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Every month More Voices invites readers to contribute short nonfiction prose pieces of 40 to 400 words on a healthcare theme.

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Tough Choices

Difficult Decisions

 
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?

 
The red or the pen?

She wasn’t just sad. She was depressed. So, so depressed. None of the usual treatments I had to offer had worked. The drugs made her feel worse. She found the talking therapy boring. The psychiatrist wanted to give her more drugs. 

Disempowered

 
"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.

Dismissing a Patient


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.

To Chemo or Not to Chemo

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

Postsurgical analysis of my biopsies indicated that the cancer had grown just into my intestinal wall. Pathology said it was a genetically aggressive type, but no cancer cells were found in the lymph nodes that were removed along with much of my descending colon. In addition, no metastases were found during either surgical inspection or imaging. 

So, to proceed with chemotherapy or not? There was no evidence the cancer was loose in my body or already in my liver, but there could be no proof it wasn't. And if it was, chemo might kill it.

A Dreary Day

 
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.

Providing Comfort, Providing Care

"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.

No Turning Back

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. 

A Painful Decision

I thought it would be easier than it was, but it was one of the hardest decisions I ever had to make. Ma had been declining mentally and physically for the previous several years. This once-feisty woman--who'd been able to add up her grocery bill to the penny in her head and work seven days a week at a local children's store while still maintaining an eat-off-the-floor home--had become a shadow of herself. Ma barely ate, rarely wore anything but an old white t-shirt  and a pair of torn underwear, and sometimes at night wandered the halls of the apartment building where she and Dad lived.

Dad was worn out caring for Ma during the day and being on guard for her whereabouts and well-being at night. I, who lived two blocks away, was worn out by panicky phone calls from Dad that brought me to my parents' home at all times of the day and night. It was obvious that Ma needed more care, that she required placement in a nursing facility. But making the decision to send her there was emotionally painful.