A young woman sits alone, dying

June 3, 2005

A young physician learns that the failure to care can be worse than the failure to cure.

In the cooling days of autumn, I brace myself against a gust of wind as I ring the doorbell. The Filipino maid lets me in with a shy smile and immediately disappears into the kitchen.

I walk into the living room past carefully hung pictures in the hallway. In these images,a life unfolds. An awkward teenager at her 14th birthday. A confident young woman at her prom. A giddy graduate, embraced by family. A proud aunt taking nephews to the park. Temporarily soothed by the innocent normality of the collection, I glance again at a photo of her tall, graceful body and finely chiseled face framed by a luxurious mane of brown hair before walking toward her room.

"Hello, Julia!"

From her oversized recliner, she tilts her face upward, blinking rapidly to focus her vision. Squinting, she waves her sleepy arm in greeting.

"Oh, how awfully kind of you to come!"

The trace of an accent remains from a childhood spent in England. On a small table edged against the recliner, the phone begins to ring. Groping for it, she knocks over a glass of water. By the time she's located the Talk button, the caller is gone.

"I suppose they will call back," she smiles wryly, her fury barely perceptible. She feels for a space on the table to replace the phone.

"Let me get you another glass of water, Julia," I say.

The day before a college vacation, Julia felt a lump in her breast. "I was 25 years old and ready to go on a holiday," says Julia. "I went." Three months later, the lump was still there.

"My mom died of breast cancer, so I mentioned it to the doctor. I was in the hospital the same day."

Medicine got to work with lightning haste. Four days later, Julia had had a lumpectomy and was reading about chemotherapy. She also started reading about the responsibilities of a social worker-her profession-towards children in foster care. Her chemotherapy and first job were scheduled to start closely together.

"The chemotherapy, then radiation was tiring, but I battled through them both. I really wanted to keep my first job."

The treatment kept its promise for seven years, during which Julia cherished her job, her close-knit family, and her independence.

"One day, I woke up and couldn't see properly. The oncologist diagnosed a spot behind my eye."

Soon other metastases were diagnosed and Julia embarked on more chemotherapy and radiation. "Second-line chemo merged into third-line, fourth-line and experimental-soon I lost track."

There were temporary reprieves in an otherwise bleak outlook. Julia was getting tired and unwell.

"Then one day, after I had been waiting for two hours, the oncologist came in and, without any preliminaries, declared, 'We are stopping treatment, Julia. There is nothing else.'

"'What do you mean?' I asked, bursting into tears. 'Am I dying?'

"'You have six months, maybe less,' he said. 'There is nothing else I have.'

"He was suddenly awkward and detached. I sat stunned and alone in that room for a long time and just wept. Then I came home. I will never forget that last, lonely clinic appointment."

Now she is a hospice patient. Her brain and lungs are riddled with metastases. She is blind and fully dependent on caregivers. She has lost all her hair and gained considerable weight on steroids. Her infrequent partner over the last seven years just left her. Her parents are dead and her siblings are busy with their own lives. Julia just turned 33.