"I think his love for you has to do with more than just your appearance. It probably has much more to do with all of the feelings and experiences you have shared."

"That's easy for you to say. You're still young and beautiful," she replied. "You just don't understand. He doesn't look at me the same way. He doesn't want me anymore. He doesn't want to make love to me. He's here only to take care of me. What do I have to give back to him? Once he was so proud of me, but now I'm a disgrace."

I couldn't argue. How could I, a third-year medical student, even begin to try and convince this woman, who was long past 70, that I had a better perspective on her marriage than she did? Although I doubted that her husband no longer loved her, I could certainly see how their relationship might have changed in the course of the past year as she struggled with metastatic rectal cancer. She had been raised in a society in which she was valued for her traditional feminine qualities; she was a good wife, perfect mother, and meticulous housekeeper. Now she was living day by day, changing bags filled with urine and soiling Depends with tarry stools. Gone from her existence was so much of her elegance, her self-respect, and her independence. Her relationship with her husband had to have changed.

Could I ask him to go to her and embrace her? Somehow this seemed far beyond my station. I tried to point out to her how he still did things for her, how he was kind and caring towards her. But this wasn't what she saw as missing. He was still there for her. He still told her that he loved her and always would. He had certainly not abandoned her, but she sensed that he was more of a caretaker than an equal companion. She would tell me how kind he was for putting up with her. She seemed to think that she deserved less. She drew all of her self-worth from giving; thus, it was difficult for her to receive.

"The chemo destroyed my body," she said to me when we were discussing whether she wanted to go through treatment again. "It made me so sick. The diarrhea was worse then. I was so weak, and I don't like wearing that pump around all of the time."

"If you do not want to go through chemo again, it's your right to decline. It is okay to refuse treatment. Only you know what you can take, and how long you can continue to fight. We are here to help you, whatever your choice may be. Don't agree to treatment just because someone is telling you it is the right choice. If it is not what you want, it is not going to help you to feel better. We don't guarantee that the treatment will improve anything—it's all a chance."

"Will I have to wear that pump again?" she asked, in a childlike manner.

"I don't know. You probably know more of the specifics than I do. Ask Dr. F. He can tell you the best approach. He needs to communicate with you, but you also need to ask him."

"He wants me to go through chemo. It is such a nuisance. I'm so filthy now, soiling myself like this. It is even worse with the chemo. I'm so tired of all of this."

"I want you to understand that you can choose to have chemo, or you can choose not to have chemo. It has to be what you want. If you are tired of fighting, that's okay."

"I'm not going to make it until next year. Why is everyone trying so hard? I'm such a burden to everyone."

"I think you are going to live to see next year. Perhaps I will not be here tomorrow, but probably I will. Perhaps you will not be here tomorrow, but it is likely that you will. I'm sure that you have made a difference in the lives of many people, and when you die you'll be remembered and appreciated. Isn't that what's important? It's hard to be sick and feel dependent, but no one is angry at you for needing help."

"Am I going to die? What's happening to me?"

I felt that I had exceeded my authority, but she needed me. I continued, not as a medical student, but as another human being.

"God decides when we die. I certainly don't know when. It is more important to enjoy what you have now and get the most out of the time you have. Please do that for me. I don't want to see you giving in just because you feel you should."