Bucks Montgomery Physician Winter 2021 - 10

FEATURE

very good support from social workers, chaplains, and
superb nurses. Family gathered, stayed, and supported
Isabel even when she could not respond. I told the
family that I believed that Isabel could hear them, knew
they were there and their presence was supportive.
Isabel passed peacefully. I felt that our treatment
team has responded to the patient and the family.
Recently after retirement, I returned to my hospital for a
minor surgical procedure. I was there very early (I got the
first case as a perk). Sitting waiting to go back, a hospital
volunteer came by. She was my patient who volunteers
in the surgical waiting area. She is a long-term survivor
of ovarian cancer. She stopped and we chatted about my
retirement. She then went up to the family waiting area
to talk to those waiting to hear about their significant
others in surgery. Barbara volunteers on Tuesday, my
main operating room day. It is amazing what a volunteer
can do to comfort families. When I come out to discuss
my findings with the family on a woman with ovarian
cancer, Barbara is there to talk to them after I leave.
She can give an optimistic message from her care.
The last in-person conversations with Arlene was my
next to last day. I came to have " the talk " as the resident
doctors call it. This is where the doctor explains that there
are not good treatments for the disease. Treatments will
not prolong life and will most likely decrease quality of life.
I may have reached my limits emotionally; on these talks,
it takes a toll. It could be one of the reasons why I retired
early. I sat with Arlene and her husband and discussed
her current condition and prognosis. I explained that
treatment would not afford any reasonable opportunity
for improvement and would cause side effects. I explained
that at this point quality of life would be improved by
supportive care and most likely quantity of life would
be improved over treatment. Many studies have shown

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BUCKS/MONTGOMERY PHYSICIAN

winter 2021

that hospice care can actually lengthen survival in these
situation over treatment. Unfortunately, most patients
spend little time in hospice and sometimes continue to
receive chemotherapy up until a week before they expire.
I had this talk, and I saw Murray tearing up and
understanding that her symptoms were not from the
experimental therapy she had but due to advancing cancer.
Arlene, however, asked, " But what about my nutrition? "
It again hit me about how a cancer patient perceived this
news. Some never come to accept that dying is a part of
life or have great difficulty in getting to that place. Arlene
was just not there despite many talks before this last visit.
I really felt that I had failed. It is disturbing to this day.
Discussion with Arlene and Murray though the next day,
my last, brought Arlene to the realization of her situation.
The hospice team came, and she went home. Her daughter
came from Florida and helped Murray. I left for a long
vacation and into retirement, so I did not get to make a
home visit. I called and gave my support. After several
weeks Arlene expired peacefully at home with her family.
However, the words " but what about my nutrition "
remain in my mind. I understand how important life is
and how difficult it is to come to the realization that it is
ending. Medical care is not only for my patients but for
the family that survives. I hope that during my career with
experience I understood that. I am unsure that I did when
I was young. That is the difficult part of the profession.
If some young oncologists read this and benefit from
my experience, I would be grateful. I do not think I was
" burnt out " on caring for patients. I loved the opportunity
to treat and care for women with gynecologic cancer.
Bucks Montgomery Physician Winter 2021

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