I felt uneasy starting my oncology and leukemia rotations. These patients were so sick, and many of them had incurable cancer, often just weeks or days away from death. I wondered how I could help them, what we could do if we couldn’t treat their cancer. I’m grateful that these patients taught me not just much about how we can always help our patients and support them but also much about life and the human spirit.

1. Metastatic colon cancer 

I admitted Ms. C, a patient in her 40s with metastatic colon cancer, which had now blocked her intestines and thus severely affecting her digestive system. Unfortunately, in addition to the abdominal pain, nausea, and vomiting she experienced, this also meant she couldn’t eat or drink anything and would need a tube placed down her nose to relieve her obstruction. Yet when I admitted her, she smiled and remained cheerful even as she tried to hide her underlying grimacing and discomfort. I couldn’t help but return to her room and get to know her better. Ms. C told me the cancer was a blessing to her, and the terminal diagnosis was as well. She learned to value the people around her and to cherish them; she learned to give and to also receive love, she learned to appreciate the value of every day. The last few months had been some of the happiest she had ever experienced. She asked me to come watch a sunrise with her in the morning from her room, and I did. There she was, beaming with tears at the breaking of dawn. “I never realized how beautiful the sunrise was,” she said. “I don’t know how many more sunrises I have left, but each remaining one is a gift.” Then she turned to me, “Thank you for sharing this moment and this sunrise with me.”

2. Glioblastoma 

One evening, I was asked to speak with a patient with glioblastoma who had failed multiple lines of therapy. “Can you euthanize me?” Ms. R asked. I was taken aback and sat down to listen to her. “I know where I am with my brain cancer. Every day, I’m losing my vision, my thinking is less clear, and my memory is not what it was. I’m disoriented and can’t walk on my own anymore. I know where this is going, and I want to be at home with my kids.” But why did she ask me? “Everyone keeps talking about another clinical trial, but I really am not scared of dying … I’m afraid of disappointing the day doctors if I tell them what I truly want.” I asked if she was aware that her leaving the hospital could cause her death, to which she said yes. I told her that she had the right to leave against medical advice if she was able to articulate these wishes. I wished her the courage and strength to advocate for herself and that I would relay this communication as well during my sign-out. She held my hand as I said goodbye. “I’m glad we met in this lifetime and that you helped me in this way.” I checked her chart the next day, and Ms. R was discharged; as I kept following her chart, she died peacefully at home hospice a week later.

3. AML

Mr. L had failed multiple lines of chemotherapy for acute myeloid leukemia and was admitted with the goal of a bone marrow transplant. We had prescribed him a prophylactic antibiotic prior to receiving treatment, but he received this medication before his scheduled inhaler, and his oxygen dropped. I was paged about this, but when I got into the patient’s room, his oxygenation had improved, and his lungs also sounded clear. I found him laughing in his room, joking that it wouldn’t be easy to kill him off. I also circled back to his room later, commenting on a sense of humor that’s often not seen in the leukemia ward. Suddenly he told me about how his daughter had died of a subarachnoid hemorrhage when she was 13. Mr. L  replayed the entire scene of him performing mouth-to-mouth on her all the way until he saw it in her eyes that she was gone. “For a long time, I had struggled to make sense of a world that could just take away someone so young, so innocent, just like that.” His WW2 veteran father told him to keep a “stiff upper lip.” “He was right,” he continued. “It made no sense at the time, but he was right. I realized no angst or sadness could change the fact of reality. I still had a lot of things to live for; my wife and my other son needed me to be strong for them…Really if I could survive that, all of this leukemia stuff … even if it doesn’t work out, it is OK … that’s life … I’ve learned not to take anything too seriously and to just roll with the punches.”

4. AML with GVHD

Ms. B had relapsed AML after a bone marrow transplant with terrible graft-versus-host disease, which was a complication of her transplant in which the donor tissue doesn’t recognize the host as its own and attacks the host body. The evening I met her daughter, she was cuddled in the hospital bed with her mom, another dynamic not often seen in the hospital. “She says she won’t eat, but you have to force her to eat, like this,” she told me as she fed her mom a spoonful of soup. “I feed her when she’s home, and the nurses here don’t know that, but please tell them that it’s okay to feed food down her throat even if she resists.” I asked Ms. B if this was okay, and she nodded. I shared with the daughter that her mother’s liver labs had been improving, as there was a concern for the involvement of her disease in her liver, which to me, as an intern, seemed to be positive news worth reporting. The next day, I found out that the patient had decompensated overnight and was in septic shock in the ICU. A few days later, the decision had been made to transition the patient to hospice, and I forced myself back into the room with the daughter as the patient was fading away. I apologized to her, telling her I genuinely thought the liver lab improvements were a potential sign of clinical improvement at the time. “It’s OK,” she replied. “Cancer is hard. I know you guys tried your best…you made my mom feel so special and cared for at the end … thank you for that.” I was the one who felt the need to thank her for her gift of forgiveness and acceptance.

At the end of my rotation, I thought back to Patch Adams, a movie I saw before starting residency. “A doctor’s mission is to prevent death and improve the quality of life. That’s why you treat a disease, you may win or lose, but if you treat a person, I guarantee you will win every time, no matter what the outcome.” I appreciate that the patients on these services, even as they were dying, affirmed this ethos to me as I cared for them.

Johnathan Yao is an internal medicine resident.