The First Office Visit:

“Hello, I am here to get this drained.  My doctor said I didn’t have to drive back to Baltimore if you could do it.”

She explained that she needed the fluid collection drained from her mastectomy site.  The surgeon in Baltimore said any doctor could perform the procedure.  Anastasia was her name.  She felt too tired to drive to Baltimore again this week.  I did not have time then to review her chart.  I took out a needle and syringe. I cleansed the area carefully with betadine and took off 20 cc of fluid.  She thanked me and left.  I would perform this procedure several more times in the next month.  She would sit there very poised without any expression of pain.  During that time we formed a bond. I learned she had a daughter around the same age as my son.  Her husband had died a few years ago. She was teaching school this summer for the Migrant Program and had plans to return in the fall to a full schedule.  I would later meet her long time friend who would provide support for Anastasia’s daughter and mother through the long ordeal.

That first time in the office, I noticed her beauty and her battle scars.  She had her head tied with a beautiful scarf to hide the loss of hair from chemotherapy.  Her makeup applied to perfection to camouflage her ashen skin.  She carried strapped to her waist an infusion pump for continuous chemotherapy.  The beautiful outfit she wore hid her thinness.  I imagined that before all of this she had been stunning even more stunning than she was even now.   Her friend accompanied her to some of the visits.  She showed a warm and supportive spirit each time I met her.  She and Anastasia taught at the same school.  She would be the one to suggest that we get help for Anastasia’s daughter and I arranged this with one of the best psychologists in the area.  She was obviously holding back the tears.  She had the special role of godmother and took it seriously.

I realized after two years in private practice that I did not feel prepared to assist and comfort patients when dying was the only outcome.

Her Story:

I later learned her story and knew that I was embarking on a long journey with this woman. She was the pride of her family and community.  Everyone who knew her loved her.  Anastasia was fighting a battle with recurrent breast cancer. She had won over 6 years before.  During the time of remission she had a child, a beautiful little girl that she adored.

Anastasia continued to see me even after her wound healed.  She had been my partner’s patient.  I felt an immediate kinship with her.  I knew that I had been chosen for the task of helping her to die with dignity.  She was not ready to admit defeat and neither was I.  Meeting her mother was difficult.  She made it clear she was not ready to lose her only daughter.  She represented all her hopes and dreams.  No mother ever dreams that their child will die before them.  For this mother, death would bring with it the responsibility raising her grandchild.  Each of our encounters would clarify her fears.  Her daughter was a perfectionist.  Her grandchild was not deprived.  She was not sure if she could live up to her daughter’s dreams for this child.

“What am I going to do?  This is not fair.  God’s will be done.”

The next few months were emotionally draining for me.  However, I learned so much about myself.  I grew from Anastasia strength and courage.  She challenged my empathy and removed the fear I had about allowing myself to care.

“ You have to help her.”  I can’t stand to see her suffer.”  Anastasia’s mother came to depend on me.  She was frightened when she witnessed her daughter’s seizure and learned she had a metastatic brain tumor.    She accompanied her to radiation treatments.  She and I took over more of the decision-making as her child weakened.  We were prepared but reluctant to make the final decision to not resuscitate her daughter at the end.  Physicians do not admit easily that their patients are terminal.  Oncologists have the hardest time.  Prior to and after the seizure we were fighting the HMO to allow Anastasia to enter the clinical trial using Taxol.  They finally agreed but realistically it was too late for her from the start.

The Final Days:

I was leaving on vacation the Monday before Christmas.  My colleague kept saying she hoped Anastasia died before I left.  I knew what she feared: if I left before Anastasia died, the responsibility would fall to her  to deal with Anastasia’s final moments. I had become for Anastasia’s mother a strong support, almost like a daughter.  I knew I had to make the transition back to myself and sever the ties before I left.  Anastasia died the week before I left.  She was admitted to the hospital.  I pushed for her to die at home with Hospice. Her mother could not sit home alone and watch her child die.   Instead, she died in a hospital bed.  Her friends and family were there.  The continuous morphine drip kept her free of pain.  She drifted into a deep sleep. Her family was emotional.  I allowed them stay in her room until she departed.    All who knew her loved her.   I was in the office when she died on Monday.  I walked over to the hospital to pronounce her and complete the death certificate.  Anastasia’s funeral would be on Saturday.

It was a cold day.  I was on call the day of the funeral.  I asked the operator to hold my calls unless they were urgent. I got there late. I hoped to sneak in the back of the church.  When I walked in the door, Anastasia’s mother grabbed my hand and held on tightly.  She wanted me to sit with the family.   She was so beautiful and still on the satin drapes of the gray casket.   Her make-up was to perfection.  Her beautiful black dress and hat transformed her.  In the distance she was radiant.  The soloist sang softly “Don’t cry for me.”  Her long time friend and high school classmate who was now a Methodist minister gave the eulogy. “She inspired all who knew her to reach for their highest goals.  She did so herself.  We who knew her will miss her.  Those who supported her in her time of greatest pain are overjoyed that she is in God’s hands.”

The soloist sang, “I am going to better place.”  We all knew she was there as we looked at her peaceful face.  No sign of the terrible pain she had just before coming into the hospital.

The Superintendent of Schools, city council members, friends and family from across the United States, attended the funeral.  Many of her friends and classmates were still living in town and I immediately recognized them as my patients and colleagues from the hospital.  They paid tribute to her as an alumnus.

The Farewell:

“Don’t cry for me.” They cried.  I cried.  I could not go the graveside service.  I was drained and on call.  I couldn’t bring myself to watch the final ceremony.  I had seen it so many times.  My grandfather was eighty and my father-in-law was seventy at the time of their deaths.  Anastasia was going too early.  I went home. In the car, I realized that this had been a revealing experience.  I could only hope that my own funeral would be so full of celebration of life and regret for the loss.  I knew she was in a better place.  Free of the pain, rid of the dreadful disease and as beautiful as she had been before the cancer. I felt Anastasia was pleased with our performance.  It would take us all to support her mother and her child.  I would be there for several years. I will always stay in touch with them no matter where I go.

I hugged my child when I got home. I answered my calls and started to pack for my vacation.  I was ready for the drive to Birmingham.  I would be seeing my own mother for the first time in months. When we finally got in the car and crossed the bridge, I sighed with relief and slept as my husband drove.  The music was soothing.  My mother would be there to comfort me.