Cancer Stories: My Myelodysplasia Patient, Nathan

Death Valley bloomingWhen I first met Nathan 14 months ago, all he thought he was seeing me for was a mild form of anemia.

It turned out to be rather worse than that. At age 70, he had developed bone marrow failure, which carries the technical term “myelodysplasia.” Like all forms of organ failure, the process is slow but inexorable.

With assiduous management, the clinical course is gradual and relatively misery-free. In practical terms, this meant that I met with Nathan once a week for those 88 weeks that he was my patient.

You might think that we would have gotten tired of seeing each other, or that he might have gotten annoyed by the constant requirement to see his doctor. Far from it. Seeing Nathan, and his wife, who came to almost every single office visit, was often the highlight of my work week. We shared a camaraderie that was not unlike two soldiers together in the same platoon making their way through a war. We overshadowed the grim nature of our business together with banter and male bonding.  After all, it was to be a long campaign. No point focusing on the worst.

For men and women in the trenches and patients with their oncologist, it is much the same: do your duty, then find a foxhole to play cards in till the next patrol…  And as the disease gradually quickened its pace, it was like hearing the mounting roar of the approaching waterfall in the distance. The sand was filling the bottom half of the 14-month hour glass. Nathan knew he was dying. And I knew that, for the thousandth time in my career, I would be losing a friend.

The gritty details of his final weeks are less important to relate here than the fact that he was in the hospital most of that time. This meant that I was seeing him daily rather than weekly. In some ways, we both welcomed this; he had the comfort of knowing that his frailty would not have to wait six days to be addressed between weekly visits and we both knew we were getting extra time together before his ship set sail for good.

I am now both old and wise enough to know that under such circumstances, the overarching goal is to celebrate life rather than to combat death. This is not to say that I stopped doctoring him. Quite the contrary. It is true that most doctors wouldn’t approach such a situation the way I did, but I must not-so-humbly say that most doctors miss the point under these circumstances. Their refusal to shift gears when the wind changes directions is a basic shortcoming of the profession, and is, in fact, something my book, The Undying Soul, and these missives hope to remedy.

Attending to Nathan’s medical needs was something I had learned to do instinctively and effortlessly. There was no need to speak of my heroics and options for exotic interventions. Nathan’s trust in me was complete. I didn’t have to prove anything to him.

Most of the time I spent in his hospital room during the weeks before his death was spent joking around and treating him like a normal human being, rather than a leper. Besides, a patient will tell you more about their medical condition by their unrehearsed dialogue concerning whether they watched the Super Bowl than what they tell you when you ask routine questions.

Through it all, Nathan was brave and jovial.  But I knew he didn’t want to die. At times I marveled at his aplomb, and yes, he probably hid his angst from me at times for my sake. As such, the delicate art so woefully under explored in all of this is to watch and wait for that one moment when the patient lets go, and to be there to give him that affirmation that no other human being is empowered to do: embrace his pain, acknowledge his mortality, and let him know that in spite of all we pretend to do in our daily lives to avoid this awareness, death itself is alright.

Only the artful oncologist knows this in the modern West, having replaced shamans and clerics — this, the oh-so-vital role played over the epochs of all humanity.

There came that moment between us. In the middle of a routine visit, I sensed the timing was right. I got out of my chair and stood over Nathan’s bed. He sat up, and clasped my hand in his. Holding on ever-so-tightly, he just nodded, probing my eyes for assent, and in that brief embrace I saw in his eyes sadness, vitality, courage and acceptance ripple gradually across his gaze…

Nathan then fell back in bed and I left quietly. He did not engage me in that way again. He didn’t have to. We both knew the whole truth of the matter. He was ready for the emergence of his soul.

He passed on a few days later…

Photo Source: By Julien Lagarde

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One Response to “Cancer Stories: My Myelodysplasia Patient, Nathan”

  1. Monica says:

    Your relationships with your patients is beyond what I would expect from most Doctors. This reminds me a great deal of the relationship you had with my husband Frank. He cherished the time you spent with him, not just as his oncologist, but as a friend. You have a gift. Thank you!

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