else happened in parallel. Every year she lived, her grandchild grew a year older. The baby learned to walk and talk, tie his own shoes and go to school.
My days include memorable patients, but I have rarely met anyone more calm. During many hundreds of hospital visits, I met her husband once and never met her grandchild. She came only to receive good news, bad news and terrible news, explaining that her husband had his hands full at home.
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Over the past nine months we saw fewer and fewer opportunities for meaningful interventions. The cancer became stubborn and turned its nose up at every idea I had. In one of our last conversations, she asked if it was better to receive chemotherapy or spend the remaining days with her grandchild. By this time she was weak, feeble and easily out of breath. That she entrusted me with such a consequential decision felt both burdensome and moving.
We discussed the idea of time poisoning, and she decided that if she could no longer live, the best thing to do would be to live better.
Her absence from the clinic was palpable, so I set a weekly reminder to call her. She was surprised and delighted that our entire team was still thinking of her, and even when talking became difficult, she graciously thanked me.
Last week her husband answers her phone, my greeting gets stuck in my throat.
The silence seems endless before he tells me that she died peacefully after falling unconscious. Somehow I never thought this day was possible.
He adds the usual nice things that decent people do, but what I appreciate most is her observation that our relationship has never felt transactional. In a place where every consultation feels rushed and the price of failure is high, this posthumous tribute feels as magnanimous as she was in life.
Her funeral coincides with my clinic. I’m afraid I won’t make it in time. Sometimes they read my columns together, he says; I ask if I can write one in her memory. Yes, he laughs, as long as I can read it to her at her funeral.
I write late into the night and the editors take care of the rest. I work with human people.
I hope to be present at the funeral to say a final goodbye to our entire team. But if not, she would laugh forgivingly that I had sent a column in my place.