Wednesday, December 24, 2008

Getting in the sterile field

This is an old story, very unexpectedly resurrected by a near-stranger. A few years ago, as an oncology fellow, I was on an outpatient "float" rotation over the Christmas holiday week. What I thought this meant was short hours, no call, and no eternal rounding on the inpatient service. Hooray! What it actually meant was that all of the attendings were on vacation, so I was double-booked or triple-booked with procedures on their patients to be done--tapping malignant effusions from this space and that one and instilling chemotherapy in some of them--and that I wouldn't eat lunch or usually even get to the bathroom during my workday for the entire week.

One of the patients I met that week was a woman I'll call Sara, a nonsmoker in her 40s with lung cancer and carcinomatous meningitis. She was getting intrathecal chemotherapy instilled into the Ommaya reservoir in her brain three times a week...and this week, while her attending was skiing in Colorado, it was my turn to do it.

As you can imagine, putting chemo into someone's brain is a tad unnerving. The sterile field is no joke. Enough said.

Sara was a delightful young woman but very scared of needles. Sara's husband was an extraordinarily hairy, extraordinarily affectionate guy. Though I had never met them before, it was obvious they were MADLY in love. They had been married for 7 years, as they told me in a giddy voice at some point, but they looked like honeymooners--nuzzling noses, rubbing each other's shoulders. It bordered on inappropriate for a clinic waiting area, but I figured: hey, she's got metastatic cancer; they can do whatever they want. I certainly wasn't going to say anything about all the physicality....

except that it was almost impossible to administer her intrathecal chemotherapy. Over and over, I would sit her up and prep and drape her upper half. At the moment of truth, dose measured, name and history number of the sticker double-checked against her hospital bracelet, syringe full of chemotherapy approaching, his big hairy hands would grip her cheeks through the drape, and he would plant a big kiss on her forehead and say, "It's just one more small needle, hon, and it'll be over in a few seconds" or "I love you so much. You are the strongest woman I know." On more than one occasion, he actually lifted the drape with those big furry hands and said, "Baby, how do you manage to look so beautiful without a single hair on your head?" He looked lovestruck every single time I saw him, as though he would die if she had to be draped and therefore out of his sight for another minute. Over and over, I explained that this was the brain we were dealing with. Over and over, I explained the sterile field and how you really couldn't get in it, seriously. Over and over, he couldn't resist--or, more precisely, couldn't resist her. Every single time I saw her that week--three visits in all--it took at least 3 tries to seal the deal and instill the chemotherapy into her brain. Though I will admit that it drove me crazy at the time, particularly on the busiest days, I always walked away from those visits kind of smiling to myself.

I learned 2 or 3 weeks later from Sara's attending that she had passed away. She was sitting on the toilet one morning and just fell over dead. Her husband was so grief-stricken by the realization that she was gone that he just held her on the bathroom floor until she was cold and it was dark outside, and then called 911. By the time the ambulance came, she was clearly long-deceased, and they did nothing more than give her (and him...in the back, lying on the stretcher with her) a ride to the hospital. Apparently it violated their policies, but apparently they couldn't say no to him. Huh.

Though I didn't know either Sara or her husband well, I was absolutely overwhelmed by their love. I have cared for a lot of cancer patients and their families at the end of life and witnessed love under the magnifying glass of impending death more times than I can remember. But Sara and her husband were different somehow. Their love was truly unconditional, timeless...raw and unstoppable.

I'm not sure why, since I really didn't know him, but I decided to write him a quick condolence card. It was a completely nondescript card from a box of generic condolence cards--a sad reality of life as a medical oncologist that we buy the bulk condolence cards in packs of 10 or 25 the way others buy their generic thank you cards--but it's the thought that counts, right? As I wrote and reflected on why I had been driven to write to this near-stranger, the words just kept coming. It ended up having 2 or 3 extra pages (all on basic white paper from a Staples 500 pack) added, folded up inside the card. Unleashed, the letter morphed out of my control--as I recall, there was talk of great loves and young life inexplicably cut short and spirituality. I never got any reply. I hadn't really expected to, but I nonetheless wondered if I had overwhelmed him (did he even remember who I was?). Eventually I let it go and kind of forgot about the letter and Sara and him in the deluge of loss we face in oncology.

Years passed. On a random busy December day, I was in clinic and one of the front office staff came to get me, saying I had a visitor. It was Sara's husband. I didn't recognize him at all at first. He had cut his previously longish hair very short and shaved off his full mustache and beard since I last saw him. He looked tired and old for his apparently middle-aged age. As I approached him, I searched his face for clues of who he might be, not wanting to deal with the awkwardness of confessing I had no idea who he was. Then he stuck out his hand--the hairiest hand I have ever felt--and it all came rushing back. "You're Sara's husband. How are you doing? I hope you're not here as a patient..." (it is a Cancer Center after all).

He proceeded to ramble, standing right there in the lobby, how much he had loved Sara, how much he treasured that letter, how much it had quieted his mind that a stranger could see how much he loved Sara, reasoning that if a stranger could be so moved by his love for her, then surely Sara must have known how much he loved her, and how that was all he could ever ask for on earth. Then he said, "We always had a bunch of photographs and knick-knacks on our hearth. After Sara died, I cleared them all off. The only thing up there now is the urn with her ashes...and your letter. Anyway, I just came to tell you that." Then he turned and walked right out the front door.

I was too dumbfounded to say anything or walk after him, but in mind, I said to him: You just got in the sterile field all over again.

14 comments:

  1. That is the most beautiful and heartwarming thing I have read in a very long time. We never know the difference we will make on someone.

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  2. Wow, thanks for that beautiful story. That made me cry.

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  3. you made me cry, too. that is such a beautiful story. thanks.

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  4. That is so beautiful. We all hope to make that kind of impact on someone's life. Thank you for sharing.

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  5. A very moving and profound story. Thanks.

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  6. "in mind, I said to him: You just got in the sterile field all over again."

    *sniffles* Beautifully told.

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  7. That is a profoundly beautiful story. Thank you so much for sharing.

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  8. What an amazing story. Years ago I too wrote a letter of condolences to a family that lost their 24 week preemie.

    I often wonder if they got and how they are doing. I'm was so happy to hear that he came back and saw you!

    The letters we write really do make a difference.

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  9. This was so perfect for Christmas Eve. Thanks for sharing.

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  10. What a gorgeous story. And beautifully written. Thank you

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  11. Oh my gosh. That made me tear up. Thank you for sharing that.

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  12. Thank you for your beautiful story. Sometimes the depth of a patient's sorrow makes me so sad that I wish I hadn't let the patient into my heart. But at the end of the day, I know that it something very special that our patients let us walk beside them in these very difficult times in their lives...It makes me once again appreciate the challenging, heart-wrenching, humbling, often frustrating job of being a physician and how blessed I am to have that duty. Thank you for your story as an additional reminder of that blessing. -OB Resident

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  13. What a moving story, and so well-written. My tears are flowing!

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  14. Thank you so much for sharing this story!
    I often wonder if what I do has any impact on others, but in the end I always realize that that's not what's important. The reason we do kind things is just that. To be kind to others, and yes, most of the time we have no idea what impact our kindness has. It's so encouraging to hear that sometimes our kind actions have a more profound effect on someone than we could ever imagine.

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