This past week, while considering the many, many things for which I am thankful, I thought about the extraordinary experiences I have had as a cancer physician. There are so many people and stories I recall, but two in particular, which occurred while I was in my training, provided lessons that could never be found in a book.
The first story is of a young man in his early 20s with recurrent leukemia who had developed a bad pneumonia, and was in the ICU on a ventilator. He was alert but unable to talk due to the tube in his throat.
My attending physician asked me to get a bone marrow biopsy to see if there was active leukemia since this would impact on how aggressively we would treat the leukemia. I explained to the patient that I was about to extract a sample of bone marrow from the breast bone (we usually get bone marrow from the hip but were unable to do so because he could not roll over). When I finished the procedure, I told him I was sorry if I had caused him any pain. He shook his head “no” and gave me a thumbs up sign.
Sadly the bone marrow revealed the leukemia was still very active. We explained to the patient and his family that there was little more we could do about the leukemia at that point. He called us into his room soon after and handed us a note that said he wanted us to remove the breathing tube so he could talk to his family during his final hours, even if it shortened his life. After some discussion of the ethics of removing the breathing tube, we honored his wish, and stood aside while he and his family exchanged hugs and tears and expressed their love for each other.
He passed away the next morning, but the family was incredibly grateful that he was able to talk to them in their final hours together.
The second story is about a woman with advanced lung cancer who I had cared for in the clinic. On this day she arrived in our emergency room unable to breathe. She had been through chemotherapy and radiation therapy, and there was little more we could do to shrink the cancer. In fact, she was receiving hospice care at home and previously had decided against heroic measures.
Through her gasping breaths she told me she had changed her mind and wanted us to help her breathe even if it required a breathing tube in her throat, even if it would only extend her life by a few days.
This was very much a change in character from the woman I had come to know in the clinic, and I asked her why. She told me she had arrived in the emergency room with her only daughter who was in labor with her first grandchild. The goal the patient had set for herself, which kept her going during her cancer therapy, was to live until she could hold her first grandchild. She did not want to give up on that goal now.
We followed her wishes and put her on a ventilator. Sure enough, about 8 hours later and two stories down, her daughter delivered a healthy baby girl. It took some doing, but we arranged for the mother and newborn to be brought up from maternity to the ICU for a visit with Grandma.
Our patient passed away about two days after having held her granddaughter. One last twist to this incredible story was that we had to be sure the medical record was clear, since the baby had been given the very same name as her grandmother, and was discharged from the hospital the same day her grandmother passed away.
When I think back on these incredible stories, I do not focus on the tragic outcomes. I think about how privileged I was to be part of them, and how much I learned from these remarkable patients and their families—both about how to be a doctor and about why to be a doctor. For that, I am forever thankful.