My patients say the most interesting, and reflective, things to me sometimes. The words “a slow march to death” have been repeating in my brain over the last six weeks. Try as I might, these words don’t seem to want to move out of my mind. Perhaps writing about them will help free them.
Ms. G is the thirty-seven-year-old woman who spoke these words to me on June 26th. She is a patient I have known for almost two years, during which she has been participating in several of our phase one investigational new drug trials.
She was diagnosed with advanced ovarian cancer in 2018 at the age of thirty-two while she was in the middle of a PhD program. I imagine she was devastated when she found out her intermittent abdominal bloating and worsening pain wasn’t diet related, as initially suspected. Her problem couldn’t be fixed with more fiber. Her problem couldn’t be fixed at all. She had an incurable, life-limiting ovarian cancer just when her adult life was supposed to be taking off.
Her treatments included a massive surgery followed by traditional chemotherapy. A year later, her cancer was progressing which required more chemo. In late 2019, she was referred to our centre for consideration of experimental treatments. Since then, she’s been going back and forth between clinical trials and standard treatments, each bridging her to the next option, but none really making a big dent in the extent of her cancer.
At the end of June, I had to tell her the latest hopeful clinical trial drug failed. Her cancer was growing . . . again. Over the last year we hadn’t hit on a treatment that had made much of a difference. Millimeter by millimeter her cancer grew no matter what drug we tried. Though a millimeter of growth wouldn’t make most physicians consider switching treatments, millimeters add up to centimeters over weeks to months.
I let her know we didn’t have another trial to switch her to. I knew her medical oncologist closer to home did not have anything left to offer either. We were in the deepest of trenches in no-man’s-land where the will wants to continue to fight but there are no weapons to go into battle with.
She took a few deep breaths. She closed her eyes. She dipped her head back against the chair. I saw a couple of barely notable side-to-side head shakes. Then, without opening her eyes, she said, “I feel like I am on a slow march to death”, so softly it sounded like it was whispered from a distant fourth dimension. She was dejected, limp, soulless.
She went on to say every time I give her bad news, she has to someone figure out how to internalize it, be okay with it, and then tell the people she loves and who love her, that her cancer is worse again. “It’s so hard.” “I don’t know how many more times I can do it”. “It’s not fair”.
All real feelings. All impossibly gutsy to say out loud. All heartbreaking to hear.
Ms. G’s choice of words was most impactful for me. She said she was on a “slow march to death”. Her intonation and body language couldn’t be missed for anything other than a painful, agonizing, unchosen, death march. Was that her experience during her five-year battle with an incurable cancer? I saw a different perspective.
Ms. G completed her PhD during her cancer journey. She continued exercising to keep her body and mind well. She remained in a committed relationship. She fulfilled a couple of bucket list trip wishes with a stop in Italy where she lived a dream of taking a cooking class, and a trip to Newfoundland with her mom to see icebergs float by a part of Iceberg Alley near Twillingate. She fought for every chance at new treatments. She fought for life.
I thank Ms. G for gifting us the perspective of time. Five years ago, she knew her time was short. She didn’t stop her life when she knew her cancer was incurable. She grew her life. She learned. She taught. She loved. She lived.
From my point of view, Ms. G is marching all right . . . marching with purpose through her life.
Author Notes:
I am thinking about my son as I finish this story. He just turned seventeen. He was born eight weeks early and spent the first two weeks of his life in the neonatal intensive care unit, requiring tube feeds because his little mouth couldn’t suck yet. Stretched out from the top of his head to the tips of his toes, he fit between my wrist and my elbow crease.
Fast-forward seventeen years (I say fast-forward in all honesty as time has flown by), he stands a strong and healthy six-feet tall. He is brilliant, inside, and out. He is a sponge for knowledge, always learning about people, places, and things. He is kind, even to his little sister!! He’s got a strong sense of who he is and what he believes in. He has opinions that are almost always fact-based. He wants to make the world a better place; undoubtedly, he will.
If my son were to have a similar fate as Ms. G, his life would be almost half over. The first seventeen years passed in light speed; the next seventeen years will be the same. Surely, he needs more than seventeen or eighteen more years to do and be all that he wishes.
None of us know how much time we have left. People die at all ages. Wouldn’t it be wonderful if, with our mortality, we could embrace a big, beautiful, dream-seeking march through life?!
Ms. G is a reminder to make our march through life purposeful. Expect less time than hoped for. Time becomes more valuable then. For me, Ms. G also reinforces my hope to be a good example of living a wholehearted life for my kids.
Let’s do what makes us feel warm and fuzzy inside. Let’s love who we want to love. Let’s figure out who we are and how to love ourselves, gently. Let’s not wait for a retirement that might not come because illness intervenes. Let’s play pickleball now. Let’s see far-off lands, full of wonder and awe, the very second we’ve saved enough pennies. If there is opportunity to capitalize on seeing, hearing, doing, or feeling, let’s be right in the thick of it. Let’s celebrate. And let’s raise our hand occasionally, to acknowledge our efforts, our successes, and our failures. Let’s raise our hand in support of ourselves. I hope Ms. G stops for a second to raise her hand with a first pump. I hope my son keeps doing that too.
I am curious to know, reader, what kind of march are you on? Are you marching toward death or are you trying to march toward warmth, toward curiosity, toward life?
