Patient is a 63-year-old woman with a history of systemic sclerosis, recently diagnosed with stage IV squamous cell lung carcinoma, presenting with worsening shortness of breath.

My patient is sitting in a hospital bed.  I can just barely make out her teary eyes as I don my gown and gloves in the doorway. She looks at me, and I imagine my image swimming in the water that streams down her face. I wonder how many white coats she’s seen this morning. 

“Hi there,” I say as brightly as possible, breaking the silence.  “I don’t know if you remember me, but I’m a third-year medical student, and I’m part of your medical team today.”

 “Hi sweetie,” she says, her voice strained from crying. “I remember you, you were in the emergency room yesterday. Come on in.” 

I feel confident as I enter her room, but she must sense some trepidation in my steps. 

“Come on, you can come closer. I know I’m crying but I actually feel better today. But I’m just crying ‘cause of my emotions.” 

Mechanically, my mind flips through the pages of her chart, and I recall a history of Depression and Anxiety. As if her current disposition warrants a psychiatric diagnosis. 

“I’m so sorry,” I tell her helplessly. “I wish you didn’t have to go through this. Do you want to talk about it?”

Her lips quiver, but she squares her shoulders. I can tell she is fortifying herself. “No, dear. My emotions get out of control if I think about it. But I actually do feel better today. Less cough. And the sputum is clear now.”

When she talks about her symptoms her tears subside. Until two years ago, she used to work as a nurse. She is accustomed to this kind of talk. And she knows exactly what the doctors want to hear. 

I am relieved by this line of conversation. I have become oddly comfortable discussing urine output and bowel habits. Her emotions, on the other hand, I’m not sure I’m in a position to handle. They are a daunting and murky abyss. Something foreign and unfamiliar, something that if I waded too far into I might never be able to return. 

“Sweetheart,” she finally asks me. “There’s been so many doctors, and I have no idea what’s happening. Can you tell me what they’re doing? How are they treating me?” 

I’m taken aback. It is her penultimate right to have this question answered, but why by me?  Of all the individuals who have visited her this morning, I must be the least qualified to answer her. And yet, for some reason, she has chosen me. 

My reply is cautious; I do not want to falsely raise her hopes. Her current condition represents a particularly steep decline from which I am praying she will recover. But unfortunately, medicine can only do so much to decelerate her downhill trajectory. 

“We think your worsened shortness of breath could have been caused by a few different things,” I explain. “The CT scan showed us that there might be a pneumonia in your lungs, so we’re treating that with some antibiotics.” I pause to see her nod. “That and the X-ray also showed us a lot of fluid in the lungs, so we’re giving you Lasix to help take off the fluid load. That should help with your leg swelling also.”

“Yeah,” she chimes in, with a half smile.“My legs already feel less boggy.”

“Good, that’s good. And then, our attending had this idea that the worsening lung function could also be because of one of the chemotherapy drugs that you got. So, we talked to the lung doctors, and they decided to give you steroids. That should help make the fibrosis better.”

“I just want to stop you there, baby,” she says, and she tightly holds my hand in both of hers. I hear another tide of tears coming on. “The steroids, they’re not going to make my fibrosis better.” I feel as if I can hear her soul breaking when she says that. “They’re just going to lower the inflammation. The fibrosis is permanent, and there’s nothing they can do about it.”

I want to kick myself. I should have known this. I probably did know this. In my fumbling attempt to raise her spirits, I’ve made her cry regardless. 

“I am so sorry,” I say earnestly. “You’re absolutely right, that was my mistake.” 

“No dear,” she cries harder. “I have to say it for myself too. I’m just not going to get better.” 

This time, I squeeze her hand and kneel beside her bed. “I’m so sorry. I really didn’t mean to make things worse.”  

She shakes her head. “No, sweetie, it’s okay. Eventually I have to face this.” She looks at me helplessly through her tears. “I’m just scared. Am I ever going to make it back home?” 

“We’re doing our best,” I say, “to help you go home soon. I know you’re not back to normal, but it does look like you’re already doing better than yesterday. So we’ll just take it one day at a time, okay?” 

She nods and gives me a warm hug. “Thank you, dear.” 

I am overwhelmed when I leave her room a little while later. I am overwhelmed by her tragic situation. I am overwhelmed by her devastating sadness. I am overwhelmed by her unfailing kindness. But most of all, I am overwhelmed by how much she has taught me in a matter of minutes. 

She is afraid of dying, afraid she will feel like she is suffocating at the end. But the breadth of knowledge that she has given me, in my eyes, makes her immortal.