Invited to attend his dying patient&s Christmas celebration, the author knew December was too far away.
Invited to attend his dying patient's Christmas celebration, the author knew December was too far away.
Lena came in to show me a lump in her right posterior soft palate. It was the type of tumor no physician likes to see: fungating, totally irregular, and painless. I referred her to one of our large medical centers, which was well equipped to take care of problems like hers. Since part of her palate would have to be removed, I explained the importance of a proper prosthesis following the operation.
But Lena was stubborn. Ignoring my recommendation, she chose one of the area's smaller hospitals. Afterwards, the path report showed her tumor to be highly malignant.
I didn't see Lena again for three months. When I did, she was filled with complaints. The food she tried to eat kept coming out of her nose, she said. She also had a hard time forming her words. Her problem was obvious: Besides excising her tumor, Lena's surgeon had removed her entire right soft palate and a good portion of her adjacent hard palate. But he'd failed to have a prosthesis made to cover the defect.
This time, Lena agreed to go to the medical center that I had originally referred her to. With the right prosthesis, her eating and speaking problems were minimized. Unfortunately, her malignancy reoccurred one year later, and Lena once again dug in her heels. Refusing chemotherapy and radiation, she deteriorated rapidly during the next six months.
Before long, the cancer spread to her jaw and cervical spine. I did my best to make her comfortable. But she became reclusive, refusing to leave her house for any reason and refusing my offers to visit her. We kept in touch each week by phone. In time, I placed her on morphine suppositories.
Another three months passed. Then, one month before Thanksgiving, Lena's daughter called to say that she and her mother wanted to see me in my office. "But would it be all right if we entered through the back door?" the young woman asked. I alerted my nurse to let them in as soon as they arrived.
Lena appeared terribly emaciated, having survived for weeks on only a liquid diet. Sad to say, she reminded me of the inmates I saw when my platoon liberated Austria's Gunskirchen Lager concentration camp at the end of WWII. Her tumor had grown to such a massive size she could no longer keep her prosthesis in place. Also, her right jaw was very swollen. Because she had difficulty making herself understood, her daughter spoke for her.
I examined Lena briefly, and then held her hand. Her eyes filled with tears. Then her daughter turned to me, doing her best to smile. "We're planning to have a wonderful Christmas for my mother. Our family from all over the country will be thereall my brothers and sisters, along with their spouses and children. We're expecting about 40 people. It's going to be the best Christmas we ever had."
She paused, and then looked at me more intently. "My mother asked if I'd mention the get-together to you. Perhaps you'd be kind enough to come over and help us celebrate. It would only have to be for a half an hour, because I know you have your own family."
Both of them were crying now, doing their best to wipe the tears from their eyes. I knew what they were really asking me: Did I believe Lena would still be here for Christmas?
I cleared my throat several times, looking from daughter to mother. I was reluctant to make a prediction, but somehow I knew I had to. Suddenly, I heard myself saying, "Of course I'll come. I wouldn't miss it for the world. But perhaps it would be a good idea if you all came together to celebrate Christmas on Thanksgiving Day this year."
I stood there totally immobile, shocked at the words I'd just uttered and wanting desperately to withdraw them. As I sat down, Lena squeezed my hand, leaned over, and kissed me on the cheek. There was an odd smile on her face.
"Thank you, Doctor," she whispered softly. "You really didn't have to tell us that, you know, because I already told my daughter the same thing on the way here."
The Thanksgiving Day Christmas celebration was absolutely beautiful. The tree was ablaze, and there were presents everywhere. There was even one for me, a tie. I held it up for everybody to see. Lena hugged and kissed me, and so did her family members. After 30 minutes or so, I said goodbye. I was heartbroken.
The next morning, I received a call from a family member. Lena had died in her sleep. Could I come over and pronounce her dead?
As I hung up, I was certain of one thing: Lena, stubborn to the end, had chosen the date of her departure.
Edward Zebrowski. A celebration that couldnt wait. Medical Economics 2001;22:54.