Remya Tharackal Ravindran
Ms. Taylor was one of three newly hospitalized patients I saw that morning. She was a previously healthy woman in her forties, single and childless, who worked in the fashion industry. As I scanned her admission notes, three things stood out: shortness of breath, elevated calcium level and kidney failure. I read on, thinking of possible causes, then something caught my eye. Her breast exam had revealed multiple breast masses, and her chest x-ray showed fluid-filled lungs.
Everything fell into place: cancer, first in the breast and then spreading to the lungs. I was spared a diagnostic challenge, but I now had to face something more difficult--talking with Ms. Taylor about her diagnosis. Did she even know what it was? It didn't seem so.
For me, breaking bad news is an elusive art. As I walked to Ms. Taylor's room, I tried to recollect some of the strategies I'd been taught, like finding out what the patient thinks is going on and asking how much he or she wants to know. Still, I didn't know how Ms. Taylor would react. I felt nervous.
Ms. Taylor was sitting upright in bed, wearing an oxygen tube. She was a thin woman; the unkempt strands of silver hair falling over her pale, hollow cheeks made her look older than her years.
"Good morning!" she said, smiling. "Are you next in line to examine my breasts?" As frail as she seemed, she also radiated unmistakable spirit.
During the interview, I learned that breast cancer runs in her family. And when I examined her, I had no trouble finding the masses--reddish, peanut-sized lumps in both breasts, clearly visible and disturbingly hard.
Yet Ms. Taylor seemed nonchalant.
"Oh, I've had these since my teenage years," she said casually. "They would come and go; I've never paid much attention to them."
"Ms. Taylor, what do you think is going on with you?" I asked.
"The other doctor told me that I would need a biopsy to find out," she replied.
"What do you think the biopsy will show?" I persisted.
She shrugged and gave me a quizzical smile, eyebrows raised. Then she looked away and fixed her gaze on the window. Outside, a beautiful sunrise was in progress, the New York skyline perched on the distant horizon.
Kubler-Ross's stages of grief flashed through my mind. Which of them was Ms. Taylor experiencing--denial or acceptance? I couldn't quite tell. But it was obvious that she needed some time to herself. And I wasn't sure whether anything I could say would help her come to grips with the catastrophic news looming ahead. I said good day and silently retreated, letting her snuggle into her own thoughts.
When I saw Ms. Taylor again, a couple of days later, she no longer wore the oxygen tube. At my suggestion, the thoracic surgeon had inserted a needle between two ribs and drained five liters of fluid from the space surrounding her lungs.
"Breathing hasn't felt this good in a long time," Ms. Taylor told me.
I in turn breathed a sigh of relief: My suggestion hadn't been futile. My feelings of inadequacy at not being able to help her gave way to a sense of accomplishment.
For a few days, we continued Ms. Taylor's care--managing her fluid intake, adjusting her pain medications--while awaiting her biopsy results. I was midway through my internship, spending long hours at the hospital and feeling guilty for not spending more time with my four-year-old daughter. Meanwhile, my husband seemed at risk of losing his job. At moments, my own life seemed precarious, making me feel overwhelmed and helpless.
When Ms. Taylor's biopsy results arrived, they revealed invasive carcinoma. And her bone scan showed widespread bone metastases.
Though I knew that she'd already talked about her diagnosis with the oncologist, the thought of facing Ms. Taylor made me queasy. What did I have to offer her beyond kind words and more fluids? Filled with misgivings, I walked into her room.
She seemed too calm and collected for someone who had just received such grave news. In one hand was a prayer book.
"Doctor Wilson told me everything," she said flatly.
"Ms. Taylor..." I began.
"Do you believe in God?" she interrupted.
"Yes, I do," I replied. Though I was born into a Hindu family, I believe in one universal spirit. I have always found solace and strength in Hindu, Buddhist and Christian scriptures. I believe that the soul, like the body, needs to be fed and nourished every day.
"Good for you," she said, her eyes glittering with unshed tears. We gazed at each other in silence.
It occurred to me that Ms. Taylor had reached a sense of acceptance. Now, her nonchalance had the feeling of calm after a storm. Even her interruption, I felt, was a skillful way of saving me from offering awkward, empty words of comfort. And "Good for you" was her way of reassuring me that I would be all right--and so would she.
She smiled at me. "The real stuff is so unlike Grey's Anatomy."
Though I didn't know much about the show, I appreciated her touch of humor. We chatted for a while longer--not about her illness but about her job, her church and the book of biblical excerpts she was reading.
Closing Ms. Taylor's door behind me, I felt a pang. As she faced her own death, Ms. Taylor had taught me something about life--at a time when my own life was filled with stress and uncertainty.
I will always remember her for her ability to appreciate and be grateful for the fragile and fleeting "now," even under such terrifying circumstances.
About the author:
Remya Tharackal Ravindran MD is finishing her internship at Overlook Hospital, Summit, NJ. She grew up in India where she did her MBBS (the equivalent of an MD) in Trivandrum Medical College, Kerala. After graduation, she came to the US with her husband, who is an engineer, and their daughter. "This is my very first story, except for one published case report. I haven't written much since my high school days. My hobbies (although I hardly have time for them anymore) include astrology, reading scriptures, philosophy, painting and cooking."