In Sickness and in Health |
Posted: September 3, 2014 |
He was already sitting on the examination table when I walked into the room, and he looked smaller than I had ever seen him. Perhaps it was the way he held his shoulders, or how he didn’t quite meet my gaze. I took his nonverbal cues and greeted him quietly. I had been following my patient for a couple of years for his cancer, and our relationship had evolved — or was it devolved? —to one of jousting one-liners. He was a throwback to the comedy greats of the 1940s and ‘50s, and more than once channeled Henny Youngman in imploring me to “Take my wife, please!” His wife of 50 years, though, was not in the room. During past appointments, as he and I traded jokes, she would laugh along with me at the same punch lines I’m sure she had heard him deliver hundreds of times. And though she was occasionally the target of his humor, in truth he adored her and was lost when she wasn’t around. He also liked to play the role of the big-shot gambler, frequenting casinos a number of times a year and wearing gold bracelets and a garish watch. But it’s as if we were all in on that joke and knew that it was a front, that under it all, he was really a devoted family man. I asked him how he was doing. “Well,” he paused, leaned forward, and shook his head, causing the dollar sign pendant on his gold necklace to rock back and forth. “Not so good, it turns out. The missus…” He trailed off. I asked him where she was. “That’s just it. She’s off at radiology. She has breast cancer.” He seemed to have trouble even saying the words. I told him as I inched my chair closer to him that I was really sorry to hear that, that it must have been hard news for both of them to hear. “How did she find out?” I said. He gave a half-laugh, as if exasperated. “We were at her regular doctor’s appointment, and he pulled the curtain to examine her. I heard him telling her he felt something in her breast. And then he asked her if she had noticed it.” He paused, as if gathering his strength to go on. “What did she say?” “That she first felt a lump there two years ago. Two years!” He was incredulous. “You sound angry,” I said, as gently as possible. He calmed down. “I’m not. I just wish she had mentioned it two years ago, when they could have done something about it. Now, who knows?” “Why do you think she kept it to herself?” I asked. He shrugged his shoulders, but I suspected I knew the answer. My patients tend to be older, and some couples seem to live their lives going from one medical problem to the next. Just as we’re able to get a man’s leukemia under control, his wife has hip surgery. Or a woman with lymphoma finally enters a remission, and her husband has a heart attack. It’s as if one waits patiently until the other’s health issues stabilize. Sometimes, spouses become so symbiotic, they even share each other’s medications – not that any health care provider likes to hear that. Recently, the wife of my patient with emphysema admitted to me sheepishly that when she developed heart failure, she borrowed her husband’s oxygen tank for a couple of days, until finally she called an ambulance. People make sacrifices for each other when it comes to health, just as they do with family and careers. When both partners develop cancer, it is no exception. Some of my patients decide to forgo potentially curative chemotherapy because it would interfere with their ability to care for their spouse, who is receiving chemotherapy. I wonder sometimes if it’s wrong for me to support that decision, to think of a couple’s needs over those of an individual, when they are so clearly intertwined. “She certainly has been by your side ever since I’ve known you, and your cancer is under control,” I offered. “Maybe it’s your turn now to take care of her.” He started nodding in agreement before I even finished my sentence. We sat in silence for a bit. “Hey Doc, can I ask you a question?” he finally said. A smile started to tug at his lips. “You think I have another six months to live?” “Well, that depends.” I answered. “On whether or not I can pay your bill?” he asked. I nodded. “And if I can’t pay it, will you give me another six months?” “You got it,” I promised.
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