I sit paralyzed at my desk. Everyone else has left the clinic. I can hear the sound of the broom in the hall as the after-hours cleaning begins. No phones ring, no patients hurry to appointments, no chatter lingers in the air. The silence is oppressive, the air is heavy, and the distance from my office to the hospital is an eternity.
I’ve just hung up the phone with the radiation oncologist. His words echo in my head. “Radiation will cause more harm than good. I’m sorry. I wish there was something more I could offer.” Dread rises like a tide, as my last hope recedes. I want to share the burden of this terrible news, but all my colleagues have left for the day, and I am alone.
Andrea M. Watson, MD
I’d been taking care of Mallory for 9 months when the progression of her disease took me by surprise. Her tumor had responded so well to upfront radiation, followed by 9 months of intensive chemotherapy. With just a few months of treatment left, the end was in sight. Mallory was an avid J.R.R. Tolkien fan, and plans for a Make-A-Wish Foundation trip to New Zealand were underway. She wanted to see The Lord of the Rings filming location and visit the small Hobbit village she’d read about in travel books. She wanted to wait until it was summer there, our wintertime, to travel.
When Mallory’s disease progressed on therapy that fall, the timeline shifted. Goals shifted. There was no realistic hope for cure; there was just hope for time. The trip became the goal, and she bravely chose to continue with aggressive treatment, hoping it would open a window of time for travel. But further disease progression got in the way. When the futility of chemotherapy became clear, hopes were pinned on radiation to buy time. Now, hanging up the phone, I realize that this strong, brave, beautiful, 16-year-old girl who had been through so much will never get to New Zealand. And I have to tell her that tonight.
I start out toward the hospital, but walking through the hall, my steps slow. My chest becomes tight, and my head swims with the devastating message I carry. I stop and look blankly at the man sweeping the floor, wondering if he can tell I am carrying a bomb meant for a young girl and her family. He keeps sweeping, unaware. I retrace my steps, fighting back tears.
Back in my office, the sobs come. I cry for Mallory, for her parents, for her little brother, and her best friend, her sister, for all they would never share together, and for all the sorrow they had already faced. I cry for myself, and the terrible burden of delivering the blow, extinguishing the candle of hope that this trip had become, and speaking the words they’d dreaded since the moment we met. And when the tears finally stop, I am empty. I take a deep breath and walk out the door.
Mallory is not surprised by my news. Her gaze shifts away from me, to a far-off place. Silent tears stream down her face and she says, “I know.” That’s all she says.
I meet with her parents alone in the family room. Their reaction is raw and palpable. Flooded by tears and sobbing, they cling to one another, lost in a storm of grief. When her brother and sister join us, I unfold the news slowly, choosing my words with great care, as the disbelief on their faces quickly melts into sorrow and then tears.
My heart feels as if it will break. I sit quietly by, trying to fade from the scene that plays out before me. I fight back the tears but lose. I have done my job, delivered the bomb. There is nothing more to do but bear witness. Then, something beautiful happens.
“All patients we care for can teach us lessons about how to live well, even when they die young. The privilege is great, and the responsibility that comes with it, greater.”— Andrea M. Watson, MD
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Mallory’s parents silently hug one another with new resolve and, in turn, embrace their children. Without a word, they stand up and walk together into Mallory’s room. Hand in hand, they pull her in and encircle her with fiery love. I quietly take my leave, feeling the power radiating from the room as I walk down the hall and out of the hospital into the night air.
Mallory’s funeral program bore a poignant quote from The Lord of the Rings film in which Gandalf assures Pippin that death is not the end, but rather another path we all must take:
“[T]he journey doesn’t end here. Death is just another path, one that we all must take. The grey rain-curtain of this world rolls back, and all turns to silver glass, and then you see it.”
“What? Gandalf?! See what?” Pippin asked anxiously.
“White shores, and beyond, a far green country under a swift sunrise.”
Shortly after Mallory died, her sister reflected that although she never saw the lush green of New Zealand, Mallory’s journey had taken her somewhere even better.
Likewise, the journey of those left behind continues. Families’ lives are forever changed after a child dies. And our lives are never the same either. All patients we care for can teach us lessons about how to live well, even when they die young. The privilege is great, and the responsibility that comes with it, greater. Delivering devastating news to beloved patients and their families may be the most dark and difficult moments of one’s career. But compared with the burden that families carry, it is light. And if you stay long enough, and you listen hard enough, you may see the blinding love shining through the darkness.
Now, at the end of the day, after the noise and activity fade, I find myself thinking of Mallory. Some days, it’s with a renewed awareness of the heavy burden we carry. Other days, it’s with a lightness of being and gratitude for those who go before us, leaving their courage as testament to what they believed in. The silence unearths a deep ache in my heart. Sometimes, I cry. Then I hear the comforting sound of sweeping in the hall. I take a deep breath and walk out the door. ■
At the time this article was published in the Journal of Clinical Oncology, Dr. Watson was practicing at Essentia Health Duluth Clinic in Duluth, Minnesota.