The room is stuffy, but the woman is shivering.
Her husband stands by her bedside. An interpreter that they've hired to stay with her day and night stands at the foot of the bed. And then there's me, the doctor (I'm an intern), waiting to deliver one of many sad speeches I must give today.
Smiling wanly, she struggles into a sitting position and shakes my hand.
Even with a diagnosis of metastatic stomach cancer, she has movie-star looks. She's only twenty-six--the same age as me. I can imagine her stepping out of a red-carpet premiere in Shanghai. Instead, having hired personal interpreters and taken a flight halfway across the world, here she is in this hospital bed, waiting expectantly for me to tell her what we can offer her.
I look at the clumps of downy hair on her head, at her gaunt face, at her hands. She is wearing a wedding band. With a shock, I see that it's the same design that I picked out two weeks ago.
This is what I'd planned to say: "We feel honored that you traveled all the way from China to this American hospital. Unfortunately, there is no chemotherapy or surgery that we can offer you at this point. We should talk about maximizing your quality of life in the time you have left."
My throat closes up. I'm thinking about the snowy day my fiancé and I went to Tiffany's. He'd wanted me to get a glitterier ring, but I insisted on a band that would be elegant in its plainness and last for decades, for as long as I hoped to be married. I wonder if she chose hers for the same reason.
"I'm nauseous all the time," she says and points at her belly, which is swollen with cancerous fluid. "It's like I'm pregnant again."
"You have a child?" I ask.
"A son," she says proudly. "He's three months old. I found out about the cancer when I was pregnant. They told me I should think about whether I wanted to keep the baby…but that never even crossed my mind. He's with my mother in China."
A son. This is the moment where my script fails me. I stare at her as if seeing her for the first time.
"It hurts," she said, putting her hands on her belly. "I know I should eat more, but I can't." She flinches as another spasm of pain passes through her, then she doubles over and dry-heaves.
I sit down on the bed, take her hand and let her squeeze as tight as she wants. It's the only thing I can do.
"We can give you something for pain," I say gently.
"She hasn't asked for anything, but I really think it would be helpful," her husband says, with an anxious look.
She whimpers and squeezes my hand again. We sit for a long minute, time stretched out by her pain.
What did she dream of doing with her life? I wonder. What is it like, instead, to slowly die in a foreign country, with her baby 8,000 miles away?
I think about the coincidence of our ages, and of our rings. I'm ashamed to admit it, but right now, I'm filled with terror. One twist of a gene, or a dose of environmental toxins, or pure luck, separates us. In a few months, one of us will be getting married, and the other will probably be dead. I have no way to stop it. Never has my white coat felt more like a sham.
Her painful spasm passes. I put my other hand over hers.
"Sometimes when fluid builds up in the belly, we can drain it using a big needle," I tell her. "But it'll come back. It may be helpful to use a special tube to drain it instead. What do you think?"
"They told me about that at home," she says. I can tell from the look in her eyes that my answer wasn't the one she'd hoped to hear.
"I think that's our best strategy for now--that, and making sure you're comfortable," I say, trying to sound reassuring. "But let's take it one step at a time."
I let go of her hand and stand up. I take a step away. Should I say it?
"I love your ring. It's beautiful."
She smiles. She touches it lightly with her other hand. "Thank you."
I excuse myself to go put orders into the computer.
By the time I circle back, and before I've had a chance to touch base with my team, the attending physician has told her that there is no cure and explained what palliative care means. Each time I enter the room, she is looking somewhere far away. Her expression is heartbroken.
Nothing I say will change what is happening or give her the time she so desperately wants, so all I can offer her is a light touch on the shoulder and a few moments spent sitting by her feet as we wait for the sedative to take effect.
My time on the ward ends the next day, and I'm shuttled off to the next rotation; I never see her again. But some patients stay with you forever.
Sometimes when I adjust my ring, I see her pale hand superimposed on mine. I'd like to believe that she was not in pain at the end.
I have to.
About the author:
Joy Liu, a graduate of the program in liberal medical education at Brown University, is an internal-medicine resident at Beth Israel Deaconess Medical Center in Boston, MA. She enjoys traveling, new foods, a good piece of speculative fiction and reading about the history of medicine. "I have a long-standing love of creative writing, and I found writing to be therapeutic during medical school and residency. This particular story is one of the defining memories of my intern year and continues to inspire me to provide comfort in whatever way I can." She recently had a couple of pieces published in the Intima and has written a fantasy novel, Watermark.