Abstract
It was an early April morning and my team had just taken over the inpatient service. I gently knocked on my new patient's door and said, “Hello, good morning, sir.” “Morning,” fuzzily replied a frail young man. Briefly, I introduced myself and promised to return later. Soon after, upon reviewing his case, I learned that he was an unfortunate young man, only 25 years old and from south Texas, who had failed his induction chemotherapy for acute myeloid leukemia. He was being enrolled on a new experimental study protocol of therapy and, mostly, of hope. Sadly, his teenaged wife had just separated from him a week earlier and took away his almost-two-year-old son. I felt frustrated. His story was painful, and yes, awfully unfair.
He looked a shadow of his picture on file. The aggressive chemotherapy entirely knocked him out and left him disabled with severe mucositis and intractable diarrhea. For days he spent most of his time in the bathroom. He kept a calm demeanor, though, and a very faint smile.
When he felt somewhat better, he begged my attending to let him go to celebrate his son's second birthday. We arranged with his father for an ambulance to take him home so he could be present at his son's second birthday. However, he was transferred back to our emergency department with harsh signs of sepsis and required admission to the intensive care unit. I saw him the next day. He looked disheartened, felt lonely, and was scared of tomorrow. His therapy had been judged to be unsuccessful and he declined spectacularly.
Upon seeing him the next morning, his diet had been restricted to ice chips. With a desperate smile, he asked for oatmeal. I explained that this would be unsafe due to the condition of his bowels. He was looking worse every morning. I felt at times that I couldn't fake a smile anymore so I would sometimes stand by his beside quietly and hold his hand for comfort. He used to tell me before I left the room, “Thanks man, I appreciate it.”
The last time I saw him was a sad sight of him trembling and clammy; his bed was covered in stools and diarrhea had blasted the entirety of his room. I told him that I would come back, then asked how he was feeling. He could barely open his mouth because of the pain but he mumbled, “I'm fine and you?”
The next day I was in his room, rushing to finish my notes before presenting his case on our morning rounds. I was wearing a gown, gloves and hiding my face with a mask, as he was under isolation. It was then that his room phone rang, so I answered it because he wasn't able to reach. It was his mother calling, and then asking if he had died. I responded “NO,” and inquired why she would ask that, before handing the phone to her dying son. He was tearful as he told his mom that the doctors weren't sure how long he had to live. I had to hold myself and stay strong; I was tearful too and felt frustrated that this young man would have to suffer such a fate.
With mixed feelings of hopelessness and helplessness, the team met with his father and judged that we had used all our weapons. We had to explain that his son's leukemia was refractory and there were no more therapeutic options available at that point. In spite of himself and his usually silent demeanor, the father expressed his sorrow and cried. He was so distraught by his son's impending death that he reported our medical team to the patient advocacy board. He felt that we did not do a good job, as we had offered his son an experimental therapy at the salvage round of chemo. We met with the father again; he was very sad, tearful, and did not have much to say.
The next day was my day off. My colleague sent me a sign-out list of patients the day I returned. When I did not see my patient's name on the list, I asked what had happened. She said that the family decided to transfer him to south Texas so that he could pass away peacefully at home. Two days later I found out that he had expired. It was only two months from his diagnosis to his death. This sad experience greatly impacted how I would view tomorrow. Later on I told this story to one of my attendings. He answered me, “Don't mourn your patients, they have their families to be sad about this.” He advised me to fight their cancer and try to cure it through hard work and by advancing science. This was especially heartbreaking, since my attending himself was battling an advanced cancer.
I am not sure what more I could have offered. Sometimes, when I smiled and held his hands, I felt that my patient appreciated my attempts to comfort him more than my routine work. This experience has changed the way that I will celebrate every event of my life, especially the second birthday of the son that I hope to have one day. What I have learned from this patient is that though tomorrow may never come, it is always worth fighting for. As I think of his two-year-old boy, I wish for my patient that he rests in peace and wish his son a future where we have found a cure for all cancers.