AHEAD OF HER TIME

This letter to our nanny (Makayla- Maki for short) from Cate speaks for itself.

What a thoughtful and amazing young woman Cate has already become at the age of 10.

Anything I have written pales in comparison to what she just poured onto that page - without any prompting, mind you.

COMING HOME

Last week, I did something I have never done before as an oncologist. I made a home visit to see one of my patients - a dear patient who had recently enrolled on hospice.

The reason for my visit was not to tend to his symptoms or to make medication adjustments. Rather, I visited him and his wife so they could say goodbye and thank you.

Dr. X and his wife had both been physicians in the Portland community until they retired in the past decade. Around that time, he was diagnosed with prostate cancer. Unfortunately, despite early surgery, his cancer returned and eventually became metastatic. That is when I met them roughly four years ago. We tried everything imaginable to control his cancer and keep him alive. Some treatments worked better than others, and some treatments were also more toxic than others unfortunately. Through it all, he was resolute and never complained.

At our last visit three weeks ago, I gave him the bad news that the cancer was progressing and that there was nothing more I could do to try to slow it down. I did let him know that we would continue to be aggressive about reducing his symptoms, and that is when we decided to start hospice.

That visit was even more sad because I also had to let him know that I would be moving to accept another position at a different institution out of state. He and his wife expressed understanding, but I could tell that they were concerned about how his care would be managed after I left. I re-assured them that I would still be here for two more months without letting them know that that is all the time I thought he might have left. We hugged at the end of that visit and said a brief goodbye.

Since that time, Dr. X became weaker, and his wife feared he did not have long to live. They had hoped to see me at a previously scheduled appointment three weeks later, but it seemed unlikely that he would have the strength to come. His wife said that they just wanted one more opportunity to see me.

Cate's futsal practice on Friday nights is not too far from where they live, so I told my nurse to let them know I would stop by while she was at practice. As I drove up to their house, I was struck by how beautiful their street and yard was. Inside, I was greeted by both doctors and their grown son who was slightly younger than me. Grandkids also peaked out from behind corners and ran away when I caught their glance.

We visited for almost an hour and a half, and I learned more about their own life stories and how they came to the US from India and settled in Portland. They talked about how difficult it had been to make their way in this state when it was even less diverse and much less welcoming to people who looked like us. They gave me this beautiful plate and a card.

The card was brief, but it ended with words of encouragement, "Change is hard, but your family will support each other and get through this transition."

That night, I had come to help them with their transition to death and to offer my support. However, it was they - who were now facing the biggest transition of their lives - who had sought to comfort me one last time through their own stories of overcoming challenges.

Not a clinic goes by when my breath is not taken away by the grace, dignity, and kindness of the men and families for whom I have the privilege to care. Dr. X and this home visit were a clear reminder that anything I give to my patients is far outweighed by the lessons I have learned from them and the kindness they have shown me.

If home is where the heart is, heart is what I found on that home visit.