Diana was one of the most grateful patients I have ever cared for. Even when she came into clinic short of breath, clutching her chest, oxygen saturation hanging in the high eighties, she always had a smile on her face and made every effort to thank you for any little deed. This includes getting her a chair, an apple juice, helping her recline and put her feet up, or hanging her blood.
One of the last days I had her, she looked awful. She had lost so much weight, her skin was dry, her lung sounds were diminished, she needed oxygen, and she could barely stand without expending nearly all her strength and energy. Her AML had relapsed and being frail and in her seventies with comorbidities, she wasn’t an appropriate candidate for a stem cell transplant. Her previous doctor had run out of options for treatment, and thus she seeked care at our facility. Her one reason for living was clear: a cute, one year old granddaughter who she was desperate to see. Through COVID and through cancer, she would see through it all just to be able to hold her little girl one more time.
Although she started new treatment with high hopes, her luck was quickly overturned when she ended up in the hospital with a nasty pneumonia. Pneumonia in the elderly can be fatal, and the hospitalization took a lot out of her. She had to come in daily for treatment and supportive care, and the trips to and from clinic alone were enough to exhaust a healthy twenty year old (LA traffic, you know). But she fought and she fought hard. Until one day she told me her “little body couldn’t take it anymore.” And that she thought it was time to go.
I was really proud of Diana because patients become so blindsided with living that they forget the reasons they live. Yes, she was fighting for her granddaughter. But the treatment had withered her away so badly, she didn’t think she could enjoy any time she may have left with her granddaughter. The foresight and understanding to “give up,” or rather, give in to this process and to simply accept that she was dying was one of the most powerful moments I have witnessed in healthcare. I stood at the foot of her bed leaning against the bed railing. Sitting on the side of the bed huffing and puffing, she looked over to me and reached out for my hand. I held it with gloved fingers and listened as she voiced how grateful she was to be able to meet people who were so willing to take a chance to help her live; how grateful she was to meet me; how grateful she was for all we did for her; and how grateful she was that she had gotten this far. I told her I would miss seeing her, helped her into her wheelchair, and wheeled her outside where her Uber ride home was waiting. The idea that she needed an Uber home hurt my heart because throughout her care, she had to overcome several social barriers. Finding a ride to and from cancer treatment everyday is not easy, but somehow she always did. Helping her into the car of a stranger that didn’t know her, didn’t know the heart she had, and didn’t know that she probably had no longer than a week or two on this earth devastated me. I closed the door to the silver Hyundai, heard her last “thank you,” and watched her drive away for the last time. Diana died the following week. The feeling is bittersweet but I am happy to know she did not suffer for long. I am happy she knows that our efforts weren’t in vain. And I am happy that even though she was only able to see her grandbaby mostly over FaceTime, they were a hundred more FaceTime sessions she wouldn’t have gotten if we didn’t try.
I’ve never met someone who was gasping for air, yet always found the breath to say thank you. I’ve never met anyone like Diana.
Gratitude is powerful. I imagine that when it’s the last note you leave on, the afterlife is pure bliss.
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