What’s In A Moment?

I sit across from my patients and have the privilege of witnessing moments in their lives that are hard to explain. I see moments of joy and of despair. I see moments of disbelief and of acceptance. With AG, I saw a moment of reckoning. It was fascinating to me.

I met AG in December 2021. She was forty-one. To say the least, she had a tumultuous course before she landed with me. Her cancer story started a year prior with several months of back pain. Her pain changed over time to include discomfort in the left lower quadrant of her abdomen. Soon, she was able to feel a growing lump in her belly. A CT demonstrated a large pelvic mass thought to be ovarian in origin. She was losing weight dramatically over this time, losing approximately fifty pounds. She was taken to the operating room thinking her cancer could be cut out. Unfortunately, that surgery found 1) peritoneal spread which made her cancer incurable, and 2) that her large pelvic mass was originating from the last portion of the bowel called the rectum, not her ovary. AG went on to receive a long course of radiation which finished in September 2021. Then, a repeat CT sadly showed the development of liver and lung metastases.

When we met, AG’s pain was improving, likely a result of both her surgery and radiation. She was still requiring pain medication but was walking a couple kilometres a day. Her weight had stabilized. She already knew her cancer was not curable but she was unaware of what that meant. We discussed the data suggesting we may be able to extend her life with our best treatments used in sequence. I quoted her an average length of life of around two to three years with the use of chemotherapy. I told her that number would be much shorter, in the order of months, if we focused solely on pain and symptom management.

I discussed a tough regimen called FOLFIRI plus panitumumab with AG. We talked about the possible toxicities of chemotherapy including, but not limited to, nausea, vomiting, diarrhea, constipation, oral ulcers, taste changes, weight loss, hair loss, fatigue, a small risk of cardiac vasospasm, rash, allergic reactions, and the very rare chance of death. We talked about the possibility of low blood counts, and that should she develop a fever an emergency room visit would be required to rule out infection; a concurrent infection and low white blood cell count could be life threatening. I was clear with her about the goals of treatment: to prolong her life, to reduce her symptom burden, and to prevent the onset of new symptoms. She voiced her understanding of our discussion.

AG wanted treatment. She consented to start. She got one cycle and hated it. She experienced many side effects over those first two weeks: fatigue, diarrhea, nausea, vomiting, and facial rash. These were expected. AG was just experiencing them vividly.

AG wasn’t ready to give up on treatment. When things settled down for her, we tried again. We used a lower dose of each drug for the next round. Again, she came back to me with a laundry list of side effects. Chemotherapy was beating her up. She persisted with it for a while with adjustments here and there. At the three-month mark, her CT scan showed her cancer was stable. She continued after that for another three months, each treatment making her more miserable. Then, she decided she was done. She didn’t want to continue. She ended up in hospice a short time later. Death took her a few weeks after.

AG died so fast. Her cancer was unstoppable. She was also one of those patients that just seems to do much more poorly from the side effect point of view than most others. I don’t know if my colleagues or I understand why this happens with some of our patients: maybe bad luck, maybe genetics, maybe life circumstance, probably a combination of things. It’s hard to tell.

The relationship I had with AG was not a long one. In total, I might have seen her five or six times. This is sometimes the way things go with cancer care. With each new patient I see, I hope I will have the pleasure of seeing her/him/them for a long time. All too often, that is not reality.

The moment I had with AG which fascinated me came on our first visit when we were talking about prognosis. Already knowing her cancer was incurable, she was experiencing significant anxiety and existential dread. I think this is a normal reaction. AG seemed much more in tune with these thoughts than most other patients I’ve had over the years.

Right after I told her the average length of life she should expect if we didn’t pursue chemotherapy, she was silent for a few minutes. I welcomed the silence. We sat in it. Then, this from her lips: “I didn’t realize I would be confronted with my own mortality at such a young age.”

BOOM!!! There it was in her eyes: a reckoning. She had a blank look in her eyes in that moment. Her light blue eyes could have gotten a few shades darker. I’ll never know for sure. It was as if she knowingly decided to look inward instead of outward, right into the depths of her being. There was no doubt about it. She saw her entire life in those moments. A connection made. An outlet plugged. A key unlocking a bolted door. I saw her experience a reckoning in the thin line she realized now existed between her life and her death.

How did she get there to that place? What did she see? How did it feel? I asked but there were no answers.

It was an honour to share those moments with AG. She let me see something not often seen – a private moment between the mind and heart and soul. It was fascinating. It was beautiful. I yearn to see it again.

RIP AG. I hope you had another one of those moments with your last exhale.

 

Author Notes:

I have been thinking about moments a lot this week. My thinking started during the Christmas tree expedition my kids and I went on last Sunday. This is a tradition the three of us started after our divorce ten years ago. Sunday was the tenth time we piled in the car with saws in hand, making our usual stop at Tim Horton’s on the way out of town, and then driving down the highway for an hour to a tree farm where opportunity awaits to search for, and cut down, our perfect Christmas tree. It is a day I cherish.

As I drove there and back, I remembered AG and my mind fluttered to some of the fleeting moments that changed the trajectory of my life. I remembered moments that for sure changed me as a kid, in my marriage, as a mother. My mind wandered to times a few years ago I now know were warning signs, not heeded, as smoke was being blown into my eyes to foggy my view. I recalled beautiful moments of surrender and ugly moments of fear. I got lost in the magical moments I am fueled by – those moments I help make happen for my loves and for myself because it feels so good inside and comes so easily; and, those moments that serendipitously occur, blatantly enough so you know it’s a message from another more powerful world.

I asked myself, “What’s in a moment?” Does it hold its own space? Can a moment be held? What does it sound like? What does it smell like? Does it have weight; if so, how much?

So many types of moments can change a life. Some moments are capitalized on. Many are not known for the value they hold until seen in the retrospectoscope – that funny instrument that only gives us a glimpse of clarity when holding it firmly in hand and focusing our gaze on the distant past that can no longer be manipulated by words or deed. I think such moments make life so interesting, in all its guts and glory.

I am curious to know, reader, if you have a moment from your past that shaped you in a profound way? What happened? How did it change you? What feelings do you have about your moment?

One thought on “What’s In A Moment?

  1. Gerald says:

    Dr Spratlin

    When a doctor starts the conversation with “I wish we could be meeting under better circumstances” then you know that you have a very serious problem. I considered my own outlook on dying at that moment because I knew I probably had cancer in my colon and liver and I found that my expectation that death would be “fade to black” followed by nothing at all, still held firm.

    Before the operation I was shown a UofA Hospital video with an anesthesiologist explaining how the general anesthetic would function. I have always been somewhat in awe of people who could leave a career and go on to study and qualify in another significant and demanding field. I was stunned to recognize the anesthesiologist as twenty years ago we had both worked in IT. I was humbled to realize that he had gone on to train and qualify in medicine. It was only later I recalled that he had left IT to work in the performing arts and I realized I had been fooled, he was an actor, I did not feel quite so inadequate then.

    Three days after my bowel resection I was allowed a first meal. As I was enjoying the small bowl of oat bran the hospital radio started playing Under Pressure by Bowie and Queen, at that moment life felt good and I had a little cry.

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