As I anticipated, the meeting at the oncologist's office this morning was pretty heavy. In attendance were the patient in question, his son, his close friend, myself, and the oncologist, a very kindly woman whose chair-side manner was impeccable.
The news was as I expected, based upon my reading of the CT-scan report and biopsy results: advanced adenocarcinoma of the stomach with metastasis to the liver, adrenal glands, and very likely lymph node involvement throughout the abdominal cavity. In other words, it couldn't be worse.
I allowed the doctor to lead the conversation, chiming in as necessary, the son and friend and I all translating for the patient who speaks less than ten words of English. There were tears, a verbalized desire for aggressive treatment, and a thumbs up in defiance of the odds so squarely stacked against survival. The doctor was very clear that surgery was not an option, and that chemotherapy---if it didn't make the patient feel worse---might prolong his life by a few months. I was very cognizant of her choice of words: months. With a cancer so advanced, survival is short-lived, and we don't talk in terms of years. There are no years left. A harsh reality by any measure.
Our meeting was classic in many ways. The patient and family members listened quietly while the doctor spoke in soft tones. A few moments after she made the diagnosis and the prognosis unmistakably clear, my patient began to cry and reached out for his son, embracing him strongly, man to man. Then he reached the other way and hugged his dear friend who was sitting on his left. Then he embraced them both and the three of them wept together. At this point, he looked up and gestured for me to take his hand. We were all four of us physically connected, the doctor quietly observing, as this lovely and soft-spoken gentleman began to digest the fact that he had been handed a death-sentence, that his body had betrayed him and was, even as we sat there, producing non-functional cells at an alarming and unmitigated rate. He began to grasp that the chemotherapy might slow the growth of the cancer but could not arrest it completely, and that the side effects of the chemo could be gruesomely uncomfortable, perhaps even deadly. All of this cascaded down upon him and upon the minds and hearts of his loved ones as we sat in that air-conditioned and spartanly modern room.
Breathing in the scene in which I was an active participant and keen observer, I could feel the expanse of the city around us, the thousands of lives careening through the streets, the myriad other life stories unfolding in that instant. It was a poignant moment of existence for me: here we were, facing death and suffering in the face, the person facing the challenge being embraced by his loved ones, the compassionate professionals observing and noting the details of the moment, present, yes, but also somehow detached.
Throughout this time, I noticed the oncologist move her stool closer to the patient, leaning in when she needed to speak of the more difficult issues. Her body language was open, her eye contact steady, her voice level and professional but compassionate. She touched his knee at just the right time, and we all sat in silence when it was needed. When the doc left the room for a few minutes of consultation with her superior, I took a deep breath and reminded everyone to do the same. Towards the end of the appointment, the supervising physician came in and made his presence known in the most gentle way. It was as if he'd been there all along. His presence was reassuring but not domineering, masculinely strong yet not patriarchal. He knew what he was doing.
When witnessing scenes such as this, perspective is the word which mostly comes to mind. That could have been me, my wife, my mother, my brother; any one of us could be on the receiving end of such a conversation, such a life-altering moment. It is profoundly humbling when one is reminded so starkly of one's diminutive stature in the scheme of things, yet also the power and focused energy which the changing course of one life can command. We are all truly stories unfolding.