As I walk down the hall of the ICU toward your room, I know I am about to encounter something new. Just two days ago you were rushed into the hospital with excruciating abdominal pain: a perforated bowel, likely an adverse effect from your chemotherapy for ovarian cancer. Just two days ago you shared your story with me despite your extreme pain. Our conversation did not hide the fear in your eyes; fear of not knowing what would happen after your surgery. I shared your fear, my instincts telling me that what lay on the other side of this surgery was something no one wished for.
“Will she be okay?,” I asked your surgeon anxiously throughout your surgery, “She is only in her forties and has a husband who loves her. I hope she will be okay.”
Even as I said these words, I knew deep down inside that your chances of a long-term survival were grim. In fact, the answers to my questions lay right in front of my eyes as I looked at your pale, lifeless organs that reminded me of something I might see in an anatomy lab and not in the operating room. When we opened your abdomen, tumors throughout your entire peritoneum stared back at us. Your bowel was worse. It was so badly damaged from the chemotherapy that your surgeon described it as “frozen bowel,” unable to move or function due to the toxic medication intended to help you survive.She is only in her forties, she still has a whole life to live, I kept thinking as each minute went by and your chances of survival dwindled even more. She is younger than my mother. It was this thought that would haunt me for days to come.
Your surgeon, and then I, spoke with your dad. “I am so sorry that this has happened. Her surgeon did a good job and took the best care of your daughter that he could. I am here if you need anything, and I will be in every morning to check in on her and on you,” was all I could say.
I had no words to describe my own feelings, as I was still processing them myself. When we left your father, it was 4:00 AM and I could tell his world was flipped upside down. As we walked away to get ready for the next surgery, regret pierced my head. Did I make a mistake? Should I have stayed and sat there with him after the night he just had? But if I did that, would there be anything that I could have said to make this situation better? Frankly, I am not sure what I could or should have done in that situation, but I still think about what I might have done differently.
The next day you were awake and moderately aware of what happened the day before. Now, the fear in your eyes was met with somnolence, anger, and frustration. “How are you feeling?” I asked, even though I was afraid I already knew the answer. You shared your frustration about not knowing what would happen next. You wanted answers, but I did not have them. I felt bad I couldn’t help you in that moment. I knew you were hurting and I knew the reality of your condition was slowly sinking in. There is so much I wish I would have said to comfort you in this time, but I couldn’t find the right words to help. “I will make sure all your questions get answered, and if there is anything else I can do to help please let me know. I am here for you and as a medical student it is my job to be an advocate for you,” I explained. Then I left your room not knowing that was the last thing I would say to you before you were sedated, intubated, and transferred to the ICU.
It all happened so quickly. One day I was talking to you and you were responding. The next thing I know I was standing next to you and I was still talking, but you couldn’t respond. It felt unusual for me to talk to someone whom I knew would not respond, but it felt necessary. “Good morning,” I would begin, “It’s Grace the medical student, and I am here to check in to see how you are doing.” Clearly she is not doing well, I would think to myself. However, I continued, “I am going to perform a physical exam and I will walk you through what I am doing.” I listened to your heart and lungs. I examined your dressing that was covering the opening to your abdomen that was never closed. I looked at your ileostomy and documented my findings. At this moment I became haunted again by my recurrent thought: She is younger than my mother. Then, I looked at your face where I once saw fear, anger, and frustration, but now saw peace and tranquility. I held your hand and said out loud, “It was nice seeing you again this morning, I will see you again tomorrow.”
I looked at your father, who responded, “Thank you for coming to see her today. I am glad she is no longer in pain.” I let him know I was here if he needed anything and the nurses were just outside the door. I left your room, just two days after meeting you thinking to myself, I hope to see her again tomorrow.
The next morning you were gone. You passed quietly in your sleep with your father right next to you the entire time. You were younger than my mother, you still had so much life to live, and I continue to wonder if there was something more I could have said to comfort you in your last days. It is funny how much communication can change in just a few days. One day you and I were able to have a conversation, and the next day I find myself talking to someone who I knew was never going to talk back.
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**Photograph taken by author, Grace Newell, with a black and white film camera then developed in a darkroom.
“To me the leaf reminds me of what we saw during her surgery. Something fragile and lifeless, yet something that was so beautiful that was part of something bigger than the damaged spots that lay on the dying leaf. Just like the tumors taking over her body when her beauty and strength overpowered what she was battling with.”