It is 8 a.m. on a Monday, and my patient Eve refuses her PICC line insertion procedure again for the third time.
No! Im not having it. Tell them I changed my mind, Eve says to the seemingly timid brand new house officer who acts uncomfortable, but is also convinced he can persuade Eve eventually to have the procedure.
Just leave me alone, she says.
The house officers beeper goes off and he says, Let me just answer this page. Ill be back.
Dont come back, please, she says. Go see your other patients. l only will talk to you when my sister gets here.
Eve is unflinching and uncompromising. The wrath and fury of metastatic gastric cancer may have weakened her already frail body, but when she speaks, it is rather forceful, unapologetic and intimidating.
She rolls her eyes as soon as the house officer leaves, then turns her attention to me.
Anthony, can you give me my Moxie, please?
I grab the orange-colored soda can and hand it to her. She pours its content in a glass and drinks it like shes really parched.
I mention I havent seen that soda before. She talks about how she loved this bitter-tasting soda even as a child. Its been around that long?
Eve gives me a playful, yet sarcastic so-what-do-you-care-if-Im-85-years-old look and says, They must not sell this in … where you from again Anthony? China?
No, France, I say. Eve laughs.
If we had not bonded a week before, I would not have just retorted as I did. But knowing Eve, I am so sure she really needs a good laugh. And she does.
When I first met Eve, our initial interactions were a little rocky because she isnt a patient who makes it easy to care for her. I set some realistic expectations and explained how nurses and patients need to work together for the good of the patient.
I knew that I won her trust when just before I bid her goodbye before my weekend off, she playfully reminded me not forget to eat my vegetables.
Ill think about it, I said.
Eve laughed at my quip. It was so nice to hear her laugh.
A few days before a family meeting to discuss Eves care with the interdisciplinary team, I realize she wants to chat, so I listen. For the next few minutes she cheerfully talks about her much beloved Moxie soda, how as a teenager she worked in her fathers shoe repair shop and that when she dies, since she has no children of her own, her niece will get her jewelry.
Instantly, her mood transitions to sadness and she is quiet. “It must be very hard, I say. She takes my hand and holds it tightly.
Anthony, I dont know what to do, she says.
This must be very overwhelming for you; I am with you, I say. You have options on how to proceed with your care. We are here to help you understand your options and to make sure you receive the care and treatment you really want.
Eve says she wants to go home and die because the chemo is just going to make her sick.
On the day of the meeting, Eves niece and her sister, who also is her healthcare proxy, the interdisciplinary team and I are present. Eve cuts to the chase, asking, So how much time do I have left?
The oncologist carefully discusses the benefits of chemotherapy and at the same time emphasizes the need to set realistic goals and expectations.
Finally, Eve agrees she will go for a PICC line insertion the following day.
Silence engulfs Eves room as everyone leaves. Anthony, I would rather go home and enjoy whatever time I have left, she says.
I can tell shes thinking about living six to nine months with chemo or three to six, without it. I cant let her be by herself so I pull a chair up to sit with her.
For the rest of my 12-hour shift, I make sure I attend to her needs. Each time I check on her, she only asks for one thing to make sure she had her can of Moxie within reach.
I have taken care of a lot of Eves in the past and I know I will take care of more. The only way for me to replicate the same empathy I gave Eve is to constantly remind myself to treat patients as I would want to be treated when Im sick, vulnerable and powerless.
I did not take care of Eve after that last day since I was assigned to work offsite. I learned the day she was supposed to have the PICC line insertion, she refused yet again.
She eventually was discharged home with hospice.