Doc, How Much Time I Got?

by Danielle Ofri
New York Times

The medical team hung back in the hallway before entering the patient’s room. The intern had just presented the case — a 50-year-old man who’d never seen a doctor until three months before, when he noticed blood in his stool. It turned out he had extensive colon cancer that had already spread to the liver and lungs. The man, Mr. M, was now admitted for his second cycle of chemotherapy.

“Nothing much for us to do,” the intern said grimly. I understood her unease, but as the attending physician, I couldn’t second her opinion. “There’s always something for us to do,” I told the team gamely. Inside, though, as we gathered in a semicircle around the bed, I doubted my words.

“If I’d known we were having a party, I’d have gotten some snacks,” said Mr. M with a lopsided grin, slim and young-looking in his Yankees cap. “All I got is Ensure, if anyone’s drinking.” My team smiled nervously.

I asked Mr. M if he had any questions, if there was anything the oncologists hadn’t fully explained. “Nope,” he said, as he gestured to the IV pump at his side. “I’m the cancer expert now — ask me anything!” He took a swig of his Ensure. “And the chocolate ain’t bad,” he said, winking at the team.

The intern was right; there really wasn’t anything for us to do. For lack of a better topic, I asked him how he was feeling. “Great,” he replied, rolling his shoulders like a boxer. “That first chemo got rid of everything — the pains in my stomach, the blood in the toilet. I’m totally back to normal.”

It was a stupendous success that one round of chemotherapy had resolved his symptoms, but something in the conviction of his voice didn’t sit right with me. I changed tactics, asking what sort of work he did.

“I just finished my first season as a park ranger in Brooklyn.” He cracked his knuckles. “If they like me, they’ll hire me back next season.”

Next season? The team around me shuffled awkwardly. Carefully, I asked him what he understood of his diagnosis.

“Well,” he said, shoving the baseball cap further back on his head. “I know that it’s traveled to the liver and my lungs. I know that it’s serious, but it’s not the fatal type.”

Not the fatal type? I could feel the weight of his statement ricochet like a ball bearing through each member of the team. Delicately, I asked if he knew what it meant to have cancer in other parts of his body.

“Means I got to do chemo every month,” he said, patting the IV pump.

And had the oncologists explained what the chemotherapy could achieve?

Mr. M rubbed a nonexistent moustache with two fingers. “I ain’t never really thought about that,” he said slowly. “I guess it’s supposed to make me better.”

I slowed my pace of speaking to match his, gently explaining that while chemotherapy might shrink the tumors and make him more comfortable, it would not be able to take the cancer away completely. That at Stage IV, the cancer could not be cured.

“I knew that,” he said, almost defensively. “They told me that.”

He swung his legs over the side of the bed so that he was sitting up straight in front of me, the crisp whites of his eyes just inches from mine. “So, Doc,” he said, letting the back of one hand fall into the palm of the other with an audible slap, “how much time I got?”

The din of the hospital seemed to dissipate, leaving a wincing silence in the room. I closed my eyes for a moment — a reflex that sometimes happens when I need to gather my courage. There are few situations more horrible than having to tell another human being that he or she is going to die. And it doesn’t get any easier with experience.

I started to tell him that every person is different, that it’s impossible to give an exact number. But five medical trainees stood behind me. If I evaded the question, or relied on euphemisms, I would fail them and fail our patient.

“According to the books,” I said, “for people with Stage IV cancer, the average. …” I stopped. Even after having told this to countless patients, I still had trouble. “The average is about 6 to 12 months.”

There. I’d gotten it out. And now the numbers lay there — harsh and unforgiving.

I quickly added that some people live longer, but some live less time, that it was difficult to predict.

Mr. M’s left eyebrow inched up his forehead, corrugating the skin directly above it. “So you’re saying that if I’ve always wanted to go to Vegas I should do it now?” His voice wasn’t accusing, or even disappointed. It just sounded thoughtful.

I told him I wished I could give him better news.

“I’m a lousy gambler,” he said with a shrug. “But maybe I’ll do better now, knowing there’s nothing to lose.” A pensive stillness suffused the room, and we all seemed to find our own spots on the floor to focus on.

Finally, collective breaths were exhaled, and as if by unspoken agreement the moment of silence drew to a close. In quieter voices, we discussed the future — when Mr. M might start to feel ill, what he should say to his employer, advance directives. We agreed to continue the conversation the next day, after he’d had more time to think.

When we reassembled in the hallway outside, the intern slumped against the wall, visibly drained. The team awkwardly shifted papers and stethoscopes. The intern shook her head slowly, but couldn’t seem to put her feelings into words. We’d all known Mr. M’s prognosis before we entered the room. But now that it had been put into words — given life, as it were — it was a palpable, disquieting presence among us. It trailed us as we made our way silently down the hall.  (from the New York Times)