Quality of Life
HEART OF A DOCTOR
Pavitra Parimala Krishnamani, MD MS
K
aterina Novik was a petite woman in her mid-sixties, who I saw on my trackboard one day— she had a history of triple negative breast cancer and had previously received chemotherapy and radiation after a double mastectomy. Eventually, she progressed to investigational therapies because of how refractory her cancer was to treatment. She had finally made the decision to be on hospice when it was discovered that she had new metastases, but the primary source of her cancer could not be determined. She had come into the hospital because she was newly short of breath and had recently found out she had COVID at another hospital.
“Which was news to us,” her son interjected. “You see, I have these new metastases and they never figured out where they were from,” she continued, delving further back into her history. “When they first found them, they just kind of figured it was from the breast cancer and offered another trial, but when I asked them whether the side effects would be as bad as my previous trial, they said the side effects would likely be worse. I declined.” “I see,” I nodded along, “Is that when you decided to go on hospice?”
“Yes,” she paused and let out a deep sigh. “I’m a hospital“Patient with cancer and ist,” she continued, “And, the symptomatic COVID,” I last trial they had me on was WHEN I HAVE BEEN FACED WITH thought to myself, “We may very difficult. The side effects LOSS AND GRIEF, I HAVE BEEN ASTUTELY not be in a state of panwere gruesome. I expected REMINDED THAT LIFE IS JUST THE PERIOD demic, but the many times to be nauseous all the time, OF TIME THAT HAPPENS BETWEEN BIRTH deadly virus is still very but to be so nauseous that I much alive and well.” couldn’t keep from vomiting AND DEATH. constantly? Between that Walking over to our anand the diarrhea, I was practe-room, I gowned up tically living in the bathroom. and donned my personal And it got much worse. At protective equipment. I one point, there was blood double-masked with an N95 coming out of my ears, blood and surgical mask for every from my nose.” Her son patient, but readjusted the looked down at his arms, fit of my N95 to make sure it which were folded together was particularly snug over my nasal bridge before walking into the room. as if to give himself a warm embrace. “And, to what end? To prolong my “Hi there, I’m Dr. Pavitra, I’ll be taking care of you today!” I said. My palife with terminal cancer? To prolong my life like that?” Dr. Novik asked. “I tient looked over at me with a quick nod, her short white hair styled in a couldn’t…Where was the quality of life in that?” bob. Her question reverberated throughout the room and continued to ring in After a quick greeting, she launched into what brought her in that day in my ears for the rest of the day, reminding me of countless attendings I a thick Russian accent, which had escaped her son who was seated next have worked with who have honored a patient’s wish to “do everything” to her. “I had a pleural effusion around my lung that they drained a few only to come back to our workspace after an intubation and lament the days ago in another emergency department,” she said, “It was loculated, patient’s poor prognosis. Like many of them, when I have been faced so I’m not sure how much they really got out, but the shortness of breath with loss and grief, I have been astutely reminded that life is just the came right back and has gotten worse this week, so I called a friend.” period of time that happens between birth and death. She paused, catching her breath through her nasal cannula. Dr. Novik’s son had earlier pulled the curtains for privacy, shielding her “Did they ask you to come in?” I asked. from the fluorescent hue that lit the department’s hallways. As a result, the dim warm lighting in the room bounced off her face, deepening the “Well, yes. Well, I was at the other hospital and that’s where they found shadows that creased her wrinkles. She looked concerned and exhaustout I had COVID and also they said maybe there is some sort of cancer ed. The exertion from speaking had temporarily brought her oxygen in my lungs.” >>
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COMMON SENSE JANUARY/FEBRUARY 2023