Note: All stories have been modified to maintain anonymity. This includes but is not limited to age, sex, ethnicity, diagnosis, as well as their family members. These changes allow me to share the core of these stories while protecting privacy. Thank you for understanding.
I my first post to be the story of Ella Garcia. I first met Ella in the emergency room. She was hunched over, hugging herself. Sitting quietly in her room, so still that one would forget there was only a door separating her from the bustle of the emergency room.
Ella was young, with four young children, all girls, as well as a husband who adored her. Ella was diagnosed with stage 3 cancer years before I met her. She was tolerating treatments well, and did all she could to maintain a semblance of normality for her children. She took them on yearly vacations to their favorite vacation destination, remained active in their schooling, and did her best to send them on each school trip. Her brothers shared with me how dedicated she was to her family - sharing how she would often drive by their house on her way to treatments to check in, drop things off, make sure their needs were met. They described Ella as the backbone of their family; she was so active her cancer was often overlooked.
The months before met Ella were challenging for her. Her cancer progressed to stage 4, and her treatments were now aimed at slowing progression. Despite her diligence, complications arose and she missed a few cycles of treatment. By that spring, her cancer had progressed even further. She presented to the hospital frequently at this point. Her medications were adjusted, she would be discharged home. Each time she presented she looked a little more frail, a little less like Ella.
Then Ella fell.
And then she fell again.
At the time of our meeting, she had presented to the emergency room fro her third fall.
She was hunched over in the emergency room, holding herself, and as I approached I saw tears streaming down her cheeks.
“I just need to make it to June. I need to go on this vacation”
This hospitalization was more complicated than the last, but the day prior to her discharge she looked okay. I met Ella early in my practice; I was still wrestling with imposter syndrome… still second guessing my abilities as a provider, as well as feeling the need to meet the impossibly high standard I set for myself. I know, so much angst.
I say all of this to say that I knew it was important to solidify advanced care planning with Ella, I knew it was important to explore the what ifs given the rapid changes we saw in her illness. But I saw the look in her eyes and the quiver in her voice when she recited her mantra about vacation. I couldn’t extinguish that. And so I held off. We spent the visit talking about outfits, about rides, about anything but her cancer. Her eyes twinkled. She smiled. She told me about her improving shortness of breath, and her improving pain. She told me about her hopes for this trip. We did not speak a word of the days following their, as we both knew there would not be many. Do I regret this? Maybe. Would it have changed anything? I can’t say for certain, but unlikely.
“Who knows Ella?”
I remember looking over in our huddle to the physician reading off our list of new consults.
“I know Ella. Why? Is she back?” My eyes scrambled to my phone, looking for today’s date. May 14th.
“Yes. And she’s dying.”
I saw Ella that morning, her brothers and father at the bedside. The room was quiet. Her eyes appeared fixed. I grabbed her hand and she looked at me. She squeezed my hand. I watched her struggle with each breath. I closed my eyes. I focused on what I could control in that second, my breathing. My heart rate. The tears I felt in the corner of my eyes - I could keep those from dropping.
“I’m going to take care of you Ella. I am sorry we are in this place, but I am going to take care of you. Your family is so loving, they are all so lovely. We are all here for you” She broke eye contact before I finished my statement. I released her warm hand. “Here is what we are going to do…”
Part of taking care of Ella was telling her children. We called schools, we called family, we scrambled the best we could to bring her children into the hospital. We learned that her husband was on his way late afternoon with the children in tow.
The moments leading to her families arrival were most tense for me. We attempted a procedure to help with her symptoms but she was not able to tolerate being turned. She began having long pauses in her breathing, each pause seeming longer than the next. We call this type of breathing ‘agonal’, and usually precipitates the final stages of life. Each pause my heart stopped, I did not know what I would do, what I would say, if she passed before her children had the opportunity to say goodbye. I knew how much this would mean to her. Moments after I was informed of her husbands arrival, she had her longest pause I’ve seen. I ran down the hallway, mumbling ‘oh shit, oh shit’ to myself. Scenarios of her family missing this moments ran through my head. I pulled the husband to the side and calmly but frantically shared her condition. He left the four kids with myself and my team member and ran to join his wife.
Myself and my team found a room where we could sit with the children. We calmly explained what we had been seeing, explained the concept of cancer, explained the concept of death. Her oldest child was in junior high, the youngest wearing a teddy bear dress with her hair in two high ponytails. I felt their innocence slipping with each word. This is still one of my most painful memories of my practice this far. The children could no longer maintain eye contact at the conclusion. I am aware this is a part of the natural grieving processes, but I hope her children regain that spark, someday.
Ella passed shortly after this meeting. She did not make it to her vacation. I’d like to think she was okay with this, that having her family around her was enough, that her motivation to provide her children a stable upbringing and her ability to do that while she was on this Earth is enough to bring her peace, although she will not be here to see them grow. But I do have lingering feelings that her final thoughts were of her vacation. Of the sadness in her children’s minds knowing they will not be there with mom next month. Of the sadness in her heart wondering if they would still go without her.
Thanks for reading,