A mother's love. I will never forget a 35-year old mother who came to my office with right-sided breast cancer. In a relatively short period of time, less than six months, it had spread to her left breast. She would always bring her two small children to my clinic for her annual exams. As usual, we would discuss not only her illness but also how much she wanted to live.
She was a single mother who had no support. One day she came in to tell me that now the cancer had spread to her brain, lungs and bones. She told me she could do another round of chemotherapy and radiation and maybe prolong her life for another 1 to 2 months.
However, she was facing the reality of the end of her fight, for now she was so tired and her hair had just grown back. I remember looking into her eyes as she said, "I am so sorry, Dr. Christina. I know you are going to get angry with me, but I just can't do it. My children are so tired of seeing me bald and being so sick all the time with my vomiting and diarrhea." Then she said, "Do not think of me as a coward. Do not hate me for not doing what the doctors want me to do."
After knowing her all this time, for her to think I would get mad was beyond my comprehension. For she spoke to me that day about what she truly felt was in her best interest—and the best interests of her children. We all have choices to make. She wanted to do what was best for her and her family in that moment, even though it meant that she may not survive as long to be with them. I looked at her and told her that this was not my choice and that I would honor whatever she decided.
She said, "None of this medicine worked for me, Doc. My kids cannot remember me laughing or having fun. For that matter, they miss playing with my hair. I want so much to live, but I know I'm not living right now." Then she asked, "Do you hate me?" I told her of course not. I said, "I'm here for whatever you decide." We both had tears in our eyes. I decided to ask her what she needed from me. It was a simple answer. She just said, "I need you to say it's okay."
We took some time to think of ideas for how her children could remember her. One of our ideas was for her to write letters to them about the hallmark times of their lives. Another idea was to make videos and digital recordings of her voice speaking to each child, so they would feel so special having their mother talk to each one of them individually for the rest of their lives.
I told her that I lost my mother due to her cancer when I was young. As I got older, it meant so much to be able to hear her voice or see a picture of her. We thought more about my patient’s smell such as the perfume she wore most often and what else the children could remember, such as their favorite foods she would make for them and the songs they had sung together that meant so much to all of them.
I shared with her the one thing that was the hardest for me about my mother: the sense of touch. I told my patient how I missed my mother's hugs and the touch of her hand, so we tried to think up things for her children to feel safe—like perhaps a blanket with her smell. We wrote all of this down for her, for she said her memory wasn't as good as it used to be. We hugged with tears in our eyes and she told me thank you. We planned to see each other as though nothing was going to happen in four months, but we both knew that this was the last time I would see her.
There comes a time in medicine when all options have been given to the patient. Once they have been informed of all of the facts, the choice of the patient’s course and care is now theirs, and their rights must be respected. The patient has the right to her or his own dignity, and we in the medical community must honor their wishes.
We always want to fight and win each battle. Even as a doctor who has practiced for so many years, it still pains me to know that I will not win every battle. Even more significantly though, I also know the importance of loving my patients as I do while losing them gracefully.
My thoughts go out to all those who have cancer, and my heart goes out to all the cancer survivors and mothers. We must not forget the families. Most of all, the children who must go on and live need to have the memories they can cherish of how great and courageous you are.
With much love and respect,
Dr. Christina Charbonneau is an award-winning doctor who has been practicing medicine for more than 30 years. She is also a certified coach, media personality, speaker and former medical school professor. Recognized with the Most Compassionate Doctor Award and the Patients’ Choice Award in 2010, 2011 and 2012. She was also a fellow in Integrative Medicine at the University of Arizona College of Medicine with Dr. Andrew Weil. Visit Dr. Christina's website at: http://www.drchristina.com