Mrs. C was used to my quiet knock every morning at 6 a.m. She smiled as I turned on the overhead lights, but began to grimace when she realized that today was dressing-change day. The rustling packages of bandages in my overstuffed coat pockets had given it away. Mrs. C had stage four metastatic endometrial cancer; a malignancy of her uterus that was not responding well to chemotherapy and had now spread into her colon. She had just undergone another tumor debulking surgery that involved a bowel resection and had left her with a temporary colostomy.
As my team followed me into her room for morning rounds, I remembered the first time I had met Mrs. C, just weeks before. She had been pleasantly discussing with her gynecologic-oncology surgeon the clinical trials that she would soon be eligible for, once she recovered from her upcoming surgery. The next time I met her, she was gowned and kissing her children a final time before being rolled back to the operating room. I remembered studying the stages of her type of cancer and memorizing her imaging, but nothing could really prepare me for the first time I saw, felt, and registered what terminal cancer looked like: A sea of pearly tumors interjected with bulky abdominal masses, all stuck to different parts of her bowels. I couldn’t believe all of that was silently overtaking her body, just a few inches beneath her skin.
Caring for her on the gynecology-oncology service, I got to spend a lot of time with Mrs. C. Every day her family came in, and every day she would save all her energy for their visit. She would spend hours talking to her children about school, checking their homework, and organizing how they were going to get to sports practices. They would watch TV together, and she would talk to her husband about his day at work as I intermittently intruded on these moments to check her naso-gastric tube output or ask about nausea. Her role as a mother gave her life meaning, it gave her a status in her family, and it was part of her purpose. Each morning, our arrival meant notes, orders, and close observation. But to Mrs. C, it also meant things like, “Will my husband still find me attractive with a colostomy bag? Who is going to be there for my daughter to teach her to be a woman?”
As I gear up to commit to a minimum of four years of rigorous obstetrics and gynecology residency training next year, questions about my role as a physician and mother have surfaced. What choices do I want to make, and what balances can I hope to strike? These are topics that my female classmates and I dissect together, worry over, and reassure each other about.
It’s a surreal thing, then, to be so immersed with patients who are facing gynecologic cancer — a disease that can hit anyone born with two particular chromosomes, and affect so many more people in its wake. In each and every case, I have truly admired those whom I have met, and their strength, hope, and perseverance in the face of malignancy. The journey through their care reminds me to pick my head up from my to-do lists and articles and remember that I am now a part of these women’s diverse and unique stories. And to all of them, especially Mrs. C, thank you for being an important part of my story, too.
Sharlay Butler is a medical student who blogs at The Doctor Blog.
