Cancer or No Cancer

DOI: 10.1200/JCO.2013.49.8857 I stepped out of the hospital tower elevator and looked through the twelfth floor window. It had been pitch dark for more than 4 hours, and the fluorescent hallway light painted my reflection a sterile white. Beyond the glass, cars streamed through the narrow Boston streets. I rubbed my eyes and turned down the hallway to see Mr. Field. The room was dim when I entered, its darkness interrupted only by green flashes from a bedside pump. Mr. Field appeared as he usually did, his shock of white hair combed to one side and his body visibly large under his blankets. I could make out the shape of someone sleeping in the chair beyond his bed. A collection of cards and pictures adorned the windowsill at the far end of the room. I turned to leave, afraid I had disturbed their rest. As a sliver of light escaped into the room from the open door, however, Mr. Field lifted his head and turned towards me. “Josh?” His voice carried across the room in a steady, low timbre. “Yes,” I replied softly. “I’m sorry about coming while you’re resting. I can come back in the morning.” “No,” he insisted, elevating the head of his bed. “Stay.” He adjusted his pillows as I pulled a chair up beside his bed. “By the way,” he continued without prompting, pre-empting yet another check of his mental status, “it’s Thursday, and I’m at the hospital, and the Patriots should have beaten San Francisco last Sunday.” He flashed a thumbs-up, and his shoulders shook violently as he chuckled. Over the course of the preceding week, I had come to know Mr. Field and his family well. Initial evaluation of the weakness that resulted in his hospitalization had revealed spinal cord compromise from lymphoma, and after treatment for his neurological symptoms, he underwent chemotherapy for his new diagnosis. When I first met him, he was several weeks into post-treatment recovery but suffering from mental clouding, debilitating hiccups, and perplexing feet discoloration. Evaluations for concerning causes for these problems were unrevealing, but Mr. Field and his family remained understandably worried. As the intern responsible for Mr. Field’s care, I wanted to help address these concerns. Each day, after checking in on my other patients and transferring their care to the overnight physician, I made my way to the twelfth floor to see Mr. Field. At first, these visits were limited by his drowsiness and confusion; he knew his own name, but not his location or the time or date. At times, he struggled blatantly, his tongue wrestling to form words, his eyes searching the room’s whiteboard for help, his wife urging him on silently from the corner by mouthing the answers to herself. At other times, he memorized responses to expected questions, incorrectly giving answers about location when asked about time or name. In the first several days, his disappointment manifested in the form of tightly crossed arms, his frustration as white, clenched knuckles. I often circled back to speak with Mr. Field’s wife about her difficulties with his diagnosis. Leaving the hospital floor late each night, I privately wondered if I was helping at all. Thankfully, Mr. Field slowly improved. He was able to hold my gaze longer and answered questions with more certainty and speed. He struggled less with difficult questions, and many of his physical symptoms resolved. Most encouragingly, he began calling me by name and volunteering information about time, person, place, and sports outcomes to prove his orientation. Our evening visits grew longer, our conversations more enjoyable. He shared tall tales from his childhood as his wife playfully rolled her eyes in the corner. I shared stories about my family’s Taiwanese heritage, and he regaled me with his adventures on the island decades ago. We discussed current events and discovered common interests. Whenever he started pausing between sentences, his voice losing its low timbre, I knew it was time to let him rest. As I turned to go, he would reiterate a singular desire: to leave in time to spend Christmas at home, surrounded by loved ones and familiarity, his dog at his feet and the warmth of his fireplace against his face. He had to come back for more chemotherapy after Christmas, he would say, and didn’t know if he would live to see another Christmas. I would squeeze his shoulder firmly and say that I hoped he JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 31 NUMBER 18 JUNE 2