Happy Mothers' day

Call Pager beeps. Transfer from MICU.

9th floor. I peeked into the room and see this very thin woman with eyes bulging from their sockets, staring back at me. I smiled and waved. She just stared back.

Chart Review: Caucasian female in her 40s, dxed with Stage IV SCLC - lung cancer with metastasis. Presented to the Emergency Dept with shortness of breath and Oxygen sats in the lower 80s. Refused to be intubated. Was admitted to the ICU and kept on a rebreather and high dose steroids and antibiotics for the past week.

Everybody knew she wouldn't make it out of intensive care. The family was primed to expect the worst. She was a mess and she could go anytime, but her advance directives told us that she was a full code, meaning full interventions if she went into cardiopulmonary arrest. She wanted a full code despite knowing that she was in the terminal stage of her disease. She said she would fight death.

And she was here now, in a regular room, with only a nasal canula for oxygen supplementation.

When i walked up to her to introduce myself, i knew she would die under my care. She was so frail looking and her sternum was so deformed because of the bone mets. I began thiking, if she were to die on me, and she's full code, how can i possible do chest compressions ...."Hi, doctor, what's your name?", her voice snapped me out of my thoughts. It sounded strong and confident, something i never expected from her.

After the introductions, i asked her when exactly was she diagnosed with the cancer. She looked at me straight into my eyes and lifted her bony finger in front of my face. She said, "Doctor, i will not allow that word to be uttered in my room."

So be it. That was the last time i said the C word.

Everyday single day when i'd visit her, she'd stick out that same bony finger and tell me, "I'm going to be better and i'm getting out of this hospital to be with my children. I'm telling you, i'm not going to die yet, not this time, Doctor, not this time." To which i would reply, "Well, that's good to hear, Mrs. S." But in my coat pocket i always carried my Advanced Cardiac Life Support (ACLS) booklet because i feared she would arrest anytime.

One day, after telling me again that she wasn't gonna die on this admission, she asked me, "You don't believe me, do you? You dont' believe i'm going to make it out of this hospital alive." And she was expecting me to answer her question. Damn, they don't teach you this for the clinical skills exam. My mind racing for an answer, i say, "Miracles happen everyday, Mrs. S. We are all entitled to a miracle." She said, "You're right, doctor. But i know you don't believe me. And i'm gonna prove you wrong, just like i did to everybody."

When i walked out of her room that day I thought to myself, "Yes, Mrs. S. I'd like you to prove me wrong."

****

I met her 10 year old son and 11 year old daughter. Her daughter was finishing some puzzles while her son was seated on the couch. She said, "Come in, doctor, i'd like you to meet my kids." She introduced me to her daughter who was nice. Her son, however just bowed his head and looked at the floor when introduced to me.

When they left, Mrs. S. whispered to me, "I'm sorry, he's just a shy boy. But he's my baby. His uncle tells me he cries all the time but he has never cried in front of me. Even when he was a little boy, he hated it when i caught him crying. He knows i'm going to leave them soon but he doesn't understand why." Tears welled up in her eyes and the determined look in them that i was accustomed to, was gone. It was now replaced by a tired and resigned expression. She stared blankly at the door, her voice faltered, the air of confidence lost, "I promised him i was going to teach him how to drive. I was going to take them both driving. They're too young. I still need to teach him how to drive." Finally the tears rolled down her cheeks. For the first time i saw her as a mother, not a patient. "Now, doctor, you see why i can't die yet."

****

A few days later, i printed out her discharge summary, arranged an ambulance to take her wherever she wanted to go. With her kids. She proved me wrong.

Miracles do happen.

Happy mothers' day.

****
I took care of this patient in November of last year. I don't know what has happened to her since.