My alarm went off at 4 a.m. in the morning. I begrudgingly pulled myself out of bed, threw on some scrubs, and headed to the hospital. Not a car was on the road. It was the third week of my OB/GYN rotation, and I was on the infamous gynecologic oncology service. Rounding begins at 6 a.m. sharp, and I needed to first check in on my post-op patient from the day before. She had undergone an extensive bowel resection for metastatic ovarian cancer and I knew her prognosis was grim.
Once I arrived to the hospital, I glanced over her chart, per usual, and headed to her room. Despite waking her, the elderly woman kindly allowed me to examine her. She was frail, with matted hair and a hollowed-out face — far from the picture of health. She grimaced in pain as I softly felt her abdomen. Despite her obvious discomfort, she continued to smile weakly throughout my exam.
As I prepared to exit the room, she questioned me about the results of her surgery. It caught me off guard that no one had talked to her about this already. As a medical student, I’m far from a cancer expert, but even with my limited knowledge, I knew this patient was dying. It dawned on me that this woman did not have good insight into her condition. Consequently, I began to fumble my words and my palms began to perspire. Feeling rather uncomfortable, I replied that I wasn’t sure of the details, and that the physician would be by within a couple hours to tell her more.
As promised, an hour later our team entered my patient’s room. The woman’s daughter and pastor were now present. The surgeon began to explain how we had removed a vast amount of tumor from the patient’s abdomen, and commented that this would likely relieve a lot of the belly pain she had been experiencing. The woman seemed very pleased to hear this news and exclaimed, “So I’m cancer free?”
“I’m afraid not,” the surgeon slowly replied. She went on to describe how the cancer had spread throughout the patient’s abdominal cavity, like little freckles coating her intestines. It had latched on to her diaphragm and invaded through her abdominal wall. The surgeon presented the facts in a forthright manner, yet her face remained soft as she knelt down to the patient’s level. The surgeon looked directly into the patient’s eyes and grasped her hands as she explained what all of this meant. Despite their best efforts, this was not curable cancer. The patient’s face sank in disappointment. I could sense her daughter’s confusion, trying to process this news. “So how long does my mom have?”
Providing a precise timeframe for such a complex disease is daunting and a task that medical professionals oftentimes dread. One can never predict exactly how a cancer case will unfold. As a third-year medical student, this was my first time witnessing such an encounter and I wondered how the surgeon would reply. As the daughter asked this question, I felt my heart flutter. My body froze and I held my breath in anxious expectation. Was it best to answer vaguely or was it better to be as honest as possible, given the surgeon’s knowledge of diseases of this nature?
After a brief pause, the surgeon replied in a matter-of-fact tone, “I would estimate about six months.” The sentence hit me like a rock; I can’t even imagine how it must have felt for the patient or her daughter. This was obviously not the answer that they were expecting. The daughter immediately became hysterical and ran from the room. The patient’s face conveyed helplessness and fear and tear drops began to slide down her cheeks. Her mouth hung open, yet no words came out. The following 45 minutes were a blur. We sat with the patient, talked through her emotions, handed her tissues and discussed what her goals were for her remaining time. I stood back, watching the resident squeeze the patient’s hand. The physician offered words of encouragement, but I honestly do not remember much of what was said. My mind reeled with pain and sadness for this woman.
As I progress through my career, I hope to never forget this encounter or the people in that room. Although some physicians may have shared the painful news differently, I admired the strength of the physician as she led that conversation. I believe that family needed a direct answer, and so the surgeon gave it to them. I truly think these conversations embody the most challenging part of medicine, so I felt honored to bear witness that muggy, July morning. Although I’ll never know how the rest of her life played out, that patient will forever be in my thoughts. People who aren’t in medicine often tell me they can’t imagine memorizing all the information I must know to be a physician. I now tell them that learning the science of medicine is far from the hardest part.