An Unadorned Legacy

As an oncologist, one has the privilege to be with patients and their families as they face the challenging diagnosis of cancer.

In this Conversation, I share the story of a young woman who has been an inspiration to me for thirty years.

My initial impression of Amy (not her real name) was that she was all business and blessed with boundless energy.

She told her story chronologically… six years ago she had had an unexpected and brutal divorce. Five years ago she was diagnosed with breast cancer. Four years ago she had finished extensive treatment that included surgery, radiation therapy, and chemotherapy. Her previous doctor said that because of her cancer’s early stage, “the odds were pretty good” she was cured.

A year after finishing treatment she enrolled in an MBA program. She then became engaged to be married. Shortly after that, her fiancé suddenly died of a cerebral aneurysm. His death was a terrible blow and she needed to take a leave of absence from school.

But she again survived and finished her MBA. She moved to our city to be closer to her two boys and start a new job as a VP at a small medical device firm. Establishing with a local oncologist was next on her “to do” list, so here she was. Her life was gaining momentum once again.

She looked quite healthy, but on physical exam her liver was large and nodular. Her cancer had recurred.

After she dressed, we discussed the findings. She asked, “Does this mean what I think it means?” Less than an hour before, she quietly stated she always wanted to hear the truth. The truth was that the cancer was quite advanced and incurable.

She tolerated the chemotherapy well and had an excellent response. After eight cycles on the medications she opted for time off chemotherapy, suggesting she might choose against any further treatment.

Six months later, a CT scan showed the cancer was again growing. I advised that further chemo might still have a good chance of shrinking the tumor. We talked for over an hour about the options. She wanted more time to think about what to do.

By her next visit she had decided to undergo further treatment, but only if I would agree to her terms. Amy then read from a crumpled white sheet of paper. She:

  • Wanted to have at least three inches of hair when she died,
  • Wished to cook me a dinner in appreciation of her care,
  • Wanted to die in the inpatient hospice unit – not at home, and
  • Hoped to be able to stand up to give me a hug within 24 hours of her death.

After minimal discussion of the terms, she started back on chemotherapy and had a good response to treatment. Four months later a nurse and I enjoyed a lunch at Amy’s home.

A few weeks after finishing treatment, she left two presents for me at the office. One was a picture book that reflected that a caterpillar must “die” for a butterfly to be born. The second was a small, framed batik of a butterfly.

At her last office appointment Amy described how she had found peace sitting at a gravesite of a young woman who had died in the spring of 1919.

In the hospice unit a few months later, I received that final brave hug. Her face is still etched in my mind – eyes streaming silent tears of completion – framed by four inches of proud, brown hair.

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Perhaps six months before she died, Amy asked me about how to prepare her sons, ages 6 and 8, for her death. The exact words are gone, but I remember suggesting she give them the legacy of a mom that had the strength to gracefully handle all that life could bring.

Breakthrough To Better,
Carl

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The purpose of this Switch Conversation is to offer a moment of reflection in gratitude to my patients.
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Edition 21 – An Unadorned Legacy
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