Two Roads

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
took the one less traveled by,
And that has made all the difference.
—Robert Frost

Seeing Lauren in my office today is like looking into a cracked mirror. We are in our early 50s, both married with one child in high school, both professionals. I am healthy and in the prime of my career, and she is dying of metastatic colon cancer. We both bear witness to the randomness and unfairness of life.

I plan my patient schedule; she schedules visits to her physicians. I plan family meals with my wife and son; she just hopes that her food will stay down. My pains respond to Tylenol; hers require high doses of narcotic analgesics.

As we converse and our eyes meet, I see someone who could have been an old childhood friend, or a college classmate. Now she sits before me, sallow, frail and gaunt, with only a few strands of hair left, somehow finding it in her to smile. Once we traveled along similar paths; now she is dying and I am here to care for her.

When I first met Lauren, she was an intense, hardworking professional who usually came to evening appointments due to her busy schedule. We reviewed her preventive care and sporadic acute problems, always saving some time to compare notes on what our kids were up to.

I listen now as Lauren narrates her story. She can no longer work as an attorney due to weakness, chronic pain, and nausea, along with undulating emotional agony. It bothers her that she cannot be productive. She still enjoys reading, movies, and spending time with family and friends, but most activities center around home as she can be abruptly overcome with exhaustion. I think of how this far eclipses the fatigue of a long patient schedule or a sleep deprived on call night. I say, “Lauren, this must be so difficult for you,” and I know that I have to find the courage to ask about how it really feels to be in her shoes. I’m not sure how she will respond, and I am afraid of how I will feel when she tells me what it is like to have her future stolen away. Will I cry for her? If so, will showing our common human vulnerability diminish her confidence in me as her physician?

Earlier in my career, I imagined that medical training endowed me with protection from the suffering I watched people endure. This magical thinking was self-protective, a way to avoid getting closer to dying patients that, at the time, felt like a frightening emotional risk. During my development as a physician, death seemed terrifying and remote, whereas now that I see more of my peers suffering with serious illness, I am moved to approach the topic of death with my patients head on.

“Lauren, tell me how you are feeling about your cancer. What does your future look like to you?”

“Well, I’ve learned to think in terms of days or weeks, and not months or years,” she replies, looking down at the floor.

I think of my own calendar, cluttered with appointments made months in advance. My voice wavers, but I go on.

“I never really asked how you have reckoned with dying from this disease. What is most important to you now?”

Lauren says that she just wants to spend as much time as possible with her family and close friends. Her head lifts and her posture relaxes, as she explains that she wants to die at home, and does not want to be kept alive by artificial means. We talk about hospice, and she confesses that she had been considering it, and was hoping that I would bring it up. I tell her I wish her other physicians and I had something more to offer her, something that would improve her prognosis.

We sit in silence for a long moment, and I hold back the shield which tries to close around my heart and take me to a safer place. Then, with a tear in her eye, Lauren says, “Thank you.” I look at her though my own tears and see my distorted reflection, then I hold her emaciated hand in mine. I am so humbled by her gratitude. The shield dissolves.

I’m not sure how many more visits I will have with Lauren. I stand with her, connected and now knowing her wishes, as she faces the end of her life. I can offer little beyond a healing presence, yet this is so meaningful and rewarding. Our roads have diverged. For now, I am the healer, but this will not always be so. Lauren has taught me how best to honor my patients on their path of suffering.