“Take one a day.”

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I look at the name on the chart. She was back again.

Letting out a deep sigh, I remember seeing her name on the schedule this morning. Always glad to see that she was keeping up with her appointments, but I always dreaded the actual appointment. I was afraid of where this may go.

One of the nurses walking, by put her hand on my shoulder and squeezed just a little. I wasn’t certain if she was giving me sympathy or strength.

Taking a deep breath, I put my hand on the door handle. Pushing the door open, I walked in. She was sitting there, staring at the cold, white floor. Shifting on the exam table she shifted her gaze up to me.

“Hi there, how are we doing today?” I moved across the room to the stool and rolled it in front of her.

Looking up at me, a small smile appeared on the sallowing face. My eyes ran down the chart one last time before I looked back up to her, placing the chart on the small counter on my right.

“I’m good. How are you?”

“It’s been busy, but good busy you know. So how are your kiddos doing?”

She thought for a moment, “The kids are doing great, we found a new park, over by Walnut St. They didn’t want to leave.”

This always livened her during the visit. Her eyes lighting up as she pulls out her phone. She finds a picture and passes me the phone. I see a little girl with strawberry blonde hair and dirt smear on her face, as she is caught in the picture running to the slide. The next few pictures show a little boy with big round red cheeks under a fluffy mop of hair on his head.

After the thought, she goes quiet. Her smile seems to fade, but her eyes linger on her phone’s screen as it darkens.

“Have you been making it to work?”

Usually, I would credit her with the possibility that she had not heard me. I knew better than that with her. She was ignoring the question.

Asking again, “Have you been able to go to work?”

“Mostly. I only missed two days in the past couple of weeks.”

“That’s an improvement, I think last time you mentioned that you had not gone to work for almost a week.”

Pausing for a response, she doesn’t look up.

“Is there anything bothering you today?”

“Nothing really.”

“Any pains, vomiting, chills, or changes in your routine?”

Shaking her head again, “No, I think I’m doing pretty good.”

Getting up and moving over to her, I hold the diaphragm of my stethoscope in my palm to warm it up then place it against the pale skin of her back.

“Deep breathe.” She follows the directions.

“Sounds good.” I move along with the routine exam of eyes, nose, and throat. Checking the chart again, I review the vitals the nurse had gathered during check-in and add my own notes.

“It seems you lost a few pounds. How have you been eating?”

She shifts as she’s sitting there, probably understanding where my questions will lead.

“Things are pretty hectic, I try to eat regularly. The cancer is pretty draining.” It sounded reasonable on its own, but the medication should’ve been causing a fair bit of weight gain.

“I know the cancer is physically draining, you have to eat consistently, you know.” I begin the usual lecture.

With a meek protest in her voice, “I know, I know. I’ll do better.”

“Did the nurse already draw your blood?” The blood test would let me know if she was regular with her medication.

“Yes. She was pretty gentle, I didn’t really feel it.”

“Are you keeping up with your medicine?”

“I try. I take it most days.”

The honesty surprised me a bit, but we had been through this several times over the past visits.

“You know it’s a daily prescription, right?”

She nodded. I could make out the tears filling her eyes already.

“What’s the point? I’m gonna die anyway. Right? That’s what all the doctors said. It’s inoperable.”

Her voice starts breaking. Suddenly, the tears start to stream down her checks.

Sitting quietly for a few moments, I let her gather herself.

“Right now, it doesn’t look like we can get to it. You never know what we can figure out. What I can tell you is, although we are not looking at a cure right now, the medicine is shown to slow things down for years. But without it, because of how your cancer has progressed, the prognosis is only months.”

I paused to let that settle in. Again.

“How about you stay consistent with the medicine for the next two weeks and come on back.”

She raised a tissue to her face, wiping away several tears.

“I can come back.”

“Great. So take the medicine. Do you need a new prescription?”

She shakes her head.

I continued, “It’s once a day with a meal. We’ll also do another blood test next week and see if there is any change.”

“Thank you Doctor.”

“I’ll see you next week and the nurse should call you when the blood test comes back.”

“Okay then, next week.”

Shaking her hand, I left her to get dressed again. Walking to the nurse’s desk I pass her file back.

“She’ll be back next week, if you could please schedule something. Also, write her down for follow up blood tests next week. We’re going to try the medicine for the next week.”

The nurse looks at me. I can make out the mix of sarcasm and sympathy on her face, but she just nods back and turns back to her computer screen.

***

Hands gripping the sink as I lean over. The cold water drips off of my face. I look up to meet my blood-shot and swollen eyes of my reflection.

A queasiness continues to build in my stomach. Clenching my fist, I force myself to free my hand. My foot steps on the pedal again, releasing the water. I splash my face and run a slippery hand through my hair.

Turning, I survey the chaos of debris strew about the room. Unsteady legs carry across to the door.

Why would she do this to herself?

Stopping at the door again, this time on the inside, my shoulder hits the frame and I pause to ease the pressure from my feet for a moment.

Throbbing, my pulse pounds through my temple, building on the headache growing behind my eyes.

As I step out the door, the nurses on the other side look at me. It’s as if the whole office halts and looks over at me. My eyes meet several of them and with the slightest nods we acknowledge each other.

Making my way down the hall, I walk into my office. I slump down in my desk chair and turn to look out the window.

She could have managed so many years more. All she had to do was comply with the prescriptions.

My eyes shift to the framed picture on the bookshelf.

I can hear her voice.

“She’s six and he’s three-years-old. She just started kindergarten.” Swiping through pictures on her cell phone, she turned the screen to me periodically. Her daughter was perched on a swing, in a flowery spring dress and her son was chasing a ball wearing Batman shirt in the next picture.

“I have a little girl, who just started kindergarten too. My son is four. He wants to go to school with his sister.”

“I haven’t told them about the cancer yet. My mother says I should, but I don’t want to worry them.”

“Well, if you keep up with the prescriptions, you should be pretty healthy for a reasonable time. We’ll do whatever we can. God willing, it should work out well.”

A barely audible laugh escapes her past her lips. “Why would God do this to me?”

As the question floated into the space between us, the atmosphere suddenly became significantly more serious.

My mind drew a blank. This is the one think medical school could never actually prepare you for.

They tried. So did the residents and mentors.

It was never enough.

“I’m not certain what I should say. I can’t speak to why God would do this to you. Why he does this to anyone.”

Pausing to sort out my words carefully.

“I can say though, maybe he sent you to me, so that I can help you.”

Did I help enough? We found the best medicine for her. Set up a schedule, diet, therapy. Could I have missed something?

Remembering my impression when she first walked in, I used to wish more of my patients would be as congenial. It’s always a difficult time when they come to see me, but she would try to smile.

She always had pictures of them to share. It made me think of my own children. We had shared stories of our kiddos. Many times trading places to take them on the weekends or about upcoming family events.

That could have been me. She was just as old as I was. She used to exercise, and take care of herself. From what I understood, she probably ate better than I did. That could have been me sitting on the exam table.

I just sat in my office. There were notes to dictate. There were charts to check.

All that could wait.

We had done all we could.

I had done all I could.

Getting up, I swing my lab coat around me before it settles on my shoulders again. Picking up the stethoscope from my desk, I take a deep breathe.

I walk down the hall, “Who’s in room two?”

The nurse answers as I take hold of the door handle.

Deep breath. Smile.