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The Art of Medicine

Family matters

Sweeney, Cameron Young MMS, PA-C

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Journal of the American Academy of Physician Assistants: March 2018 - Volume 31 - Issue 3 - p 58
doi: 10.1097/01.JAA.0000530298.00409.4d
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No one wants to come to the cancer center. Most patients bring a supporter with them. Sometimes the family needs as much care as the patient does.

We saw the older couple regularly. The gentleman's thin white hair was askew, and his corneas were milky. He was tall, even when he leaned heavily on his cane, and he shuffled slowly in heavy orthopedic shoes. His beloved trundled down the hallway behind him with her walker. At every visit, he would proclaim, “Did you know that we've been married more than 58 years?” as his wife glowed. Their cancers were in his-and-hers remissions, until his wasn't. The day we told them that his disease required treatment, he focused on logistics. He wanted to know the name of the chemotherapy and how many cycles he would need. While the oncologist addressed his questions, his wife sat clutching her walker so tightly that her knuckles whitened. Her eyes brimmed with tears. I handed her the tissue box and patted her knee. “Take good care of him,” she whispered, “for me.”

The new retirees planned distant travels and uninterrupted time together that had long been postponed. Then his cancer was diagnosed at an advanced stage. At the initial consultation, he laughed, “If you hadn't told me, I wouldn't know I have cancer!” His wife wanted to fix his disease, so she earnestly encouraged him to exercise and choose more healthful foods. She pressed him to quit smoking. At subsequent visits she was frustrated that he wasn't “doing anything to make himself better. He won't get up and walk. Maybe he'll listen to you.” As his condition rapidly worsened, she worried that he was depressed, so we referred the family to the cancer center counselor. He was reticent, but his wife found the outlet of counseling cathartic. She later told me that she had spent their road trip savings to retrofit their house with an access ramp and a handicapped shower handle and seat. I worried that in his absence this invalid's quarters would no longer feel like her home, yet this was all she could control. At the last appointment, he slumped in a wheelchair, head sagging on his thin neck. He peered at me desperately from under the brim of his cap, pulled low over his dark eyes, now dull. We discussed pain management, appetite stimulants, how to make him more comfortable. The end was near. As she rose to leave, the wife clung to me as a koala grips a tree, reluctant to leave. We wouldn't see them again.

The middle-aged son brought his father to chemotherapy every 3 weeks. Several therapies had already failed, over many years. Eventually we would run out of options, but not yet. The patient's scan was mixed, with some tumor in retreat while other areas appeared to be progressing. I asked the patient how he felt. “You tell me—what does the scan show?” The son volunteered, “He seems better than he's been in years.” They had even played nine holes on an unseasonably warm fall Friday. I reassured them, “That says more than any scan could. We treat the person, not the test result.” The son fixed me with grateful eyes and smiled wistfully.

The pale white woman was slim and fragile. It had been a year since her breast cancer diagnosis and double mastectomies, and although she had multiple comorbidities, she had no signs of recurrent cancer. “Who's with you today?” I asked, nodding toward the black woman seated in the corner. “My daughter, my heart,” the patient beamed. “So,” I said, turning to the daughter, “When was your last mammogram?” She was surprised that I directed the question to her. “You have a family history of ‘triple negative’ breast cancer. You are past due to begin screening mammograms.” She nodded.

The raspy voice of the black woman in the wheelchair croaked, “How you doin' today, child?” as she greeted me with a broad smile that filled her thin face. Her joy was infectious and never failed to brighten my day. Her husband of 60-plus years sat quietly with his cane propped between his knees. Their children traveled hundreds of miles to take her to chemotherapy. They gently reminded her of symptoms when she denied complaints and requested refills when her pill bottles were nearly empty. She had been an educator, and her goal was to be present when her youngest grandchild graduated from college and another was awarded her master's degree from an Ivy League university. A few weeks after attending both commencements, she died. I wondered if her family would continue to come together across the miles without the matriarch to unite them.

Ours is a rare privilege. We share the most intimate information with patients and families. We strive to provide some small comfort when they are most vulnerable. We cheer when they do well. We learn from and are moved by them. As we care for our patients, we thoughtfully attend to their tremendously diverse families.

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