Listen and subscribe on , , and , so you don't miss the next episode. And if you like what you hear, a five-star rating goes a long way in helping us share the story side of medicine!
This story is from the Anamnesis episode called At a Loss and starts at 3:00 on the podcast. It's from , medical director at The Center for Hepatobiliary Disease at Mercy Medical Center in Baltimore. Following is a transcript of his remarks:
Making a New Friend
Several years ago, I got a call from a local medical oncologist I didn't know. We'll call him K. He had read about me in our cancer center online, had asked around, and wanted to come see me. He was cagey about why and I didn't press him. He came late in the afternoon and was escorted to our clinic by the front office team. He was a small man, late 50s, Indian, and deeply jaundiced. He was quiet. He had only a few questions. "I haven't seen many people do well with pancreatic cancer. Have you?"
I dove into my usual discussion of prognosis and treatment options, types of complications, and side effects, etc., when he interrupted me. "Yes, but what would you do? We both know these things work for only a few people." I never liked this question. None of us are the same. We can't predict how we will respond to a treatment, what we'll tolerate, or how we experience benefit. More time is not always better. I hesitated to answer. "Well, I would try for my family, see what I could get." He nodded, looking at me straight in the eye. "OK."
I offered him an admission to get imaging in a workup, which he accepted. We got him in and made the diagnosis of a borderline resectable adenocarcinoma in the head of the pancreas. We started him on neoadjuvant chemotherapy, followed by chemo-radiation, and he underwent a Whipple operation.
Over the next few years, he sent me many patients and we grew closer with frequent phone calls and shared patients. He was a family man with a younger wife and children. I was also friends with his nurse practitioner because she had previously worked in our office.
Life Goes On
Life went on quite happily for about 4 years. Over the past year or so, I was coming to a decision point in my career. I had built a strong hepatobiliary and pancreatic program over 10 years, and recruitment efforts began from outside institutions.
Ultimately, I made a decision to get back to my hometown. I had a good offer and it got us closer to family and friends. We let my patients and referring doctors know what was happening. I spent the summer winding down my practice and preparing for the move.
A few weeks before I was to leave, K called. It seemed he was having trouble eating and had started to lose weight. I offered to admit him for a workup, but he didn't want to come in at first. He was worried about what we might find out. The next day he called back, asking to be admitted.
When he arrived, I was so sad to see what had happened. He was emaciated. He was jaundiced again. His abdomen was swollen. He had widely-metastatic disease, liver failure, and acute renal failure from dehydration. His wife was quietly sobbing at his side. He could barely keep his eyes open.
"I got your letter. I'm sorry you're leaving." "Thanks for saying so, but right now, my friend, I'm mainly worried about you." Silence. He looked at me steadily for a few minutes. "Anything we can do?" He asked quietly.
"Well, let's get you hydrated and see if you can eat, and I can get our medical oncologist to come by and see you. We can try some chemotherapy, but it's not clear to me if that will buy any time at this point or just make you sicker." He closed his eyes.
His wife started to talk. It was hard to understand her. She was obviously distraught. Somewhere in there, it was clear she was begging me to save him. I walked over and took her hand. I wasn't sure what to say. She wasn't letting up, however, so there was no way to say anything. I just let her talk. After a few minutes, he raised his hand to quiet her down. She trailed off. "What about TPN? We can do that." I knew he knew better. "OK, let me think about it."
I swung by his room before leaving the hospital that day. He was alone. "Hello, my friend," I said. He smiled. He beckoned for me to sit. Pulling the chair close to the side of his bed, I sat down and put a hand on his shoulder, bony, and bird-like. There's something about people at this stage. They feel extraordinarily light as if their bones had hollowed out.
I'm Hurting So Much
"I think I should go to hospice." "I think so, too." "She won't understand, but I'm hurting so much." "I'm sorry for that. Are we giving you enough pain medication?" "I don't want any more than what I'm getting. I can't stay awake as it is." He closed his eyes. I stayed there for several minutes. With a pat, I stood up and went to the door. "Can you get my nurse, please?" "Sure."
The next day I saw him in the afternoon. Hospice had been arranged for him. I told him to call me if he needed anything. A few days later, we learned of his passing during a busy clinic. My nurse took me aside between patients to let me know. We said the usual things and forged ahead in clinic. "He's at peace," we said.
"You Gave Him Hope"
On the day before I left my former hospital, my cellphone rang. It was K. I answered. His wife's voice, torrential, "Dr. Bose, it's K's wife. Sorry to bother you. I hope I didn't alarm you by calling on K's phone. I just wanted to call you and thank you. My daughters and I had so much hope when we met you a few years back. You gave him hope. I thought he was cured. I thought he would be one of the lucky few. Now what am I to do? I'm alone. My daughters are with me. I'm sorry, I called to thank you. God bless you. Keep helping people, OK? Just keep doing what you're doing. Keep trying. He loved you. He said you would always take care of him. Keep well, OK? I'm sorry, I can't talk anymore."
"Will you let me know if there's anything we can do to help you?" "OK, OK. I'm all right. Just hard. Be well, OK, and thank you. Bye-bye." "Bye-bye." "Bye." Exhale. I sense my own conflicting thoughts and let them linger, then pass, paused before I answer the phone again, ringing now with questions from the office.
The next day, after seeing my last clinic patient and signing my last note, I took off my badge from the lanyard around my neck. I set my office keys down. I took my lab coat off and set it on the chair. I walked out into the hot August sun and then I headed home.
Check out other stories from the Infectious episode including "A Broken System Killed My Young Patient" and "What Could I Have Done Differently?"
Want to share your story? Read the Anamnesis Storyteller Tip Sheet and when you're ready, apply here!