I looked at the admission diagnosis and frowned. Even as a novice student a few months into clinical rotations, I knew the weight that "painless jaundice" carried. It always raised the concern of a pancreatic tumor quietly growing til it announced its presence by blocking flow through the liver and infusing skin with a characteristic yellow hue.
I'd never met a patient with frank jaundice before and your skin glowed fluorescent yellow. You were kind and quiet; the type of elderly woman who is someone's beloved grandmother. Fortunately at that time, other than the superficial change in color, you were not experiencing any symptoms of your underlying disease and you felt like your usual self. Your husband was faithfully at your bedside more often than not. Your children lived several hours away; I met your son on his brief visit during that first admission.
A gastroenterologist placed a stent as a conduit through the biliary system to relieve the backup. Not a surgical candidate, you were discharged with the question of possible chemotherapy though we knew it was unlikely. I'm not sure if you or your family fully understood the magnitude of your disease.
A few weeks later, your name appeared on the list again as a fresh admission. I volunteered to take you as a patient considering I knew you. When I walked into your room, your husband was relieved, "I'm glad it's you again, because you already know Mrs. A and us." It was the first time I understood the significance of continuity of care and the impact it had on patients and their families, and I was touched that I'd made an impression on them.
In the few weeks since we last parted, you had declined significantly. Your husband, dedicated as he was, was unable to support your care needs at home. You'd grown weaker and it was apparent that you were approaching the end of your time here. Pancreatic cancer is brutal like that all too often.
I remember, one afternoon when I went to see, you were sleeping in semi-darkness with the curtains of your hospital room drawn. Even four years later, I still remember the look on your husband's face as he silently watched you. He momentarily raised his eyes when I came in; I spoke quietly with him as I did not want to disturb your slumber.
I asked him how long the two of you had been married. "Over fifty years," he replied with his gaze fixed on you. I heard a lot about you and your marriage. With a sad, sweet smile, he talked about how you'd met at a fair and how you were married soon after. He told me about how your children had moved away but that you were closer than ever. He told me about the difficult times and hardships, and the accomplishments and triumphs. It was very obvious how much he loved you, and from what he said, how much you loved him. After all, "in sickness and in health." It wasn't the kind of dramatic, ostentatious love of Hollywood movies. It was a quiet, steady kind of love. As an outsider who had known you two a scant few weeks, I saw the bond between you as being a part of each other. He clearly loved you so much that he would have gladly taken your illness for his own.
My therapeutic effect that day was not related to our unremarkable and brief exchange about symptoms and medications. Your husband, who had been struggling with an unexpected and difficult change in your lives, did not tell me anything that changed our medical management. But it was cathartic for him to talk about his beloved wife not as a constellation of symptoms but as the woman who he loved so dearly and worried so much about. He did not define himself as an individual; the two of you were blurred together one.
You and your husband illustrated the idea of a "great love". It conjured up the image of a profound bond that was steady and enduring despite weathering trials. As we talked, I remember hoping and praying that one day I would be blessed to experience that. I hope that my generation is still capable of embracing the ability to love in that manner. In the modern age of swiping and ghosting and the tendency to discard people rather than work things out, I hope we are able to muddle through it enough to forge such enduring connections. God only knows if that's meant for me but here's to hoping. You gave me faith that real love does exist.
With your husband at your side, you passed away peacefully several days later - "til death do you part". I can't imagine his grief. Four years later, I wonder if he is still carrying on or if his time has come as well. Thank you, Mrs. A (and Mr.) for teaching me about the human ability to love.
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