A Cancer Patient’s Last Wish

It’s not a good feeling when as a doctor, you cannot do too much for your patient. That’s how I felt when I walked into the room to see Valerie for the first time.

She was in her 60’s. She was flanked by her two adult grand-daughters who you could tell were very close to their grandma. You could tell that at some point in her life, when she was younger, she may have been an athletic person, but now she was reduced to skin and bones. She couldn’t walk without assistance and that’s why she was sitting in a wheelchair which was taking up a lot of room in the relatively small exam room. She had certainly aged a decade more than her real age. This was reflective in the wrinkles on her face. Some wrinkles are age related but hers looked like wrinkles of self-abuse. The kind of wrinkles that people develop when they smoke and drink a lot. I’m not even sure if there is such a thing, but we all have seen people who start looking a certain way if they abuse their bodies. She had a raspy cough clearly indicating that she had a cigarette right before entering the room and was waiting impatiently for her next one which she would smoke as soon as we were done with the visit.

I had already read in her chart that she woke up one day and her eyes looked yellow as if her grandson had colored them with his crayolas. Before that, she had already lost more than twenty pounds but she was attributing it to cutting down on energy drinks. She wasn’t in any pain. Yet. Tests had shown that she had developed pancreatic cancer that had spread to her liver and lungs. Her kidneys had also taken a hit and the nephrologist had told her that she was lucky that she did not need dialysis right away but that she may need it any time. Food tasted like garbage. Breathing was OK but every few minutes she had a feeling that she had to catch her breath. While her body was wilting away rapidly, her eyes were filled with hope as she was talking to me.

“Typically we are able to give chemotherapy which doesn’t cure this kind of cancer but can buy us some time and also quality of life. In your case however, I think chemotherapy will be worse than the cancer because your body is too weak to go through it.” I concluded.

“So what do we do then doc?” She inquired desperately.

“We will make sure that you are comfortable and we will focus on your symptoms. It would be best that you transition to hospice level of care.” I responded.

“You mean you want me to go home and die?” She asked.

“In a way, yes. If you were my mother, I would say the same thing.”

 The hope in her eyes shut down as the lights go off in a theatre after the show ends. She did not say anything for a few minutes. Her granddaughters became tearful and I offered them tissues.

So far, whatever was happening in that room, was quite a routine occurrence for me and scenes like that are unfortunately a daily occurrence in a cancer center. But then she said something for which I was not prepared.

“Hey doc. You remind of me of my boyfriend that I had when I used to live in New York City.” Her eyes went into a reminiscing dreamy state for a moment. She stared in the air and continued, “He was the best man that I had ever had. He left me but I never found a man like him ever again.”

 I became paralyzed for a moment because I did not know how to respond. I just nodded. “Thank you, I’m flattered.” That was all that came to my mind to say.

“He was from Pakistan and took care of me like a man takes care of his woman.” Now she was looking at me in the eye.

“I am also from Pakistan.” I told her.

This was probably her way to change the topic of her grim prognosis and make the moment lighter. She wanted to be brave for her granddaughters and show them that even the news of death couldn’t break her. She shook off the grief and a cute mischievous smile spread across her face. She saw me getting slightly uncomfortable in my chair and proceeded with her flirtation.

“He used to make the best lamb curry for me.” Her mouth watered probably for the first time since cancer rendered her taste buds useless.

“That’s interesting, because I also make lamb curry that my friends like so much, I must have made it for them dozens of times.” I smiled.

“Doc, would you fulfill a dying person’s last wish?” She asked, looking at her granddaughters as if to get a kick out of how she was now playing with the doctor’s emotions. “I want to have Pakistani lamb curry for the last time. Will you make it for me?” She asked.

“C’mon gramma, that’s not what you’re here for.” Her granddaughter said embarrassingly.

Thinking to myself whether she was serious or just joking, I said, “well I can’t promise but you certainly have me thinking about it.” We did not make any follow up appointments and she went home on hospice level of care, or to die, in her own words.

I went on seeing the rest of my patients for the day and went home. The weekend came and no matter what I did, my mind wandered to our conversation. My mind kept telling me that she was just joking. Who does these things nowadays? Maybe she had even forgotten what she said to me. But then how could I not fulfill her last wish? How often are you given the task to fulfill the last wish of a person? In the legal system, in those places where a death penalty is given, isn’t it a thing that that last wish of a person is asked and then fulfilled? Its as if it’s the dying person’s right that should be granted whenever possible.

Finally I decided that I would make her the lamb curry. While I was cooking, I was thinking whether she would even be able to eat it due to her disease. At the time of adding spices, I thought whether I should use my usual amount of spices or cut it down?  What if it’s too spicy and she gets nauseated? I looked up her address in her medical chart and took the neatly boxed lamb curry and a packet of naan. The neighborhood was not the nicest part of town. I found her house and knocked on the door. A young woman opened the door and we instantly recognized each other. She was one of her granddaughters. She saw the boxes of food in my hand and she yelled, “hey grandma, you wouldn’t believe who’s here.”

I walked in to the house. It was very small. There she was, sitting in the living room on a couch. She had oxygen tube in her nostrils. She appeared a bit drugged probably from the morphine. There were atleast a dozen empty cans of beer on the table in front of her. The ashtray was full of cigarette butts and rather than emptying it, she was now using the beer cans as ashtrays. There was a thick cloud and smell of marijuana in the room. She was a little disoriented perhaps from all the prescription and non prescription drugs that she was under the influence of but could recognize who I was. “Did you really think that I would not fulfill your last wish?” I smiled and put the lamb curry in front of her and instructed her granddaughter how much time to heat it up for in the microwave.

Val wasn’t in a condition where she would could have a long conversation with me but she knew exactly what was going on. I saw her eyes smile for a moment that tore through the pain that was otherwise displayed all over her face. She didn’t say much, but just enough when she said, “God bless you.”

I left her house wondering to myself that we have always read in books that when somebody is given the death sentence, they are asked about their last wish. We seldom do that in medicine. Should we?

July 10, 2022

This article was published online on KevinMD.com.

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