Last Hug

Get Permission

“Good evening, doc; I wanted to check on you and update you on my mom” read the text message on a late Thursday afternoon. I recognized the sender; it was not uncommon for me to share my cell phone number with patients and their families. Having been a caretaker of my own parents’ medical needs, I had pledged to make it much easier for patients and their families to find me than it was for me to find my own parents’ doctors.

Chadi Nabhan, MD, MBA, FACP

Chadi Nabhan, MD, MBA, FACP

It had been several years since I heard from her. I had left academic practice a few years back to pursue an administrative and research post and transitioned her mother, my patient, to a different physician. I was used to receiving a Happy Holidays text from her toward the end of every year, but we were in the heart of a raging COVID-19 pandemic and nowhere near the end of 2020. I was pleasantly surprised by the text although a little nervous. I responded: “I am doing well despite the circumstances. How are you, and how is your mom; is everything okay?” “It’s not okay,” she said. “Do you want me to call you?” I inquired.

My patient was dying. She had endured a relentless illness and undergone many chemotherapy treatments, but there were no options left, and the doctor had recommended hospice care. She was at home with her daughter and was still functional. She had less than 3 months to live, the doctor had said. He advised her to spend time with loved ones and focus on her comfort and optimizing her quality of life.

The daughter struggled to muster her words: “She is dying, doctor, and she wants to see you. She always enjoyed her visits with you and has missed you since you left; she always asks about you and the twins.” My patient and I had always joked about my twin boys and what troublemakers they were going to grow up to be. She gave me motherly advice on how to raise them and how not to spoil them. Every visit at the clinic was an opportunity for her to gently lecture me on good parenting and proper children rearing techniques.

We decided to meet in the next few days.

What Really Constitutes Nonessential Travel?

There were strict recommendations from the scientific community about avoiding nonessential gathering and travel. But really, who was to define what was essential and what was not? Nonessential outpatient visits were being canceled, elective surgeries were being postponed, and imaging and screening tests were being put on hold. The need for chemotherapy in end-stage cancer was being questioned.

I knew how important it was for my patient that we meet one last time. Equally critical was for me to see my patient one more time. Being there for her, fulfilling one of her last wishes, gave me a sense of belonging and purpose. We had developed a very special bond throughout her long fight with the disease. The physician-patient relationship was sacrosanct and made even stronger when a patient was living her last days. There was a fine line between public health guidelines and restrictions dictating the essentials and my deep desire to share in the last days of one of my favorite patients. In many ways, the COVID-19 pandemic had redefined the value of care and showed what was truly important to patients and to their physicians.

‘The Right Thing to Do as a Physician’

We met on a beautiful sunny day. As I was driving to our meeting place, I wondered if I had made the right decision. I was not sure how my colleagues would react if I were to tell them about my patient encounter. When every nonurgent medical visit was being characterized as nonessential, I would have risked being labeled as reckless. Sharing this planned endearing encounter with few trusted colleagues and my family would not have been unusual, but the fear of their disapproval made me keep this to myself, until now. Deep inside, I knew it was the right thing to do as a physician.

My patient’s daughter pulled her car up next to mine and found me sitting on one of the three folding chairs I had brought from home for us. My patient was visibly happy to see me. She looked at me with a weary smile and reached her arms out as we hugged in an emotional embrace. I noticed her daughter tearing up and found myself doing the same.

Time flew by and before we knew it, an hour had passed. We talked about life and the journey. We laughed, and we cried. She advised me, like many times before, to spend more time with family and not to work too hard. She reminded me about that year I had missed my twins’ birthday because of academic travel. My beloved patient managed to make me feel guilty one more time. I could not help but smile as we both recounted that incident. Her daughter joined in reminiscing about shared memories. We had a good laugh.

She was getting tired, and it was time to go. I found no comforting words. If I said “see you soon,” I would be lying. It was the last time we would ever see each other. If I said “hope you feel better,” I would be lying. Things were going to get worse every day as she neared the end. As if she was guessing my thoughts, she said “don’t say anything, doc, and give me one more hug.” We hugged again as my mask was getting wet from our tears. It was so hard to let go. I watched their car leave and reflected on so many past heart-wrenching goodbyes.

The Human Connection of Oncology

Did I do the right thing? Yes. Did I perhaps violate Centers for Disease Control & Prevention recommendations and ignored the opinions of thought leaders? Certainly. Spending these last moments with my patient filled me with a sense of peace and strange happiness, despite the overwhelming sadness of the moment. Hugging my patient one last time felt like the most humane thing I had done during the pandemic. I had not prescribed treatment, ordered imaging studies, or provided medical counseling; yet, somehow, this meeting felt more essential to both of us than any of our previous encounters. I needed to relive the human connection of oncology one more time, in a world where closeness was increasingly being replaced by distancing.

Six weeks later, my phone rang with that number I now recognized. Tears filled my eyes as I learned of the passing of my beloved patient. I felt a deep loss, and at the same time, I felt hopeful, at peace with my decision to preserve some normalcy during a chaotic time, and grateful for the inspiration I felt from that moment of human connection. 

At the time this article was published in the Journal of Clinical Oncology, Dr. Nabhan was affiliated with the Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, and Caris Life Sciences, Irving, Texas.

Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.

Originally published in the Journal of Clinical Oncology 39:3083-3084, 2021. © American Society of Clinical Oncology. All rights reserved.