My Condolences

“All I want is a way to clean myself after I make a mess.”

I began mentally reviewing my patient's CT findings: metastatic cervical cancer to the lungs, lumbar spine, and liver and left lower-extremity deep venous thrombosis. I spent most of the previous night poring over the literature: How do I talk to her about her “goals of therapy”? Can I search PubMed for a script? The books state that in medicine, there are 2 options for therapy: curative versus palliative—black and white in a world full of grays. What does “palliative” mean to a 36-year-old mother of 2, dying of cancer?

The literature told me to be frank, forthright, empathic, encouraging, and supportive. As I entered the patient's room, waking her as I usually did at 6:30 in the morning, I mentally rehearsed my talk. She had seen her CT scan; she had experienced, firsthand, the ravages of metastatic disease, as the cancer maliciously tore through her young frame, making reaching for a glass of water a chore. She smiled and said, “Good morning.”

After checking her vitals, I stuck with my script and asked, “What are your goals of treatment?”

“All I want is a way to clean myself after I make a mess,” she replied, pointing to her diaper. Cancer may have the power to ransack the body of its function, but my patient's humanity remained unscathed. I smiled back, at a loss for words, struggling to maintain my “doctor composure.”

“Also, I want to do my hair real nice when my kids come and see me.”

I nodded, again at a loss for words. PubMed did not prepare me for this, I …