“I’m not ready to go yet.”
The words were barely understandable through the sobs, but the feeling and power with which they were spoken was immense. My patient was in her 30’s and had been admitted through the Emergency Department to the surgical ward I was working on with excruciating abdominal pain, likely due to bowel obstruction caused by her metastatic malignancy. Although she’d been given morphine in the ambulance which had helped a bit, and further analgesia in ED, her pain was still severe and every few minutes she was doubled up, verging on delirious and barely able to speak. But between the spasms she was lucid, and scared.
She’d been plagued by this cancer for the last few years. Initially it was hoped surgery and chemotherapy would be curative, but within a year the cancer had returned, and this time it had spread to her liver and her bones. Further surgery had resulted in a colostomy and then there had been more rounds of chemotherapy, and radiotherapy of the bony metastases. There was not going to be a cure; the most she could hope for was a few more weeks, maybe months. The disease had now reduced her to a shadow of her former self, emaciated, anaemic and depressed, but she wasn’t ready to let go yet. Her children needed her. Her husband needed her. Her parents and siblings needed her. She still had lots of living she wanted to do.
“I’m not ready to go yet,” she repeated, looking straight into my eyes with desperation.
I knew I had to reply, but was struggling to find the right words. In fact, I’m not sure there were any right words. There had been a marked deterioration since we’d last met a few weeks ago and treatment options were running low. We had always known that complete bowel obstruction was a real risk, and due to previous operations, further surgery would be treacherous, if indeed an option at all. I felt glad that it wouldn’t be me needing to make that decision, instead able to ‘delegate’ it on to my boss.
But my boss wasn’t in the room at this moment: the moment when I was desperately trying to find the words to reply to my patient. It was down to me.
Maybe it was instinct that took over, human instinct. Two people connected in the moment, joined together by their common humanity. I moved forward and held her, embraced her like I would a friend or a child. “I know” were the only words I could say, “I know;” the only words that seemed right and true. Words wouldn’t make this thing go away, and words that offered false hope seemed cruel and wrong.
Did I say and do the right thing? A question I have asked myself many times since and one I will never know the answer to as the only person I could ask is no longer living the life she so desperately wanted to live, or indeed any life.
I can only hope that I did; hope that my acknowledgment of her statement validated it, helped her to feel less alone in making it. I hope that it helped her, hope that the humanity I felt guided me that day did so in the way that both my patient, and I, needed it to.
Sometimes, I suspect that’s all there is left for us to do.