Tough Choices

The hospital café was a long walk from our classroom, so, as a group, some of us from the summer program walked there together for lunch. I was out front, with earbuds in, not paying attention, when I felt a slight tap on my shoulder. I turned to see an elderly woman. She was bent over and looked weary and lonely. I took out my earbuds and said, “Excuse me?”

She said, “I’m a veteran.” She showed me her badge. “Can you take me to get some food? I don’t have any money.” She said that after she ate, she needed to get to the VA Hospital, but she would do that on her own.

I hesitated. 

 

We stood there for a moment of silence and trepidation. I was grateful that I wasn’t the one who had to make the first cut. To do that would mean presiding over this person’s transition from former human to current specimen. I am still unsure whether that sensitivity refers to myself or to the cadaver. Do we perform these dissections to study someone else, or are we studying ourselves?

My parents made their end-of-life decisions long before they needed to by signing an advance directive. Dad was lucid until the end, but things were different for Mom. After his death, she moved into a nursing home where her slow, sad decline from Alzheimer’s disease continued for seven more heartbreaking years.

During her last winter, mom developed aspiration pneumonia. In the emergency room cubicle, she gasped for breath and tugged on the oxygen mask as her eyes darted to the scrub-clad personnel who hovered around her: a lab tech drawing blood, a nurse starting an IV, a respiratory therapist getting an arterial blood gas. A red emergency cart drawer filled with endotracheal tubes was left ajar. 

 

The red or the pen?

 

“So, what do you want to do?” asks the man with the pointed nose and the stethoscope around his neck.

Hmmm. Swim with dolphins? Eat a steaming bowl of spaghetti? Dance with the sun on my face? Yes. All of those, I think to myself. But, no. They’re not the options on offer, not any more. My interrogator’s nose is waiting. His grey eyes assess me from under folded lids.

I could smell the greasy, fast food before I even reached for the door. As I entered the exam room, I caught her rummaging through her McDonald’s bag, then she quickly looked up with a big grin on her face. Without even a pause, she shoved a french fry in her mouth and exclaimed “Hi, Dr. Eisenberg!” Her T-shirt was taut over her pregnant belly, slightly riding up to reveal her chocolaty, smooth skin.

Sigh, I had reminded her before to not bring fast food into the office.

 

Twenty years ago this month, I was diagnosed with colon cancer.

 

It was a dreary January Seattle afternoon. I’d lost my job helping my son, who’d suffered repeated outbursts of angst despite doctors, counselors and inpatient hospitalizations. 

 

I sat sipping tea across from Martin, my child crisis system advocate. Martin’s eyes seemed kind. We discussed my options. It became clear that the Child Study and Treatment Center (CSTC), Washington State’s inpatient child psychiatric facility, was the only viable residential choice. State programs meant mounds of paperwork and procedures. As I said, “Let’s get the process going,” Martin’s demeanor changed.

“It’s your patient. What would you like to do?” my attending asked. This question was not meant simply as a test of my knowledge; I was expected to give my opinion as a valued member of the team. A requirement for fourth-year medical students, my acting internship was more “intern” than “acting.” I worked alongside residents on the inpatient medicine service, calling consults, updating families and placing orders. There was one difference, however: all of my orders required an MD’s signature.

Buoyed by this safety net, I got a taste of the thrilling yet overwhelming influence physicians can have in the lives of their patients. Our everyday decisions regarding diagnostics, medications, and procedures can have profound consequences. In just a few years, I would have to make my own choices, without the safety net. I was and am aware that in some cases, the right decision could end up meaning the difference between life and death.

My first chemo was a year ago today. It had been scheduled to start eight months earlier, when I was first diagnosed with breast cancer, but I chose a different path and had hoped to avoid chemo altogether. My oncologist had initially recommended four months of chemotherapy to shrink the tumor before surgery, but he also mentioned that I qualified for a clinical trial that would use a pill for six months to cut off its estrogen supply.