New Estrogen Pathway
Division Dynamics

Genetic Clashing

In the Community

Research Briefs
Around & About
POV


We took the office van to Hope, in the North Country, for a home visit. A brief history on the ride included "lung cancer," "real simple people," and refusing hospice because of a nurse's "attitude." We pulled through the pine trees scattered with trailer homes and rolled to a stop in front of a pea-green one. A bounding, barking dog named Brownie met us.

Mr. O—a sort of St. Nick looking man—filled the doorway wearing an old undershirt over his belly cinched into his green work pants by a belt. Thick glasses obscured his eyes. He seemed apprehensively appreciative as we climbed the two steps into the smoke-filled trailer. After introductions, he sat at the kitchen table as Tricia, the nurse, went off to the back room. I stood tall, conspicuous in my white coat—trying to somehow apologize silently for my voyeuristic intrusion and 29 years of amassed privilege. Dr. M's warm, booming voice made us all feel more comfortable.

The kitchen had counters piled with pizza and doughnut boxes, dishes in the sink. On the table was an old cookie tin filled with orange, plastic pill bottles. Mr. O's right hand rested on an ashtray, his fingers stained brown around a lit cigarette.

He pointed toward the new, glossy box of narcotic patches and explained he would replace the current one on his wife tonight, this being the third day.

"But," he said, "she's still in pain."

"Are you staying in the bed with her?"

"I've been sleeping on the couch here for the last few, so as not to bother her. She worries me. She only ate a bite of pizza last night and a bite of doughnut this morning." He got quiet, looking askance at Dr. M. "I know when you go, you go, that's it . . . Plans? What do we need a will for? We don't have anything to give anybody but a pile of junk. She's got a bunch of kids, but they don't come round to visit. It hurts her feelings. I don't like to leave her none, except to go down the road when we need some food or pills. I don't want to bring her to the hospital. We been together since she was 21. It's just been us. No, I never seen anyone die in person, in the house like."

He was quiet while Dr. M described death, "a quiet passing in the night, maybe a shudder of the body, no need for pain."

"We don't like to talk about it or think about it much," Mr. O said. "When it's time to go, she'll go. I'm glad you come, though."

Dr. M rose, saying, "We'll go see her now." Tricia came back and sat with Mr. O and we walked through a room filled with the vibrating whir of the respirator and oxygen tanks and then into Mrs. O's room. Pine-filtered sunlight fell through the small window, casting a dusty haze over Mrs. O, a small figure. She was neatly buttoned up in a faded pink quilted robe, with a lace collar, that reminded me of one my grandmother had worn. Her long, silver hair flowed over the pillow; thick eyebrows of the same hue lay above her tiny, crystal-blue eyes sunken under her high cheekbones. She folded her delicate, bony hands on the edge of the covers at her chest. She looked ancient yet childlike—as if the cancer had dissolved years as well as flesh. Her hand felt tiny and cool in mine as I said, "Hello."

She nodded as Dr. M talked about the lovely summer, their spot in the pines, her 86 pounds, shortness of breath, the coming frost. We could see and feel the hard tumor pushing out of her rib cage over her left breast.

She did not retreat from our pressing hands, told us of her pain, but smiled. She thought it would be soon. "No, we don't talk about it, we don't think about it. Yes, I'm afraid of pain. I'll go when it's time."

In his customary manner, Dr. M asked me if I had any questions of a woman with lung cancer. All I said was that she was a beautiful woman and "Thank you for letting me in." Her eyes captured mine as I held her hand good-bye. The pain in my chest silenced me. Dr. M clenched too, something I'd never seen him do.

We retreated and choked cheery good-byes and a "take care now." I asked a quick, distracting question about home oxygen respirators to ready ourselves to face Mr. O.

Mr. O looked up from the table. "It means a lot to us that you come."

Dr. M sat down and told him, "It's all right if she goes, when you're not here. You've been wonderful to her. Put on as many of the patches, two or even three, if she feels any pain."

Mr. O clutched his mouth. A few tears pooled at the rim of his glasses. We stood, held hands, clenched teeth, and fought tears. I was blurred and blinded leaving the trailer. The cool air of the woods helped us make the good-byes. The now-resting Brownie watched us go. Dr. M, Tricia, and I walked to the van. We waved as Mr. O turned back into his dark doorway. The van crept over the pine needles through the trees leaving the husband and wife their privacy. To say I understood their love, or comprehended their suffering would be patronizing. I can only say—that was an hour in a day I don't think I'll ever forget.

In 1996, Sue Cullinane, currently a third-year resident in the P&S Department of Medicine, wrote "Hope," which was edited for In Vivo, while she was a third-year P&S student at Bassett Healthcare as part of the P&S affiliate's Humanities and Medicine Program. In the program, primary care internal medicine students write about their earliest encounters with patients. The full version of "Hope" is in the book "Let Me Listen to Your Heart," a collection of student writings that Bassett published through a grant by the Arnold P. Gold Foundation, an organization dedicated to promoting humanism in medicine. Dr. Alan Kozak, course director of Bassett's Internal Medicine Medical Student Program and associate clinical professor of medicine at P&S, and Dr. David Svahn, Bassett's humanities and medicine program course coordinator and associate clinical professor of medicine at P&S, edited the book. To obtain copies, call Bassett at 1-607-547-392, email medical.education@bassett.org or pick them up at the medical center bookstore on Broadway.

In 1996, Sue Cullinane, currently a third-year resident in the P&S Department of Medicine, wrote "Hope," which was edited for In Vivo, while she was a third-year P&S student at Bassett Healthcare as part of the P&S affiliate's Humanities and Medicine Program. In the program, primary care internal medicine students write about their earliest encounters with patients. The full version of "Hope" is in the book "Let Me Listen to Your Heart," a collection of student writings that Bassett published through a grant by the Arnold P. Gold Foundation, an organization dedicated to promoting humanism in medicine. Dr. Alan Kozak, course director of Bassett's Internal Medicine Medical Student Program and associate clinical professor of medicine at P&S, and Dr. David Svahn, Bassett's humanities and medicine program course coordinator and associate clinical professor of medicine at P&S, edited the book. To obtain copies, call Bassett at 1-607-547-392, email medical.education@bassett.org or pick them up at the medical center bookstore on Broadway.

Have a Point of View you would like to share on a topic relevant to the In Vivo audience? Contact the editors at invivo@columbia.edu.


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