Doctor, What if it Were Your Mother?

What do I know personally about death as an oncologist who has been battling it for thirty years? I know that it hurts deeply, it robs us of life and opportunity and happiness, and it destroys families, futures, and promises. Paradoxically and ironically, although it fractures and ruptures, its effects are not permanent. In fact, death can instruct and lead to life changes that can even heal and mend, and death can resolve both conflict and dependency among those who mourn the loss of a loved one. It can actually create hope or make hope acceptable where only cynicism and doubt existed before. Walking through the valley of the shadow of death can bring insight and an inexplicable peace to a troubled and trying existence. We need to think more purposefully about controlling illness, without curing it, in the context of the everlasting promise of hope. If we are to make better decisions about treating serious and life-threatening illnesses, we must understand where we now spend money for our care, how our beliefs can influence our decisions for treatment, and why medical technology cannot cure all of our ills. Mom trained in the 1940s, before medicine experienced its modern technological explosion. She amazed me with stories from her early career about melting medications on spoons over alcohol lamps, and sterilizing hypodermic needles for reuse. She knew what I was becoming before I knew, and she quietly and gently reflected that knowledge and confidence as I slowly acquired competence and experience through my training. Our family, being stoic German Calvinists, did not speak often in explicit terms about our emotions or our feelings for one another, so Mother and I communicated our love for each other silently rather than explicitly between the lines of our conversations about medicine. Mother’s call about her breast biopsy created for me my first personal awareness of the battle Christian physicians fight all of their professional lives in regard to their faith and the health of those they treat. After Mother called, I desperately wanted to pray for her. I cannot remember whether I wanted to pray that she be well or that God would give her the strength to face her ordeal. I probably hoped for both … It scarcely mattered, because in mid-February, I received a telephone call that would profoundly change my life and the lives of our entire family. My mother’s oncologist told me with no audible emotion that she had developed acute leukemia. This is a cancer of the bone marrow and is a complication known to occur in women with breast cancer who are treated with both chemotherapy and radiation. I had blithely told patients in the past that this complication was so rare that it did not even deserve consideration. Now, one of the rare “statistics” was my own mother! The words of Major Greenwood, one of Great Britain’s famous epidemiologists rang true: medical statistics are human beings with the tears wiped away. Now, however, my own tears would not go away. I envisioned horrible crises and much more coming in my mother’s future. It was like seeing two great armies poised on the battlefield before a major conflict, knowing that the coming battle was inevitable and that there was absolutely no way to avert it. The impending devastation was as vivid in my mind’s eye as the incipient carnage surely must be to a commanding general before he sends many young men to certain death. I, like the general, had no choice but to stand and fight, because I knew that without an attempt to stave off this mortal enemy, Mother would be gone very, very soon. Sitting in the chair next to her bed and facing her at eye level, I asked if she was aware of the bone marrow findings. She stared back blankly. Dad appeared startled. I thought he knew. I explained both the leukemia cells and the breast cancer in her bone marrow. Mom was silent for a minute. Then she asked, “That’s not good, is it?” I wanted to scream and cry and run. I wanted to be anywhere but in that awful, stark, morosely sunny hospital room. I had let her down. We had sent her to the best hospital in the country, and they had let her down. Her fair-haired boy of promise, her companion on the great ride that is a career in medicine, had just delivered the saddest and most ominous personal news this gentle, loving, caring nurse had ever received. All I could do was to hold her hand and tell the truth.