Gina: When the patient heals the Doctor
I was surprised to see Gina standing up, beaming at me as I walked into the examination room. My resident doctor had just given me an overview of Gina’s case. Ten years ago I had treated Gina, then age 60, with radiotherapy when she had early breast cancer. Gina had been well all those years until a couple of months ago when she developed a nagging cough and shortness of breath walking up stairs. Her doctors had found an egg-sized lump in the middle of her chest and a biopsy confirmed that her breast cancer had returned.
Gina extended her arms out towards me, her voice warm “Oh, Dr. Rutledge, I was so happy to learn you are going to be my oncologist again. Can I give you a hug?” She had lost weight and looked frail. Her golden hair had thinned markedly but she still had a twinkle in her dark brown eyes.
We held each other tight for a moment then she looked me up and down “You haven’t changed a bit. What’s your secret? Must be something wicked!” she teased with her Newfoundland accent. I winked at her “Hanging out with people like you.” We bantered back and forth before getting down to the business of making plans for radiotherapy to this lump in her chest. Gina seemed completely at ease – she was more concerned with the inconvenience she’s causing to her daughters then her own health.
That night I got a message from the emergency department that Gina had a mild heart attack and was admitted to the coronary care unit (CCU). The plan was to get her well enough to deliver radiotherapy. But the news kept getting worse as the week wore on. She needed to be intubated one night, and, though the tube was out, her breathing hadn’t improved. The cardiologist asked me to sit down with Gina and her family at the bedside. I would have to decide to try emergency radiation, or tell Gina and her family that we would simply keep her comfortable.
The CCU room is crowded. I sit at the bedside while one of her daughters stands beside me rubbing Gina’s back, and four other adult children sit in a semi-circle of chairs across from us. Gina is struggling, smothered in a mix of tubing, probes, and an oxygen mask. Her breaths are coming fast and hard, sweat forms on her furrowed brow. “Can I have something to calm me down”, she pleads, eyes widening. “I feel so short of breath”. The resident doctor tells her that if they give her Ativan she won’t be able to stay awake and listen to what I have to say.
Feeling like I need to get some key information in fast I launch into a quick barrage of statements. “Your breast cancer has come back. We can’t cure you of your cancer. You’re too sick to undergo radiation or chemotherapy. I expect this lump in your chest to grow…” I look up at her oxygen monitor and watch the numbers start to fall. Gina is looking scared, shifting in her bed, trying to get comfortable. The resident doctor calls in the nurse and respiratory therapist – everyone is scrambling, bumping into each other, adjusting oxygen masks, giving another inhaler, injecting a little morphine, adjusting the pillows. I wait and watch Gina closely. Waiting.
I reach out and hold Gina’s hand, careful not to disturb the oxygen probe clasped to the tip of her finger. Gina looks over to me. I say, “I’m sorry my hands are so cold”. She winks, “It feels good. I’m too hot in this bed”. We hold hands in silence while her nurse and therapist work away. At one point I suggest increasing the amount of oxygen she is getting. I look up again at the monitor and Gina’s numbers are climbing into the safe range. Gina’s body begins to relax.
“Gina, I know this is such a difficult conversation but do you understand why we shouldn’t be treating you?” Yes, she says sadly. “I just want to get home”. I am completely honest with her. I tell her I don’t think she will get home, and later on in the conversation, that her life would be measured in days and not weeks. Our goal is to keep her comfortable and deal with problems as they come up. I look to the circle of her kids with tears in their eyes – there is so much love in that room.
Gina takes my hand in both of her hands and begins to stroke my hand lightly. We look into each other’s eyes in silence – she has such a loving presence – and our spirits meld together. And then we joke again about her never shutting up – even when she was intubated she was still writing messages to her family like telling them she’s thirsty enough to drink Niagara Falls.
I walk away from being with her filled with a sense of awe and inspiration – rejuvenated from basking in Gina’s love.