To the Ones Who Keep Me Up At Night
Letters to my patients, day 21
Your name flickers across my mind multiple times during the day.
Is he still in the hospital?
Did he already have the stem-cell transplant? I should make sure we have a follow-up scheduled.
I hope the refill for pain medications went through so he won’t be without those this weekend.
This new chemo regimen is a tough one, I hope they’ll remember to call if he has worsening side effects.
I wish I could fix his neuropathy.
It was so good to see his emotional outlook improving at the last visit.
Is the new nausea medicine working better for him?
These are questions I ask about many of my patients, but you are on my mind tonight. I am worried about you.
I see the cane you use now, after the previous stem-cell transplant left your feet numb. The side effects of the current chemo have been accumulating in your body and you are tired. Your magnesium has been depleted by the recurrent diarrhea that does not respond to any of the medications we throw at it. Every visit you have lost more weight.
I think about that as I get ready for bed tonight — what other options do we have to increase his appetite? How can we adjust the timing of his nausea medications to provide better coverage through the day?
Part of it is my own struggle with work-life balance, I know. Believe it or not, I am doing better. But there is another part that reminds me it is good to care this much.
I think about you the most when I can tell treatment is nearing the end, when you are nearing the end of life. I don’t always know it yet, but that’s how it goes. It is my mind’s way of processing that we are running out of options — it has to go over and over the ones we have already tried. Because part of me just wants to hold onto taking care of you.
And so I think about you as I brush my teeth tonight.
I don’t want to miss anything — a diagnosis, a treatable symptom, a dose-adjustment to help with tolerating chemo.
I don’t want to lose you before we have exhausted our options or before you’re ready to call it. I want to support your active fighting as long as you have that in you.
I don’t want to say goodbye to you — goodbyes in our world often mean more than “follow-up in a year.” My parting words to you would be so final.
I don’t want to forget your name, ever.
As I fall asleep tonight, I will tell myself:
It is okay to not know everything, you are doing the best you can to take care of your patients.
They can find emergency help if they need it, you shared those resources with them.
They have a caring spouse who is there for them tonight.
Those symptoms will be there tomorrow, you can look that question up in the morning.
Deep breaths, get some sleep.
To you, dear patient, I hope you know that your provider cares about you. They think about you, research treatments for you, read up on your case, fight with insurance, consult with other providers on your behalf, wonder about how you’re doing.
It has been 2 months of hospice now. I don’t see you in follow-up, I just choose to believe you are comfortably resting in excellent care.
Next week I am going to read your obituary. The nurses will pull up the pictures of you playing guitar, graduating high school, holding your firstborn baby, and then surrounded by family at that last reunion. And we will all smile back at you, misty eyed. Happy to have cared for you, happy to have known you.
Now that you’re gone, I will still remember your name.
And sometimes, you will still keep me up at night.
When you wonder if there is anyone who cares, take what you need:
I have a team who cares — nurses, lab team, front desk staff, doctors, pharmacy members, PA’s, NP’s, office managers.
My friends are my chosen family and they support me.
I can ask for help, there are people who care.
I will seek out quality care, I am worthy of that.
I will not be forgotten when I pass away.
Thank you for being here,
This is part of a 31-day series of letters to my patients — those undergoing a work-up, diagnosis, or treatment for cancer. Topics are also focused on those caregiving and supporting individuals affected by cancer. This is not an easy journey, but you do not have to do it alone.
If you know someone who would be uplifted by hearing this, please share with them. Many of my posts are free. Thank you for reading!
*Details changed for patient protection while maintaining the integrity of the story.
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