An Oncologist in the House: Home Visit Vignettes

201 ROXBURY, MASSACHUSETTS: I was a fellow at Boston City Hospital when I first saw a patient at home. I remember feeling a bit scared when the hospice nurse said, “I’ve been out here at all hours of the day and night and have never been harmed, guess they know I’m a good guy.” The smell in the patient’s room is unbearable. Gail, the oncology nurse who brought me along on this visit, looks bright-eyed and completely at home. The young Haitian woman with a hole in her chest where her breast used to be, cannot understand a word of English, and yet her eyes light up and she looks grateful. Fall River, Massachusetts: The longest drive to see a patient at home. Gail’s car, its seats covered with a fine layer of dog hair from her pure-bred Siberian Husky, makes the trip in record time. Mr. DeLucia, a quiet man with advanced chronic lymphocytic leukemia, struggles to walk me to the door. He can barely move because of the bulky nodes that disfigure his giant frame. It is a beautiful view of the river from his doorstep, and it is probably the last time he or I will ever see it again, I think to myself as I walk back to the car. Medford, Massachusetts: Death certificates are now a permanent feature in my black bag. I am called near midnight to pronounce a hospice patient at home. He is yellow due to the pancreatic cancer, but in death he looks happy. He had lobster for lunch, and they said he ate it like he knew it was his last meal. Elizabethton, Tennessee: First visit to see a dying patient at home without the security of nurses. I am not afraid. Mr. Isaac, whose leukemia has relapsed soon after transplant, looks astonishingly well. He shows me around his house on the hill, built entirely by his own hands. As I leave, he takes me to a clearing in the trees and points to his chosen grave site: “Picked this spot ‘cause this here’s God’s country and it’s home.” Johnson City, Tennessee: The young man with melanoma, his left leg in traction after it snapped like a twig one night, is pain-free on morphine. His bed is up by the window of his trailer “So he can see the mountains out yonder,” says his girlfriend. I ask him about his pet iguana which he spoke so fondly about during his chemotherapy days in the hospital. He grins sheepishly and turns away. His girlfriend answers, “He died last week,” and then adds excitedly, “We got ‘im in the freezer back there if you want to see ‘im.” Little Switzerland, North Carolina: The hospice nurse meets me in the parking lot of Nations Bank in Spruce Pine. She said it would be impossible to give me directions to Mrs. Fuller’s house. The house is on a hill off a dirt road. The living room has a clear view of Mount Mitchell. Mrs. Fuller, dying with advanced colon cancer, is pleased to discover that we have common interests: Miss Marple and Agatha Christie. As I leave, she empties an entire shelf of Agatha Christie novels into a plastic bag: “I won’t need these anymore,” she says, “Look after them for me.” Greenville, Tennessee: This home visit is special; a graveside service for a young veteran who lost a nine-year battle with non-Hodgkins lymphoma. Open fields on all sides, his grave lies beneath shady trees off to one side of his home. It grew real quiet when his buddies flew rickety old cropdusters low over us in perfect formation, dipping their wings as they flew on by. Roan Mountain, Tennessee: Rhododendrons everywhere. I push open the kitchen door, and Mrs. Parks exclaims: “The doctor is here. There hasn’t been a doctor in the house since Sheila was two.” Sheila is forty now. Mr. Parks is slumped over on the sofa. I do not recognize him; his handsome features made bloated and grotesque by the superior vena cava syndrome. He is barely arouseable. The walls are studded with hunting