Is that part of an oncologist's job description? I wondered. Dressing in fiercely optimistic clothing? Or is that just the only way they can get out of bed some days? She was a stout lady, probably barely coming up to my ears, but with quite a few pounds on me. Curly dark hair, and an almost traceable accent. Italian perhaps. She waved the DNR sheet around nonchalantly as she talked to my Longitudinal Clerkship preceptor. Tragic, yes. Maybe not the worst thing if she, the patient, didn't come out of this. She didn't have much time as it was. Add in the current systemic inflammatory response syndrome (SIRS) and you weren't left with much. Especially since we couldn't trace the SIRS to a source. Frustrating really. It could be some sort of damage in the bowel....leaking somewhere. Perhaps. Maybe the blood cultures were bad. Unlikely. Could be in her lungs? Hard to say.
And yet, also hard to just accept death at this point. Even with that purple DNR sheet being waved around like a flag. Quicker, sometimes, when the oncologist really got thinking. And then slow again. Barely a tick. Like a cool spring breeze that might whip the Stars and Stripes up into a frenzy for a few seconds and then die off. And just flutter. But yes, the patient. 44 years old. Seems much too young. In this day and age. Much too young to have your insides invaded by your own cells, choking the life out of your every organ. Metastatic cancer from the breast had invaded her ovaries, her liver, pushed her kidneys to the point of exhaustion. Dialysis buys her some time, but...it's really only a matter of time. Time. Funny thing at the end. How it lengthens and slips away all at the same time. And all the while the pale purple DNR flag waving around between me and the bright bright BRIGHT orange sweater of the oncologist. Above the bright bright BRIGHT floral skirt. A skirt of the flowing variety. An outfit they no doubt put together on some mannequin in Macy's to announce the spring arrivals. Do oncologists have time to go to the store? Especially oncologists with 44 year old dying women on their hands? Or are they strictly an order-by-mail consumer? Internet must make that much easier these days.
44, sighed my preceptor. I hadn't seen him so upset and so resigned before. A man who, as an intensivist, must see a lot of death. But this case was bothering him. Especially bothering him. Disturbing to be at a loss like this. Unable to explain her newest symptoms. Vanquished by the cancerous adversary. And mystified by it as well. He'd entertained even the most absurd theories earlier from the nursing staff and PA's surrounding the screen of the patient's CT scans. Considered them, tried to reason an answer out of even the most unlikely of possibilities. And still, nothing. Annoying, but not annoying in the "my problems aren't problems" way that sometime captures us. This is a problem. A real problem. A problem problem. And there was no solution in sight. The battle was over. And so was the war.
I was distracted by the oncologist again and couldn't focus on what they were saying. The orange was just so so orange. Would it distract our patient's family like it was distracting me now? Would they be able to understand and listen when the "do not resuscitate" living will was explained to them and to the patient? Or would they be like me, thinking of nothing but a pale purple flag in the gentle spring breeze, framed by the bright orange sky of a setting sun.....and wish they could just curl up in the flower below. Or by a peaceful lake. Or....anywhere but here, really.
And then, just like that, there was no time to dwell. My next patient was waiting. I straightened my white coat, took a deep breath, and left the orange orange oncologist and her pale pale purple DNR sheet to her duties. I stepped into the next patient's room, washed my hands of any bacteria and of all the thoughts that had been racing through my mind, and dove into yet someone else's life.
