Mildred and Jack

Posted by on May 5, 2015 in Cancer Care, End of Life, Family & Disease | 5 comments

Mildred and Jack

 

That first time there was a moist sweet smell, the hiss of oxygen and pictures of grandchildren on the wall.  Unopened juice containers, papers, a Kindle, the phone and some plastic table wear, crowded the bedside stand. Jack was thin, tired and the tightness of his eyes spoke of uncontrolled pain.

 

“Oh, I know you. You took care of my wife’s friend. You’re the cancer doc.’

“Yes, that’s me, nice to meet you, Jack.”

“No offense, but its not so nice to meet you.”

“I appreciate that, no offense taken. What did they tell you was going on that they wanted me to see you?”

“The surgeon said, I have the Big C. Cancer in my lung. Stage IV, he said.”

“What did he tell you about it. What was the plan?”

“The plan was call you. But, I know what that means.”

“What does that mean?

“It means that I am going to die. But, you have got to do me a favor.”

“What is that,” I asked.

“You see I have been through a lot in the last few years, so I have been expecting this. I can handle it. But you can’t tell my wife.”

“Don’t tell your wife what?”

“Don’t tell my wife that I have cancer. Don’t tell my wife I am going to die. She couldn’t take it.”

 

I sat silent for a moment. This was a remarkable request. Not that it is remarkable for a man to want to protect his wife. Not that it is remarkable to desire the small amount of denial that comes from not sharing tough news with loved ones. No, what made it remarkable was the conversation I had with his wife, minutes before.

I had run into his wife, Mildred, down the hall. Not a great place for important talks, dodging rolling gurneys, racing interns, and the bright intrusive noise of even the calmest hospital ward. Still, she cornered me between food carts.

 

“You’re the oncologist who is going to see my husband, aren’t you? I recognize you from the office. You took are of my friend.”

“Yes, I was just on my way to see Jack. How are you doing?”

“I am very upset. I just got the news from the lung doctor.”

“What news did you hear?”

“Jack has terminal cancer.”

I had to try to get out of a deep talk in the hall. “Do you want to come with me, while I see Jack?”

“No, not right now. But I wanted to warn you.”

“Warn me?”

“Yes, Jack has been through a lot in the last few years. He is very frail. I don’t think he can take it. So, you can’t tell him how bad it is. You can’t tell him he is going to die.”

 

Therefore, here I was, sitting next to Jack, reflecting on their remarkable request. Not wanting to bring each other pain, perhaps wanting to deny horrible reality just a little while longer, they had built a wall, opened a chasm. After spending a lifetime together, sharing careers, children, success and failure, relying on each other’s advice and emotional support, they were creating separation. Just when they needed each other the most, they were pulling apart.

It is a natural and common behavior, based in /. It may be temporary, until each person can cope and then open themselves to sharing. Or it may continue as a permanent mal-coping action, with denial and miscommunication through the hard times, until the patient ends life not at home, not in comfort, not surrounded by those they need, but in an intensive care unit invaded by machines and strangers.

While communication must move gently, slowly, at the pace and with the method that is special to each relationship, it is vital we share. It allows support, understanding and communication. To deny that connection at the worst of times is to deny the chance to find closure and heal.

For the doctor, sometimes opening up family communication can be difficult. First, the physician must teach every family member, individually, that the physician can be trusted to give bad news in a supportive way. Trusted that they will not cause unnecessary pain. Trusted that they will be there. Only then is it possible to empower families so that they can have these most critical, but difficult, discussions.

 

Jack and Mildred were easy. I said, “Jack, what do you think your wife just said to me, five minutes ago?”

“What?” he asked.

“Mildred said, exactly what you just said to me. She is worried about you.”

Jack relaxed. A sad smile came to his lips. He looked past me.

“Do you want me to get Mildred?” I asked.

“Yes, thank you.”

 

I found Mildred standing alone down the hall, looking out a window seeing nothing, and brought her back to Jack’s room.

Mildred sat on the bed. They held each other close. They began to cry. I closed the door.

 

5 Comments

  1. I recognize this from friends of my parents when I was a kid, and from my hospice nursing experience. For me it brings up the pain of failed connections. Some of your stories go to the core for me, and I go early to the kitchen with some tears. And part of what I love from your stories is the swing of my pendulum: I need to laugh in some way that feels right and moves the day forward. After your story this morning, a picture of Yogi Berra comes to me, and he is warning “Go to other peoples’ funerals, or they won’t go to yours.”

  2. thank you for writing this story

  3. Why do medical/quasi-medical people (almost) always seem to believe that they know the inner workings of the relationship of every couple they’ve just met? Why is it so hard to imagine any other scenario? Perhaps this exchange is this couple’s way of protecting each other and might have been this way, and probably was, for years. Perhaps, they each simply wanted to be the one to tell the other one the “bad news”…not you…not a stranger…maybe, not here. Perhaps they didn’t want to hurt your feelings by telling you that. The way this story is written, I find it difficult to believe that either of these individuals were throwing up walls of denial and cutting off communication with one another.

    You used the sentence, “It is a natural and common behavior, based in /.” What is the missing word(s) in place of the “/” sign?

    Then, you end that paragraph with “until the patient ends life not at home, not in comfort, not surrounded by those they need, but in an intensive care unit invaded by machines and strangers.” This scenario is described here and over and over by so many others but really neither scenario is completely true.

    Not every patient who ends life at home is 1) in comfort, 2) surrounded by those they need or 3) actually wants to die at home. The often quoted statistics are that the vast majority of people want to die a natural death at home. What gets left out (in public discussion) is that the vast majority of those same people, when the time actually comes, want to be in a hospital. This doesn’t even include the rogue, vindictive or unqualified “medical care” provided by some home health or hospice agencies.

    On the flip side, not everyone who enters the hospital at end of life will be put in intensive care. Not everyone will have full resuscitation measures applied to them. The hospital is supposed to (and often does) ask what is wanted either of the patient or of the family members present. I know because I was one of the ones who was asked.

    What is the purpose of repeating these home/hospital scenarios other than to scare people and/or to direct them to do the bidding of someone else?

    The most important ‘end of life thing’ for couples and families to do is to discuss what you want before you need it. Then everyone knows and there’s no snap decision at the end during a high-stress situation. It doesn’t make it any easier or less heart-wrenching, I certainly know that, but at that time you will know what needs to be done.

    Then, there’s no need to listen to the hospital, home-health or hospice staff TRYING to sound compassionate and caring as they “push you” (and they will, sometimes very vigorously…trying to be uncharacteristically “nice” here) to opt out of using any extraordinary measures not just because they are likely futile or invasive but because they cost a lot of money AND are likely futile and invasive.

    In the end, it all boils down to that money. It’s not about you or what might be best for you. It doesn’t mean that there are no truly caring, qualified medical professionals involved. It does mean that at some level there is someone, usually well removed from the situation, who is calling the shots by holding the purse strings and asking the questions…How much will it cost? How much will their insurance pay? How much can they pay? How much will the government pay?

    The dollar value of our lives is pre-determined by a plethora of actuaries. To believe otherwise is some real denial. Control, that is, YOU having it is discouraged and described (to you) as a bad thing. But if YOU don’t have it, then someone else does and that someone else likely works for the medical industry in some monetary capacity. Ultimate control comes from knowing what YOU want and not deviating from that course unless YOU want to. There’s nothing bad about that.

    This is just a little of what hospice and our medical system taught me about life and death.

  4. Points well made; thank you.

  5. Great story and an important lesson
    Thanks

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