The Words Of A Mother

One of my favorite patients over the years was named Elsie. She died in September from complications related to her metastatic colon cancer. She was lovely. So were her children. As the month of May closes, to honour Mother’s Day a few weeks ago, and to recognize what would have been a milestone birthday for Elsie this week, I wanted to write about a beautiful moment I witnessed between Elsie and her children on the last visit I shared with them.

At the time of her death, I had known seventy-nine-year-old Elsie for almost five years. She was diagnosed with adenocarcinoma of the cecum in 2017. The cecum is the first part of the large bowel.

I met Elsie shortly after her curative-intent colon surgery. Her cancer had spread to regional lymph nodes which meant her cancer stage was stage 3 back then. I recommended chemotherapy to try to improve her chance of cure. She completed this treatment halfway through 2018. We then shifted to a surveillance program to monitor for disease recurrence.

Although we had a few cancer recurrence scares early on when we found lung nodules on a CT, we couldn’t confirm cancer spread until 2020 when a CT showed the development of multiple liver metastases. I remember the look in Elsie’s eyes when I told her. While her daughters teared up beside her, Elsie took that information in looking me straight in the eyes. She paused for a few solid seconds, then asked what treatment options were available. She was not going to go down without a fight, that was made very clear.

Truth be told, and so it seemed to me, there wasn’t much fight required. Elsie powered through almost two years of first-line chemotherapy without much difficulty before her cancer progressed enough that we had to change treatment. For another seven months thereafter, she tolerated a somewhat harder second-line chemotherapy better than most half her age typically do. She was assessed either in person or via virtual phone visit every two weeks for most of that time, rarely reporting bothersome side effects.

I can’t recall a visit or phone call when Elsie wasn’t upbeat and cheerful. She was consistently happy to see me or hear my voice. I hope she knew I was equally consistently happy to see her or hear her voice. “I’m doing really good, Dr. Spratlin,” were the words she most frequently spoke. Of course, she had some side effects now and then like most people do. She didn’t complain though, not once. Without fail, after we were finished with the business of chemotherapy talk at her visits, she asked me how I was doing. She really was the loveliest human.

The last time I saw Elsie she was in one of our phase I clinical trial rooms. Her cancer had grown through all the standard treatment options. I was screening her for possible participation in one of our early drug trials. Sadly, that was the day her cancer decided it was taking charge of Elsie’s liver. Her liver function had dramatically decreased over the preceding two weeks. She was yellow and she was weak. She was starting her dying process. The change was so fast.

Her two daughters were with her. Her son was on speaker phone. I let Elsie know her liver was being overwhelmed by her cancer. She asked about her timeline. Though I couldn’t tell for sure, I told her she likely had less than a few weeks to live.

Her daughters broke down, their tears flowing freely. Her son was silent on the other end of the phone. Some seconds went by, all the while, Elsie held my gaze. I saw tears start to form in her eyes. Her tears brought tears to mine. Neither of us saw the others’ fall though.

She told me she understood. She thanked me for everything we had done together. Then, she looked at her daughters. In the most solid, kind, and knowing voice she said, “It’s okay. You will be okay.”

I sat there for a while watching them have this experience together. I knew Elsie’s words were true. It was okay. Her children would be okay. Anyone in the room would have known this to be true.

Elsie died two weeks later at home. Our electronic health records helped me learn her children were her care givers at the end of her life. Doing this would not have been easy. My best guess is they didn’t think they knew what they were doing. But they did it. I have a feeling, whether Elsie could have expressed this or not, she would have said they did exactly what they needed to do and they were okay.

Elsie would have turned eighty this week. I hope those who love her had a great big party in her memory. Happy 80th Birthday Elsie, wherever you are! Thanks for making the world a better place and thank you for giving me a line I will surely use with my two kids, if I get the chance, when I am on my way out:

“You will be okay.”

Author Notes:

Being a mom is one of the most challenging and rewarding parts of my life. Much of the time I have no idea what in the actual hell I am doing! So far, we have all survived. Sometimes, we even thrive. This shocks me some days!

I was a doctor before I was a mom. Interestingly, there is no doubt in my mind becoming a mom made me a better doctor. In many ways, being a mom is nothing like doctoring. There is no study guide to memorize and regurgitate back to ace a test. There aren’t blood tests or X-rays to help diagnose a problem. There are no formulas, no guidelines, no provincial or national consensus building meetings to declare expert recommendations for every scenario.

There are, however, skills that translate across medicine and motherhood: be ready for the expected, unexpected, and a little bit of crazy too; practice patience, listening, and the ridiculously cool and informative tool of observation; accept limitations – mine and theirs; do my best with the information I have at hand at any given moment; love; then, love even more.

One of my favourite things I have ever heard about mothering was said to me by my best friend: our job as a mom is to raise an adult. I love this. I believe this to be so true. What a wonderful feeling it is to know our children will be okay. It’s even better if we can know, in part, they will be okay because we raised them. I hope my mom knows I will be okay. I’ll do my best to make sure my son and daughter know they will be okay too, simply because they will be.

I am curious to know reader, what is your favorite mom saying? How does it impact your life?