Secondary Logo

Journal Logo

AAPA Members can view Full text articles for FREE. Not a Member? Join today!
Becoming a PA

Moving forward

Barrett, Jessica MS, MMS

Author Information
Journal of the American Academy of Physician Assistants: August 2020 - Volume 33 - Issue 8 - p 1
doi: 10.1097/01.JAA.0000684152.25240.3c
  • Free

The patient came into the office in a wheelchair. She was in her 50s but looked much older. She was thin and had wiry hair and leathery skin. Her 20-year-old daughter, on the other hand, looked more like a young teenager. She had bright blue hair, wore ripped jeans and a colorful sweater, and sat in the corner of the room, scrolling through something on her phone.

My preceptor had told me a bit about this patient while the nurse was taking her vitals in the other room. She was diagnosed with colon cancer several years ago but was lost to follow-up. By the time she returned to clinic, it was too late. The cancer had spread to her liver. Then her lungs. Then her brain. She was told that she had 9 months to live.

The conversation seemed to start right where it had left off.

“How's the baby?” my preceptor asked.

“She's doing well ... she's 5 now. We started the adoption paperwork. We made it clear that when I go, my daughter is going to adopt her,” the patient said, nodding toward her daughter in the corner. My preceptor had explained that the patient had a niece who called the patient “mom” because the child's mother rarely saw her daughter. I glanced over at the patient's daughter, whose eyes remained glued to her phone screen. I couldn't imagine losing my mom or adopting a child when I was 20.

“How are things at home?” my preceptor asked.

“It's been rough. My son tried to commit suicide again. His ex-girlfriend is trying to say that she's pregnant with his baby but we don't think it's his. I had to kick him out of the house. I love him but I just have so much going on right now that if I found his body....” She trailed off and wiped tears from her eyes. “I just couldn't handle it. It would be too much. On the bright side, my ex-husband is being more helpful than ever. He called me to tell me that the police had my son in custody and that they were taking him to get help. He's also been helping me with some of my paperwork and legal things. I don't know if he's actually trying to help or if he's just trying to get me in the grave.” She shrugged.

“How are you dealing with the pain? Are you taking the medications?” my preceptor inquired.

“No, I don't want to be a druggie,” the patient mumbled.

“No one is judging you. At this point, do what you need to do to control the pain. Have you tried marijuana?” my preceptor asked.

“I have a stash hidden in my room for emergencies. My son got it for me,” she said quietly.

“You do?!” The patient's daughter finally looked up from her phone. “Ooh, it's gonna be a party. I can get you some, too. I have connections,” she smirked.

“No, the last thing I need is for you kids to get into trouble because of me,” the patient replied, shaking her head.

“I'm not gonna get in trouble. What are they gonna do to me? I'm white,” she laughed.

My preceptor shifted her attention back to the patient. “Have you made funeral arrangements? Have you made sure that someone knows your wishes?” she asked.

“Yes, my friend stole me some Navy dress blues, and my daughter knows what I want for the funeral,” she affirmed.

“Do you hear that?” my preceptor said, gesturing toward the patient's daughter who was back on her phone.

“Yeah, I know. It's gonna be an awesome funeral!” she beamed.

When the patient and her daughter were about to leave, my preceptor had another difficult piece of news.

“I'm retiring,” she announced.

The patient's eyes welled up with tears. “Not you, too. I can't take any more than this,” she whispered.

“I'm moving to the beach. I need to move forward,” my preceptor said, also holding back tears. She had been through a few tragedies of her own in the past few years. Her patients knew everything she had been through, and as soon as she said these few sentences, the patient understood.

“Good for you. I'm happy for you,” the patient quickly nodded. She pushed herself up from her wheelchair and held her arms out toward my preceptor. “May I?” she asked. The patient squeezed her eyes shut as she gave my preceptor a tight hug. Then she turned to me. “This woman saved my life,” she said, gesturing toward my preceptor. “If you're anything like her, you'll be good.”

We watched the patient roll her wheelchair down the hallway, with her daughter following close behind.

I took a deep breath.

I swallowed the lump in my throat.

And we moved on to see the next patient.

Copyright © 2020 American Academy of Physician Assistants