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The Art of Palliative Medicine - 2016 Semester 2

I have chosen to write a creative narrative inspired by Ms X’s story. I didn’t refer to her by name as I did not want to tell her story for her; as that is something only she can tell. But I have used her words as much as possible. I chose this medium as I found it helped me to see beyond what she’d told me at face value. In writing a narrative, I was forced to try to understand the impact of the diagnosis on her life, and yet also to focus on how her life is not defined by her illness. I tried to portray the way that Ms X described her journey in a matter of fact way, with acceptance but not overt emotion. Speaking to Ms X has taught me a lot about end of life experiences. It has also shown me how I can improve the way I talk about this with patients in the future. The overarching theme that I learned about and have tried to portray in my narrative is how cancer/a terminal illness can affect all aspects of a patient’s life while at the same time, life still goes on. I learned that end of life care doesn’t mean that a patient’s normal life is already over.

PDF version of " Lifelong "

‘I’ve known cancer all my life’. It was there with her when she began, taking away the sight she had yet to use. A cancer which marked the beginning of a fraught relationship.

They met again decades later. A short visit. Simple tumours removed before they had the chance to dig their way deeper. She was always aware that cancer might be waiting to strike. She asked her doctor about a mammogram, fearing its presence within her. ‘You’re too young’, they reassured her. If they had searched, would they have found the mass of cells organising themselves into a lump deep within one breast?

It began with something that seemed innocuous. A run of the mill pain in the back, the same ailment that thousands wake up with every day. She took the Panadol and ibuprofen she was given, and did the resting she was told to do, and then there she was, back in the doctor’s office. This was the start. A steroid injection failed, and then came what she couldn’t yet know was to be the first in a very long list of scans. Cancer was about to make itself known again, and quickly. There was a mass – inoperable because of the way it was nested in the spine. She met the oncologist, who introduced her once more to cancer. This time, it was almost everywhere. They came into the hospital to give radiation on Easter Sunday, their holiday, just for her. A special Easter radiation session.

She speaks about it in a matter of fact tone. They had to write their wills. There was more radiation, chemo, and then more chemo (all awful), and so many scans. ‘For the first chemo, everyone cares. Everyone’s bringing in flowers, sweet treats, lovely smelling little creams for your face. By the second time, no one knows anymore. They don’t understand why you’re still sick’. People ask if she’s better, if it’s come back, is she in or out of remission? ‘I’ve never been in remission.’

Some friends have left. Some want to help, others want to want to help. If there’s anything you need, just ask. They leave it up to her to do the asking. ‘And then I have to come up with something that they can do!’ The best ones know that cancer makes one’s schedule unpredictable. They know she might not make their dinner plans if cancer doesn’t want her to.

For a time, there were others who she found on the internet. Individuals spread across the globe, linked by the infiltrating malignancies lurking within their bodies. But soon, some of their battles came to an end and it was too much for her. She has her own cancer; how can she also take on the burden of others? She was told that fighting cancer should be her job, but she already has one. She has done the slog of cancer, she has tried all the diets, she has thrown out each grain of sugar and yet the slow march hasn’t stopped. Now she knows that’s part of the process. ‘It’s all rubbish really, but every cancer patient has to go through it themselves.’

There have been specialists, and surgeons, and nurses. There has also been the hospice. She was reluctant at first – it’s ‘the place you go with five minutes left to live’. But they’re another voice to talk to, another source for information less harrowing than the type spurted out by the internet.

It might pull some of the strings, but cancer is not her life. Plans for the future are less certain, but there are still plans all the same. She sings. Sometimes cancer interrupts with a coughing fit, or sometimes she can’t manage a concert, but then, sometimes she can. She teaches her students. She works from home. She is a loving wife, closer to her husband than ever before, all in the face of the shadow that cancer has cast. Her focus has moved. She seeks things that will make her happy. She cherishes people that will make her happy.

No one has ever told her how long she has to live. ‘If they had, I’d have proved them wrong by now.’ For now, she prepares for yet another treatment, another in the long list of barrages her cancer has withstood. ‘I’m not ready to stop trying things.’ Cancer has always been a presence in her life, but even as it has become more prominent, so too has life always continued on around it.