Abstract
Ms A, a sweet lady in her 40s was admitted to our team with abdominal pain about three weeks ago. CT imaging of her abdomen revealed new masses. Ultrasound-guided biopsy of her periaortic lymph nodes confirmed a high-grade metastatic adenocarcinoma. No primary site could be identified. She was initiated on the first cycle of chemotherapy but her clinical status deteriorated rapidly with worsening dyspnea, diarrhea, intermittent fevers, and loss of appetite.
Prior to hospitalization, she lived with her significant other (and health care proxy) Mr. B, for the past 26 years. She had three children in their teens and three very loving sisters. I watched Mr. B take care of her tirelessly everyday for long hours. Nurses told me that he had almost moved in with her in that small room.
When her condition didn't improve in spite of our best efforts we proceeded to discuss with her and the family her fragile health, guarded prognosis, and the futility of further chemotherapy. These revelations were very disheartening for the whole family. We consulted the palliative service as well and, as part of the team, I attended my very first family meeting. During the meeting my attention was even more fixed on Mr. B than Ms A, as I could see the agony and fear in his eyes in the wake of these developments. I realized that in its true meaning, “death” is not only difficult for someone who is dying, but more so for the loved ones left behind. As the meeting progressed Mr. B's words made an impact on me in a way I could never imagine. He had but one question in the entire discussion. He asked me how much time his fiancée had and if he could marry her over the weekend, two days later. Everybody in the room was taken aback, but he maintained that this was what he wanted to do. They loved each other and this was a commitment he would affirm through the most difficult of times. Ms A was emotionally overwhelmed after hearing his words and expressed her earnest desire to get married.
Later that night she developed severe respiratory distress. A CT scan of her chest was performed to reveal a new massive left pleural effusion. She was determined to fight it out, as she wanted to live for two more days. She maintained full cardiopulmonary resuscitation as her advance directive and, subsequently, a chest tube was placed for drainage.
Finally the day arrived and I could feel the palpable change in the atmosphere of the whole floor. Everybody including nursing staff, interns, and medical students alike were very excited about the wedding ceremony. As the team leader I was trying my best to maintain my composure and carry on with morning rounds. As time passed close family members began to arrive. One of our nurses did Ms A's hair, while another helped to dress her in her wedding gown, keeping the chest tube securely in place. The others decorated the entire floor with flowers and balloons. The social worker arranged for the chaplain for the wedding ceremony. Pictures were taken by one of her sisters. I rushed in soon after rounds to congratulate the newly wed couple.
Over the next few days, very surprisingly and defying all previous assumptions, she began to improve symptomatically with significant resolution of her diarrhea and dyspnea. Marked amelioration of her clinical and functional status persuaded the oncology service to reconsider the plan for a second cycle of chemotherapy. Was this an expected improvement after the first cycle of chemotherapy? Or was this a reinstitution of the strong desire to live, stemming from the love and reassurance of her marriage? Perhaps it was both. Surely this experience was one that not only touched the married couple, but everyone who stood witness to what they shared, bearing truth to the words of commitment, “in sickness and in health.”
As I sat there in my chair reminiscing on events, a nurse's voice startled me out of my thoughts. “Good to see you vertical,” she said. I looked up and realized that the lady just walking past me was Ms A. Although the battle ahead of her still remained, here she was, walking proud, with a desire to live and to love, and I feel like we all learned from her. True, we all did our part to make a difference in her life. Perhaps, however, she has already returned the favor; she has made a difference in ours as well.