Avoiding Death on Rounds

Overwhelmed and on the brink of tears, I walked down the hallway slowly. My legs felt heavy as lead and I was breathing rapidly. I had enjoyed my time with her almost every single morning for the past three weeks, but today I was dreading our encounter. My mind was racing, trying to figure out how I could avoid rounding on her that morning. Defeated, I took a deep breath and walked into her room on the fifth floor of the medical tower. “Good morning, Mrs. M.! How are you doing today?” I said halfheartedly with a fake sense of cheerfulness to hide my inner despair. To my astonishment, she was propped up in bed watching the morning news with an empty container of Italian ice on her hospital tray. “You know, my grandson was acting up today in school,” she stated matter-of-factly with a scowl on her face. “He obviously misses his father and is looking for attention, but he was so mean to a little girl in his class!” I looked at her quizzically. Why was she telling me this? Was this not the least of her concerns? Confused, I went through my usual routine: “How did you do overnight? Any fevers or chills? Any nausea? Any vomiting?” I hesitated. “How is your pain?” She started laughing. “My nausea is much better. Yesterday I had a few lemon Italian ices, which I loved. It's so nice to finally eat some real food! I'm about to ask the nurse for some other ones this morning. I wonder what other flavors they have!”

I was in shock. I stood there awkwardly, nervously rolling my red surgical clogs from side to side. Meekly, I mumbled, “Can I take a look at your belly?” I lifted up the bed sheet and looked at her protruding abdomen with its large midline vertical incision and spaced out retention sutures holding the parts of her abdominal wall together. Almost robotically, I went through the physical exam. Then it all came back to me. What do I say? How do I act? Does she know? Do I, the medical student of all people, have to tell her? Mrs. M. had end-stage ovarian cancer. After holding her hand as we rolled her to the operating room, I scrubbed into her surgery and watched in horror as we tried to find an outlet in her abdomen to reach the large hiatal hernia that was contributing to her nausea and protracted vomiting. Several hours later we realized that any which way the surgeon would slide her hand, all she could find was cancer. There was no outlet.…There was only cancer, resembling a vicious white cement plastered throughout her abdominal cavity—an image that will forever haunt me for the rest of my career as a physician.

I guess Mrs. M. could see me struggling to hold back tears. She looked me in the eye and said, “Don't worry. I know and I'm ready. I'm happy. I knew this day would come. But, look, I'm so incredibly lucky—my family is here! They all came to visit me. Even my son…I haven't seen him in over a year! All the people most important to me are right by my side.” And that's the first time I really looked at her that morning, not as a postoperative surgical patient with a terminal illness who needed my pity, but as a loving, courageous woman who understood and accepted her body and her disease in a way that I never could (even after looking inside her body).

In retrospect, that morning, rather amazingly, actually, she looked the best of any of the nearly 30 days I had been following her in the hospital. She was smiling and appeared calm. A faint blush could be seen on her cheeks and her dark eyes twinkled in the rising sun. She held her bald head up proudly and continued chatting with me about her grandson. I was both amazed at her and ashamed at myself. Why had I been so apprehensive to see her this morning? Why had I been so convinced that she needed my consolation and comforting, when it had actually been the other way around? Why, as physicians, are we so terrified of admitting that our patients will die and that, sometimes, they will even die under our care? Mrs. M. didn't fear death, but rather accepted its reality with fortitude and serenity. Mrs. M. didn't need my sympathy, but rather provided me with solace, kindness, and a sense of peace. Mrs. M. was my first patient to die, but I certainly won't remember her for that. Instead, she'll always be the patient who taught me never to avoid death on rounds.