A LUCKY MAN | Leena Ambady
Mrs. C and her husband carried walking sticks. Perhaps they would be better classified as canes, but to me they seemed like walking sticks, because they were in fact large sticks that the couple had found outside on one of their walks in the woods near their house. While her husband used his in the typical manner — plodding it down methodically in front of him with each step — Mrs. C’s had more of a symbolic purpose. She carried it so that it hovered a few inches above the ground, occasionally punching it more forcefully in the air to emphasize a point she was making in conversation. Paired with her purposeful stride and general air of self-assurance, she looked more like royalty with scepter than an octogenarian with a mobility device.
The day I met her, she was using her walking stick to gesticulate to her husband both the way to the clinic as well their tardiness to their upcoming Oncology appointment. I was supposed to meet them in the waiting room: As a part of my clinical year rotations, I was meant to longitudinally follow the course of a cancer patient receiving treatment at the hospital. I had been assigned to Mr. C, who I had met a few weeks prior when he was hospitalized for severe anemia and subsequently diagnosed with colorectal cancer.
While I knew that in my role as a medical student, my focus was supposed to be on Mr. C’s clinical course and his psychosocial coping with his illness, I found myself paying closer attention to Mrs. C. While Mr. C appeared quite stoic during his oncology appointments, Mrs. C would react openly as she listened, furrowing her brows, shaking her head, or nodding in agreement, her facial expressions quickly betraying her opinions on the treatment options at hand. Sometimes growing frustrated with the telephone Mandarin interpreter, on whom her husband was more reliant, she would roll her eyes impatiently, translating quickly for her husband instead. At times, she would talk over the interpreter or even over her husband, though after noticing the oncologist’s discomfort with this, she began instead raising her hand to ask questions and make comments (which left the oncologist perhaps equally perplexed).
Her determination to understand what was happening to her husband struck me. At one appointment, the oncologist explained that recent imaging had shown that Mr. C’s cancer had spread to his liver. He laid out the options for Mr. C’s care from most to least aggressive: surgery, chemoablation, chemotherapy, and comfort measures only. Mrs. C asked him to repeat the options and list the pros and cons of each, writing them carefully down in her notebook. She asked him what life might look like for Mr. C should he choose each option. She asked for an appointment with the surgeon and the interventional radiologist. She questioned, clarified and advocated with a doggedness that did not wane over time despite the worsening outlook of Mr. C’s illness.
At one appointment about seven months after his initial diagnosis, the oncologist disclosed that based on the most recent CT scans, Mr. C’s cancer was continuing to spread, despite the interventional radiology procedure he had undergone a few months prior. Mr. C reacted to the news with characteristic stolidness. He shared that he wanted “nothing invasive” to be done to him, and the discussion turned to home hospice care. Mrs. C was quieter than usual during this discussion, her emotions harder to read on what was normally such an expressive face. But once a referral to hospice care had been decided on, she raised her hand and proposed a series of questions, one after the other — who would help her when Mr. C began to lose some of his functionality? Would someone be there to bathe him? How often would nurses come? Who could she call if something happened when he was at home? And, how much time did he have left?
After the doctor left the room, Mrs. C turned to me. “He’s lucky,” she said, gesturing to her husband. I was confused — Mr. C had just been told that his cancer had spread further, that the treatment hadn’t worked as expected, and that he likely had less than six months to live. I wouldn’t have labeled his condition as particularly fortunate. But she continued, “He’s lucky to have me. I will take good care of him. He’s lucky to be the first one to go.”
In the weeks and months that followed, I thought often about what Mrs. C had said. She was true to her word — she took care of Mr. C with extreme care and devotion. She kept close track of his symptoms and arranged times for the hospice nurses and social workers to visit. She opened the blinds so Mr. C could feel the sunlight in bed, and read him the Chinese poetry he liked. She made him special broths with his favorite ingredients, and when he lost his much of his appetite, she spoon-fed him watermelon juice.
And yet amidst her diligence, she did not sugarcoat the fact she found this caregiving incredibly difficult. She and I would email occasionally, and I appreciated her honesty in describing how hard it was to see her husband suffer — to watch him lose continence or have trouble staying awake for more than a few hours a day. She noted too, the burden of being his primary caregiver while their children were abroad and unable to come home, that it was tiring and draining and unrelenting, that she no longer had time to swim in the pool in their apartment building. She shared these details in a clear, matter-of-fact way, not asking for sympathy or pity but instead striving to communicate truthfully about both the satisfaction and frustration she derived from caring for her husband.
About three years prior to my meeting Mr. and Mrs. C, I had taken care of my dad, alongside my sister and his girlfriend, as he was dying from renal cell carcinoma. I remember quite vividly how hard it had been. While I wanted nothing more than to make sure my dad was comfortable, there were many times when I resented the role of caregiver and felt sorry for myself, a feeling that was quickly followed by guilt. Caregiving also affected my relationship with my sister — in our worst moments, we would argue about the sacrifices we were making for our dad, and then feel deeply ashamed of our bickering. If we really loved him, wouldn’t it feel natural and easy to care for him? Unconsciously, it seemed we had decided it was better to be martyrs, slowly accumulating internal resentment, than to confront our feelings of loss, pain and frustration head on.
Yet in watching Mrs. C, I realized we could have chosen differently. When she commented on Mr. C’s luck, she was not dismissing the magnitude of his illness but recognizing the value and comfort she could bring to him as a caregiver. And in refusing to minimize her own suffering throughout his death, she did not make his any smaller. Talking with Mrs. C made clear the fact that while being sick and dying is hard, caring for someone who is sick and dying is hard too. It seems such an obvious truth to me now as a medical student interacting with patients’ families, but in the moment, as a loved one myself, it felt thorny and even morally fraught to confront my own negative feelings about taking care of someone who I loved so much.
About nine months after I met Mr. and Mrs. C, Mrs. C wrote to me to tell me her husband had died: he had been at home in hospice care, and she had been with him. He had been very strong his final days, and she very devoted in tending to him. She was apprehensive about transitioning to a life without him, but one thing she was looking forward to was beginning to swim again.
Two months later, I ran into her in the hospital as she was leaving her own primary care visit. I saw her walking stick before I saw her, suspended in its usual aerial position, and noticed her notebook tucked into her purse, filled with what I was sure was a careful record of her appointment. I asked her how she was doing, and she replied she was alright, all things considered. As she put it in her matter-of-fact way, “I’m lucky — I know how to take good care of myself.”
Leena Ambady is a third-year medical student at Harvard Medical School. She is interested in a career in primary care and enjoys reading and writing.