It was a beautiful sunny day outside and yet I dreaded getting out of bed. Although I've almost always enjoyed working, this was one of those days that put the "almost" in that comment.
Suzanne, one of our patients being treated for breast cancer, was coming in for the results of her CT scan, and the report was not good.
The mass in her lung had expanded, and there appeared to be some new bone metastasis on her ribs.
She came in with her mother (thank goodness) and her three-year-old daughter.
"It could be a long wait," the receptionist said to her. "you may want to take your daughter to the Magic Castle."
The magic castle is a supervised play center we have at the hospital for children of patients attending oncology clinics. Someone noticed a while back that not everyone has access to childcare, and so for some, attending oncology appointments was dependent on whether or not they could find a sitter.
A wonderful donor allocated some funds to create this amazing space for the children of parents who needed a little help in that regard.
I watched the little one run off with her grandmother, and we asked Suzanne to enter the clinic room.
We asked if she wanted to wait for her mother to return, and she said she would prefer not to as she had some questions she wanted to ask.
"We'd like to share the results of your scan with you" said the doctor. "It looks like the cancer is getting worse, despite the chemotherapy."
I felt my eyes start to burn with tears and looked hard at the ceiling to reverse the process.
The doctor talked some more; he spoke of trying a different type of chemotherapy, even though this was already her second-line chemo. He also talked of palliative care and advanced directives and comfort care. He talked about a lot of things that I don't remember because my primary focus was to ensure those tears stayed away.
And then he left.
It was just me and Suzanne, a wonderful strong woman who had been through a lot.
She was divorced and had sole custody of her daughter. She'd had a rough go with first-line chemo and suffered with horrible nausea and vomiting, only to find it didn't work. Now she had failed second-line chemo, too.
"Do you have any more questions you'd like to ask?" I offered.
"Just one thing -- can you tell me how I will die?"
I was at a complete loss. How would she die? I thought to myself. There were many possibilities, but none that were certain. What the ultimate cause of her death would be was something I just couldn't answer, and it was a question I had never anticipated.
"I really don't know," I said to Suzanne. "Is there a reason you are asking that question?"
"Well, as you know, I live with my daughter. It's just the two of us at home. I don't want her to come looking for me some morning and find me dead. I'd like to have some warning. I'd like to know when I should arrange for her to be somewhere else."
To me, these were things only a mother would think to ask when being dealt such a nasty blow.
She wasn't worried as much about dying as she was about her daughter's well-being, and she wanted to make sure her daughter was safe both physically and psychologically.
"We'll keep a close eye on you," I said. "We'll monitor you regularly and let you know how things are looking. We'll be available by phone if you ever need to get in touch quickly. We'll always be honest with you. I can't answer your question today, but I can help you by giving you lots of information along the way."
And then we both cried, for a very long time.
Suzanne died several months later. I was relieved to hear she passed away on the palliative care unit with her family close by.