I tried to focus on the chart in front of me, but it may as well have been written in Russian. I'd been awake for thirty-two hours, and my brain, thick with fatigue, refused to cooperate. I knew I shouldn't be working, but I was too proud, too stubborn, too something to admit that I wasn't coping.
On the first day of my neurosurgical rotation, the resident I was replacing had told me, "Ten-to-fourteen-hour days, twelve days on, two days off. Say goodbye to your life for the next three months!"
I was prepared for the long hours, endless paperwork and ward-round humiliations. I expected that it might be necessary to take a leave of absence from my personal life. What I didn't expect was that my personal and working lives would collide headlong.
As I sat there, not writing up ward-round notes, my boyfriend, Adam, lay across the hall in the neurosurgical ICU. Twenty-four hours earlier, he'd had a tumor removed from the back of his brain.
We'd met in the med school library when I was a final-year medical student: Waiting in line for the photocopier, we'd struck up a conversation. Adam had just been diagnosed with testicular cancer; he was reading up on the disease. His warm brown eyes and infectious smile attracted me instantly, and his humor and glass-half-full attitude completed the job. We went out for coffee that evening and soon became inseparable.
Adam was a country boy from the outback, with a passion for competitive sheep shearing. He had a keen intelligence and although, or perhaps because, he hadn't attended college, he felt a deep connection with and appreciation of the natural world.
For several months after his initial treatment had finished, Adam and I enjoyed a fairytale romance. In remission, and with a 98 percent chance of cure, my one-testicled Prince Charming introduced me to many of the joys I'd been too preoccupied to notice. One Saturday morning he said, "This weather is so good, it would be criminal to waste it. Are you up for a weekend down the Coast?" Before I had time to even consider, I found myself picnicking with Adam in the rainforest, luxuriating in a spa and walking together along the beach by moonlight, gazing up at the stars.
Those heady, carefree days didn't last. Ten months after his initial diagnosis, as I was working as a neurosurgical intern, Adam had a seizure. He ended up on my ward, diagnosed with an occipital lobe metastasis: the cancer had spread to his brain. (True to form, he joked that growing a brain tumor showed just how far he'd go to see the woman he loved.) For obvious reasons I wasn't his doctor, but his being on my ward gave us many opportunities to sneak in some time together--the situation's only silver lining.
The nurse's voice penetrated my mental fog.
"Adam's back from the ICU. Apparently he just got up and left." She shook her head affectionately. "That boy is something else."
As I approached Adam's bedside, he smiled broadly, looking pale but lively, the bandages around his head somewhat askew.
"What's this I hear about your walking out of intensive care?" I asked with mock sternness.
"That place is creepy--full of really sick people. I figured it would be much better to be back on this ward. I knew a bed was being a held for me, so I grabbed my IV stand and walked here."
"But you had brain surgery yesterday!" I protested.
Two days later, Adam turned up on my doorstep bearing gifts. He'd discharged himself from the hospital: "I didn't want to be stuck in there when you were having your only day off in two weeks."
He seemed invincible. His inspiration was Lance Armstrong, who'd survived a diagnosis of testicular cancer with metastases in the brain, abdomen and lungs. Soon, however, it became clear that, for Adam, a cure was not going to be possible. Despite surgery and several weeks of radiation therapy, his tumor markers steadily increased. In a matter of months, new tumors were visible on his CT scan. His doctors encouraged further treatment.
They removed almost all of his occipital lobes, which drastically reduced his visual fields, leaving him only a tiny, blurry window through which he viewed the external world. When the tumors appeared elsewhere in his brain, they gave him more radiotherapy and chemotherapy. I felt they knew, deep down, that they were rapidly losing the battle, but still they peddled hope like a drug to my vulnerable Adam, saying, "It's unlikely to work, but it's possible. We can try." Adam had always said that he didn't want to prolong the inevitable, but when push came to shove, offered even a remote chance of cure, he couldn't say no.
As a result, Adam did not have a good death. He spent most of the final weeks of his life in an acute care ward being subjected to unpleasant treatment regimes. Although I felt powerless to do anything, I still regret letting this happen.
In medical school, they'd told us that we would learn more from real-life patients than from lectures and textbooks. Especially from patients we can't fix. Patients who die. They were right. What they didn't say was that watching a loved one struggle against and ultimately lose the battle with an incurable disease would teach us things that years of medical training never could.
Adam gave me a very special gift. Through our journey together, I learned that treating cancer is about so much more than trying to find a cure. It's about more than whether the patient lives or dies. It's about how whatever life left is lived, and ultimately, how one dies.
I learned, too, that a patient's death is not the end of the story. Today, in my own practice, I try hard to actively involve my palliative patients' family and friends, and I continue to offer them care and support even after their loved one has died.
Adam has made me a better person--and a better doctor. I owe him so much. I can't pay it back, but I am trying to pay it forward.
I'm sure he'd be pleased.
About the author:
Genevieve Yates is a family physician and medical educator in Queensland, Australia. When she is not caring for the sick or teaching other healers, she indulges in a range of creative pursuits including theatre, music, film and writing. A performed playwright and published author, she's passionate about putting creativity into medicine and medicine into creativity. She uses film, theatre and music in her teaching and finds that medicine inspires and complements her writing and vice-versa.