Hejira

I met the ovarian cancer patient only once before and it was about two weeks ago. I met her oncologist in the elevator a few days later. I informed him that she had just come into my care.

‘I wouldn’t,’ he cautioned me, ‘waste too much energy developing a relationship with her. She won’t be around for long.’

I laughed, saying ‘ouch.’

She’s in my clinic exam room now, waiting to be seen. I go in the room and she’s still concerned about her blood pressure, which is not ideal, but not acutely high.

‘I noticed,’ I tell her, changing the subject, ‘that you were in the hospital this weekend.’

She nods.

‘What happened?’

‘I’s vomiting all weekend,’ she says. ‘I couldn’t keep nothing down.’

‘Did you get chemo on Friday?’

‘Yes sir,’ she says.

‘Were you vomiting before the chemo?’

‘No,’ she says.

‘You understand that the chemo isn’t going to cure you,’ I ask her again. ‘Just perhaps keep you around a bit longer or be more comfortable.’

‘Yes.’

‘Well,’ I say, taking a deep breath, ‘it appears the chemo isn’t making you more comfortable. In fact, it seems just the opposite is happening.’

She doesn’t say anything. I consider how to proceed. In the spring and fall sometimes people will take chemo to extend things a few weeks, to see someone graduate or make it through one more Christmas. When it happens in the winter or summer, sometimes people have some other short-term goal.

‘Is there some big event coming up for your family?’ I ask. ‘Someone pregnant or coming home from somewhere? Some particular thing you are hoping to see before you die?’

‘No,’ she says, a little surprised.

‘You understand,’ I say, perhaps too firmly, but wanting to make myself clear, ‘that you are going to die.’

Our eyes lock on each other. Neither of us says anything or moves. Like a child’s contest or a war negotiation, we’re waiting to see who blinks first.

‘Well, what do you want me to do?’ she says, harshly, ‘Cry?’

‘No. I want you to understand there’s nothing your cancer doctor or I can do to stop you from dying. I want to change the focus of your care from trying to extend your life by a few days or weeks to making your remaining time as comfortable as we can.’

She doesn’t say anything.

After a bit, I take my stethoscope and listen to her heart and lungs. I begin writing my note. After a bit, she begins talking.

‘I ain’t afraid of dying. I lived a good Christian life. I read my bible. I go to church. I don’t mess with no alcohol or smoke no cigarettes. I ain’t never gone out and messed about.’

She frames these as criteria for not fearing death, but there’s anger in her voice. They’re objections to her diagnosis. They are eminently logical.

There’s more silence.

‘Do you remember when I first met you, I said you seemed older than you were?’ she says.

‘Yes, ma’am. I remember.’

She stares at me now. I’m not sure what she wants me to say.

‘Alright then,’ she looks at the ground. She’s disgusted and finished with me and I’m not sure what I’m supposed to say, what she wants me to do.

I get up and through the closed door of the exam room, I hear her say ‘Damn Yankee.’

---

I sit down with a group of nurses in their break room. One of them is talking about a doctor that she finds attractive, but doesn’t know his name. The other nurses are trying to figure out who she’s talking about. When I join them they pretend they’re going to change the subject for a moment or two, but revert to the game of twenty questions quickly enough.

Eventually we figure out that she’s talking about Pasteur. The girls are in agreement that he’s pretty hot and, they claim, has a great ass.

‘Erik can hook you up,’ one of the nurses says. I chuckle, eating a peanut butter cookie. The nurse is—not unattractive but—not Pasteur’s type: she’s about twenty pounds past the technical definition of obese.

‘You don’t want to go out with Pasteur,’ I tell her.

‘Why not.’

‘He’s kind of a flake,’ I say, which is true enough.

‘So?’ one of the nurses says, ‘We’re not looking for a soul mate.’

‘We’re just looking,’ one of the other nurses says, ‘for a check-mate.’

The other nurses give a bit of a disgusted groan when she says this.

I laugh, saying ‘ouch.’

---

An half hour later, I’m walking through the ED and I see the ovarian cancer patient laying in one of their stretchers. The timing is so tight I know she went directly out of my office and into the ED. I shake my head and avoid eye contact.

I laugh, saying ‘ouch.’