I almost wept today

Mohammed Suhail, MS4 at UCSD SOM

I almost wept today for the first time in years.

My patient was a 45 year old woman with a metastatic soft-tissue sarcoma. Head shaved, eyes tired, she fell asleep twice as I spoke to her. Her daughter, 20 years old, sat nearby and woke her up with a few words in Spanish whenever she drifted back into sleep. By the time I saw her with the attending, she had gotten a milligram of dilaudid and was in and out of sleep. She spoke English well, but she became so tired that the effort of speaking her second language was too much. She spoke to her daughter in Spanish and the daughter did her best to translate to us.

It wasn’t when I asked her the first open ended question, like we are taught so much to do, and she answered with such resignation: “I have…cancer.”

It was not when she detailed the process of diagnosis, of getting her leg amputated, of relapse, of chemotherapy. It wasn’t when she resisted tears and turned to look me dead in the eye when she finished.

Medicine hardens us. I see it in our culture, I see it in our faces, I see it in the words we use: “noncompliance.” You know, that word we use when we really mean, “Why won’t they let me help?” We ask, over and over, why won’t they let me help? Why won’t they let me help? I went to school for this. I gave years of my life for this. I sweat and bled and cried for this. I lost friends for this. I beat myself into the ground for this, I went countless sleepless nights for this. So why won’t they let me help? We ask and ask until our throats are dry and chapped and we ask until our hearts are rock. And one day, we stop asking.

I don’t know why, but for once, the hardest part wasn’t when my attending asked her about her code status. It wasn’t when he asked her what she would want to do if something were to happen — does she want everything done? Does she want us to snap her ribs with CPR? Does she want us to attach a machine to her to keep her body pumping away?

The hardest part was not when she turned to her daughter and answered us in Spanish, because I understood.

No. The hardest part was when her daughter responded. Her eyebrows furrowed. She tilted her head to one side, as if questioning, and she whispered, “Mama…”

Mama. Oh, this must be what defibrillation feels like.

I saw it all so clearly: I saw a 45 year old woman who was just tired — tired of the needles, of the scans, of the poisons, of the bullshit. Tired of being taken care of, tired of losing her leg, of losing her hair, tired of the smell of rubbing alcohol being her only perfume for weeks at a time.

And in the eyes of the daughter, I saw a young lady, coming into her own womanhood, newly an adult, hit all too suddenly with the mortality and the resignation of her mother. Unable to understand.

I don’t speak much Spanish, but from what I understood, she said: I’m tired, I’m tired. They’ve done enough, mija.

And I don’t know if the daughter understood. But then again, who can? What is left in this world after the womb that carried you is buried under the cold earth? Where do you turn? Who will show you, in ways only a mother can, how to love yourself? Who will remind you where you come from? Who will teach you what being a woman means?

I saw the two of them, years ago, wrapped around a dinner table, laughing, young and full of love; the mother with hair still, the daughter with a laugh untainted by such adult loss. Is this what she thought of? Is this what she realizes will never be again?

So, I almost wept today for the first time in years. But I didn’t.

After all, I’m going to be a doctor soon.

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