A Lady with Cancer

A lady was brought to casualty.  She was in her 40s, and was in desperate pain.  She had been diagnosed with cancer a couple of years prior.  She and her family had been referred to an oncologist.  But someone who called himself a doctor had told them that the hospitals would give her poisons that would make her feel terrible.  The “doctor” instead offered them “supplements” that “will make her feel better and treat the cancer more effectively.”  They chose to use the supplements, and so the cancer grew, otherwise untreated.  She had now developed abdominal pain that rapidly worsened, and was brought to us. 

She was miserable, unable to find a comfortable position.  Her abdomen was greatly distended and tender.  Ultrasound showed her abdominal cavity was almost completely filled with her spleen and liver, packed with cancer.  She was rail-thin, and her nail beds were almost white.  Surely she had a dangerously low red blood cell count.  We started all the “doctor things,” ordering meds and blood and labs and such. 

The family had many questions.  They were kind, educated people.  They said she had been doing so well on the supplements but seemed suddenly to have worsened.  I struggled with what to say.  They had been fooled by a quack, who had been taking their money while the cancer grew.  The cancer was a type which tended to respond well to chemotherapy, and the family had good insurance which would have paid for the chemo, which added to my frustration.  But here she was dying, well beyond most intervention.  We came up with a plan to evaluate her pain and contingencies for the findings. When they asked why she was so sick despite the expensive supplements I tried to gently explain that the cancer had been growing and would soon take her life, and that the supplements had done nothing.  They were quiet. Perhaps they were unsure of my advice.

Her condition worsened and she became unresponsive. I realized that she was near death, and that her illness had progressed well beyond our ability to rescue her.  I felt a push to help the family with realistic expectations.  If her heart stopped, we needed to know what to do.  I told them that her condition was very serious and she could die at any time, that we would continue to treat her well, but the end would come soon. They were not expecting such news, and the truth of the consequences of their earlier decision became an unspoken reality in their faces.  I explained that when her heart stopped, we could try to resuscitate her, but the efforts would probably be unfruitful and dramatic.  The chest compressions would break ribs and the electrical shocks would make her convulse.  None of those actions would change her overall condition.  On the other hand, when her heart stopped, we could treat her with dignity and not do those other dramatic acts.  I recommended this latter course.

We had a time of prayer, and I was very glad to learn that she was a devoted Christian.  There were tears.  The family withdrew to consider.  I checked the clock.  I was about an hour late in going home, and other staff were available to take over her care, but I wanted to stay.  I needed to stay.

The family returned.  They were confident in their decision to go the way of a quiet end with dignity.  To my surprise, they asked me not to continue with CT scans and surgical referral, as we had previously planned.  I took a little time to finish the paperwork, then the family and our excellent resident and I began to push her on her bed to the ward.

As we neared the ward, her breathing slowed.  The ward wasn't ready for us and we paused at the entrance.  Hearing her breathing slow further, I told the family that she was finishing, and we turned  into a side hall.  I was so very relieved that we had discussed the plan for her end when we were in Casualty.   We prayed again, commending her soul to the Lord, thanking Him for an end to her suffering, and rejoicing, with sorrow, for her promotion to Heaven.  Her breathing stopped altogether. 

The family thanked us for our efforts and asked God's blessing on us.  Then they departed.  We did the necessary things for the body, and I walked home.

The walk home normally takes four minutes.   It seemed much longer this time.  My patient had been a young woman with three kids.  Her cancer had been very treatable.  She died “needlessly.”  She and her family had been deceived by a charlatan, with deadly consequences.  A grievous injustice.  I felt sick.  But God remains Sovereign.  “See now that I, I am He, and there are no other gods beside Me. It is I who put to death and I who give life.  I have wounded, and it is I who heal, and there is no one who can deliver from My hand.”  Deut 32:39.  Both were true.  The deceiver had profited from malpractice and she had consequently suffered and died.  And God was sovereign in the whole event.  Surely, He was grieved by the sin of the situation as He is with all sin.  I was grieved, too.

Martha and Meredith and James were already sitting at supper.  I washed and sat.  Martha asked what kept me, so I told the story.  Tears came, which was surprising.  I don't remember being that emotional at the death of a patient since my time in a combat hospital in Afghanistan.  Surprising, but welcome.  James gave me a long hug. 

I believe that God arranges for us people to intersect with each other for a reason.  So why did He put me in contact with that family, with that lady?  I hope that I was able to guide them medically and spiritually in an important time.  I hope that it was right to choose less medical intervention and more spiritual support.  But those God-arranged intersections usually have purpose for both parties.  What was I to learn?  I think I was supposed to be reminded that ideas matter, and that we must be teaching to prevent the suffering that comes from deception and greed.  I think I was supposed to feel a little of God's grief at the brokenness of this world, and cry about it.  And ultimately I think I was supposed to really live in a situation in which medicine was largely futile, but God's sovereignty was the source of all comfort.  Ps 116:15: “Blessed in the sight of the Lord is the death of His holy ones.”