An Oncology Fellow Reflects on End-of-Life Patient Care

Rebecca Zweifler, MD

“The sun is my coffee,” she says, explaining to me that she has always been a morning person, which is perhaps why she is more alert today compared with other days I have rounded in the afternoon. Regardless, I’m surprised she can carry on a coherent conversation. She has 10 mg/hour of hydromorphone dripping into her veins. I smile at her declaration and at the same time my eyes begin to water. She is 31; so am I. She is dying of cancer, and I am her treating oncology fellow. Or at least I was until the treatments stopped working and the day I was dreading arrived, just 8 months after her diagnosis.

Until today I hadn’t been able to have a conversation with her. She has mostly been sleeping for the past week, which is why the decision to transition to hospice had to be made by her family. I spoke to her husband in English and repeated my words in Spanish to her mother. I wanted to tell her mother something meaningful about her, but my mind was jumbled by anxiety and sadness and guilt. The only word that came to my lips was “especial,” a plain and flimsy adjective to describe the girl who wore long rainbow wigs after she lost her hair.

But today she is talking. Unprompted, she tells me that she ate candy this morning and for a second I think she is hallucinating or telling me of a dream, but then I notice the blue stain on her tongue, and I realize it is true. She is not as disconnected from reality as I thought or perhaps hoped.

We talk more about food. I silently question whether it is frivolous to talk about this with someone to whom I may never speak again, but I am happy to be on a lighthearted topic and listen intently as she lists the fruity flavors in her favorite seltzer.

The ugly truth is that selfishly I was hoping she might not be able to converse with me again. I had been dreading looking her into her eyes and acknowledging my failure. I had been so sure she would live a couple of years. I wish I could say it wasn’t that bad, confirming to her that there is no more treatment, but it was, my words feeling like a serrated knife exiting my mouth.

Later that day I drive to visit my family. My 8-month-old nephew is there. His 8 months have been joyously filled with bubbles and music and giggles. Eight months of the beginning of a new life. Eight months of the end of another. Over the weekend she drifts away to who knows- where and we never talk again. But in my own world, disconnected from reality, I imagine her in a place where she gets to have a mug of bright, warm sun every morning forevermore.