The Trial
Jace
I’m sitting in my office, telling a patient of mine, Robert Wilson, that his kidney cancer, against all expectations, is in remission, but my mind is somewhere else entirely.
I thought she was kidding, but after 10 minutes and a cup of yogurt, Grace did exactly what she said she would do.
Today’s the first day of the clinical trial, and if I had any objectivity before that morning in her apartment, it’s gone entirely now.
“That’s good news, right?”
“I’m sorry?” I ask.
Mr. Wilson asks again, “That’s good news, right? Remission means it’s gone.”
“Unfortunately, the cancer isn’t completely eradicated,” I tell him, “but your tumor has begun to shrink. We still have a way to go before we can call it a total victory, but this is great news. You’re back near the top of the transplant list, and I think we’ve got a really good shot of knocking this thing out. With that said, I do want to impress upon you the importance of managing our expectations here. Renal cell carcinoma is very serious, as you know. Still, I think there’s cause to be optimistic.”
“Thank you, Doctor,” he says. “I can’t tell you what a relief it is to have you as a physician.”
So far, at least, crossing the line with one patient — Grace — hasn’t caused me to lose sight of my work in general.
“Talk to Yuri and we’ll get you in sometime next week,” I tell Mr. Wilson. “And it’s okay to smile.”
He gets up beaming, and he leaves the room.
So often I have to tell people the worst news they’ll ever hear. It’s nice, every once in a while, to be able to give a little bit of hope instead.
It’d be even nicer if it wasn’t just once in a while, but I’ll take what I can get.
Yuri comes to the door and says, “Grace is here; should I send her in?”
“She’s here?”
I told her that I’d walk her down for her first day of the trial, but we were supposed to meet in the lobby.
“Yeah,” I tell Yuri, “send her in.”
Yuri turns and walks out of the room.
A few seconds later, Grace comes in and closes the door behind her. “We’re really doing this, aren’t we?” she asks.
“Yeah,” I answer. “We’re really doing this.”
“It’s not that I’m ungrateful or anything like that,” she says, “but I don’t know. Do you really think this is a good idea?”
“You’re having second thoughts?”
“It’s not that,” she says. “It’s just that, well — I’m nervous. I don’t really get nervous, so it’s kind of a big thing for me.”
“Everybody gets nervous,” I tell her. “Don’t worry about it. You’re going to do great.”
“I guess,” she says, “only…”
“Only?”
“I don’t want to lose you as a doctor,” she says. “I mean, the other part of our relationship is pretty great, but you’re still my doctor, and I don’t want to be the reason-”
“Don’t worry about it,” I interrupt. “Nothing’s going to happen except that you’re going to get into that drug trial and we’re going to do everything we possibly can to get you better.”
“I’ve been looking at the statistics,” she says. “Okay, I’ve been looking at the statistics ever since you told me I had oligodendroglioma, but I’ve been looking at them again recently, and it’s not like I don’t have time to live a good life. If I had my way, I’d live to be a hundred and sixty, but I don’t think that’s really in the cards for me.”
“A hundred and sixty is probably a bit on the optimistic side,” I tell her with a smile. “But if this trial can extend your life by a year or even a few months, I think it’s worth it, don’t you?”
“Well, yeah,” she answers.
“Look,” I say, “this is totally up to you. If you don’t want to do this, we won’t do it. I just want to give you every opportunity that I possibly can, okay?”
“Okay,” she agrees.
She must be scared. I’ve never seen her go this long without making some sort of wildly inappropriate joke or observation.
“You’re supposed to be there in what, 20 minutes?” I ask.
“Yeah.”
“Let’s just get you down there, and if it’s not something you want to follow through with, you can always quit. People drop out of clinical trials all the time.”
“It’s just,” she says, but doesn’t finish the sentence.
“Don’t worry about it,” I tell her. “This is going to be a good thing. I promise.”
That may very well be the first time I’ve used the words “I promise” outside the phrase “We’re going to do everything that we can.”
I know she’s scared, but I really believe this is her best shot. I don’t just want her to live for another 10 or 12 years, I want her to have a full life.
“Okay,” she says. “There’s someone else out there; do you have to see them before we go?”
“Yeah,” I tell her. “If you want to, you can wait out there with Yuri while I finish up and I’ll walk you down and introduce you to Dr. Willis. She’ll be the one in charge of the trial.”
“Okay,” Grace says, but hesitates. She quickly makes her way over to me and gives me a quick kiss on the cheek before she turns and walks out of the office.
“Yuri?” I call out.
She comes to the door, saying, “You know, we do have an intercom.”
“Yeah,” I answer. “Would you send in Mrs. Probst?”
“Sure thing, boss,” Yuri answers, and leaves the room again.
Mrs. Probst has stage four small cell lung cancer. She doesn’t have much time left, and there’s not a whole lot that I can do for her.
We’re past the point of treatment now and we both know it. Today’s appointment is to discuss how best to make her comfortable over the remaining week or so that she has left.
The hard part with Mrs. Probst is that she refuses to be admitted to the hospital, though by all rights she should have been in a bed here weeks ago.
Her son, Brian, wheels her into the office and guides her to the far side of my desk before taking a seat next to her.
“How are you doing, Brian?” I ask.
“I’m doing,” he says. “I think it’s time we get Mom to come to the hospital, though. I don’t know how much longer she’s got, and I don’t want her to have to spend her last days in so much pain.”
I turn to Renee. “How are you feeling?”
It’s a stupid question, but one that still needs asking.
Right now, Renee is in a great deal of pain. I’ve given her prescriptions for painkillers, but she refuses to take them. Every breath for her is a struggle, and it’s one that she never fully wins.
With a heavy wheeze, she lifts her oxygen mask enough to say, “I don’t want to be admitted. If I’m going to die, I want to die in the house my husband built.”
“Mom, you’re in pain,” Brian says.
“That’s life, dear,” she says, and puts her oxygen mask back over her mouth and nose.
“It is her decision,” I tell Brian and then turn to Renee, “although there is a lot that we can do to make you more comfortable, even if you choose not to stay in the hospital.”
She shakes her head slowly.
She’s already resigned.
In my business, in her progressed stage of small cell, resignation isn’t necessarily a bad thing. The five-year survival rate is about two percent, and unfortunately, everyone sitting in this room right now knows that’s not going to be her.
Still, there’s no reason she should suffer any more than she has to.
“Would you consider a morphine drip?” I ask. “We have buttons that you can use to give yourself a dose, within limits, of course. That way, you can still be in control of-”
“I’m not...” she wheezes, lifting her oxygen mask slightly, “in control…of anything… anymore…”
“This can give you control over your pain,” I tell her. “There’s always going to be some discomfort, but you might be surprised how much a little relief can help.”
This 75-year-old woman is, without a doubt, the toughest person I’ve ever met in my life.
For an oncologist, that’s a hell of a statement.
The fact that she’s even sitting up in her power chair is a small miracle. She shouldn’t even be out of bed right now, and it’s astonishing that she’s capable of doing it. I’m not exaggerating when I say that I’ve never seen anything like it.
Renee just says it’s the only excuse for her to leave the house that anyone will accept anymore.
For her, as painful and exhausting as it must be, this is the closest thing to a vacation she’s likely to know from here on out.
“No,” she says, not bothering to lift her mask this time. “I’m tired…I’m weak…I’m ready…”
“You’ve got to talk to her,” Brian says. “There’s got to be something you can do.”
“There’s nothing more we can do at this point,” I tell him. “Other than manage her pain and try to make her as comfortable as possible…” I sigh. “There’s just nothing else for us to do.”
“Why isn’t she on the transplant list?” he shouts, startling me and his mother.
“Her cancer’s metastasized,” I tell him. “There’s nothing more we can do. I advocated getting her on the list, but the transplant committee denied it. I’m sorry.”
Brian turns to his mother, tears in his eyes. He’s young. He can’t be more than 35.
“You’ve got to do something,” he says.
“I’m ready,” Mrs. Probst breathes, and with that, her head droops forward.
I’m on the other side of the desk and crouched down next to Mrs. Probst in a second, feeling her neck for a pulse.
“What’s happening?” Brian asks.
Shit.
“I’m sorry,” I tell him.
I’m not feeling a pulse and she’s DNR. I try to find a pulse in her wrist, but there’s nothing.
“You’re sorry?” he shouts. “Why the hell are you sorry?”
I look at my watch. “Time of death, 11:47,” I pronounce.
“What?” he cries. “No, you can bring her back. You’ve got to bring her back.”
“She signed a do not resuscitate order,” I tell him.
“I don’t give a fuck what she signed!” Brian yells in my ear. “You need to give her CPR.”
“I can’t,” I tell him. “Legally, I can’t.”
“She’s dying!” he yells, and the door to my office opens.
Yuri’s in the doorway, waiting for some kind of instruction from me, but I really don’t think now is the time for me to tell her to call the morgue.
“I’m going to need a little help in here,” I tell her. “Mrs. Probst just passed away.”
“Why aren’t you doing anything?!” Brian screams at me.
“Mr. Probst,” Yuri says. “You need to come with me.”
“Fuck you!” he shouts. “I’m not going anywhere. This is my mother, and you’re just letting her die!”
“Brian,” I say in as calm a voice as I can muster given the situation, “you need to come with me.”
“You’re just going to leave her here?” he asks, his anger turning to grief and confusion.
“No,” I tell him. “A couple of doctors are going to come in here and help me move her to a gurney, all right? I’m sorry, but this is what she wanted.”
Brian’s in tears now, clutching his mother’s hand.
I’ve had patients die before. I’ve been in the room when it’s happened, but it’s never happened in my office.
After a few minutes, a couple other doctors and a few nurses are in my office and we’re lifting her as carefully as we can onto the gurney. Brian’s just standing off in the corner of the room now, watching us in silence.
For now, we leave the gurney where it is. I’m not about to tell Brian that he has to leave his mother’s side.
“If you want,” I tell Brian, “we can give you a few minutes with her.”
He’s wiping his nose with his sleeve and doesn’t say anything.
“We’ll just be right outside whenever you’re ready to come out,” I tell him.
With that, the other doctors, nurses, and I exit the office, and I close the door behind us.
Most of the nurses leave, and all but one of the doctors go, as well.
Yuri’s sitting at her desk, looking at the grain of the wood in front of her.
“Are you all right?” I ask. “That was pretty hard in there.”
“It’s okay,” she says. “I’d probably be doing the same thing in his shoes.”
“Okay,” I tell her. “Let me know if you need anything, will you?”
This isn’t what I expected of today, but something like that is never out of the realm of possibility.
I look back over the waiting room, but immediately turn back to Yuri.
“Where’s Grace?” I ask.
“She left when Brian started screaming,” she answers.
“Do me a favor and see if you can get her on the phone, will you?” I ask. “I’ve got to stay here until-”
“Yeah,” Yuri says. “I’ll call her.” She picks up the phone and dials the number.
Brian comes out of the office, his eyes red from crying.
“I’m very sorry, Brian,” I tell him, but he just walks past me and out the door.
Mr. Probst died a few years ago, so Brian’s the next of kin. There are some things he needs to sign, but I feel okay giving him some time.
“Boss?”
“Yeah?” I respond, turning back to Yuri.
“She’s not answering her phone,” she says. “I can keep trying.”
“Please do,” I tell her, and look to the doctor and nurses still in the waiting room with me. “We should get her down to the morgue,” I tell them, and that’s what we do.
It’s about 20 minutes before I’m back in my office, and Yuri’s quick to tell me that she still hasn’t been able to reach Grace.
I have another appointment in about 10 minutes. I’d planned to use my lunch break to take Grace down for her first day in the trial, but with the situation being what it is, that’s just not going to happen.
“Has anyone been in to take the chair?” I ask Yuri.
“It’s still in there,” she says. “Do you want me to call someone?”
“Yeah,” I tell her. “Let’s see if we can get it out of here before my next appointment comes in.”
“Sure thing,” she says, and picks up the phone.
“Are you sure you’re all right?” I ask.
“Yeah,” she says. “I’ll be fine. I’m just a little shaken, I guess.”
“Okay. When you’re done, you can take a break if you need it.”
“That’s okay,” Yuri says. “I’ll stay.”
“All right. I’ll be in my office. Let me know if someone can get up here in the next few minutes.”
The sheer impracticality of getting the electric wheelchair out of my office without climbing in and driving it — more than a little insensitive, I think — is something I’m going to have to deal with if Yuri can’t get someone to come in and take care of it.
I’ve never given much thought to that sort of thing, but it can’t be a new situation to the hospital.
I pull out my phone and dial Grace’s number. It rings a couple of times and then goes to voicemail. She’s ignoring my call.
If I knew she was still in the building, I’d risk being a little late for my next appointment to talk to her.
There’s no telling where she is, though.
After something like that, she might already be in for her first day of the trial, or she might have left the hospital entirely.
Yuri pops her head into the room and says, “Nurse Travis is on her way.”
“Thanks, Yuri,” I say. “Let me know when Mr. Farrer gets here. And if Brian Probst comes back in, let him know where Nurse Travis took the chair and call Benedict so Brian can fill out the paperwork.”
“Okay,” she says, and leaves the room.
Nurse Travis comes in a minute later and removes the chair from the office, leaning over the back and using the joystick to propel the chair forward.
I guess I could have thought of that.
I’m still trying to get my head back together when Yuri comes back into the office.
“A couple of things,” she says. “First off, Brian Probst came back in and he’s waiting for Benedict to get here. Nurse Travis left the chair out here, so that’s all taken care of, and I don’t know if you’ve gotten ahold of her or not, but Grace still isn’t answering her phone.”
“Thanks, Yuri,” I answer, and rub my eyes.
“Oh,” she says, “and Mr. Farrer just called to cancel his appointment. I got him rescheduled for next Tuesday.”
“When’s my next appointment?”
“You’ve got about 20 minutes,” she says. “It’ll be Mrs. Frost at 12:40. After that-”
“Thanks, Yuri,” I interrupt.
After Mrs. Frost’s appointment in the office, I check up on my admitted patients. It’s a full day.
I just wish I knew where Grace is.