“How much do you know about Chronic Lyme Disease?”
It’s 2006, and each patient I meet is brand new to me, as I’ve just started my first full time job as a family doctor.
Her words feel sharp and peppery to me.
“Very little,” I reply truthfully. I can feel my heart rate rising.
This admission takes her back a little, as she was gearing up for a fight, based on her body language.
I look at her, smile just a little, and invite her to tell me about her illness. My heart rate settles and we both settle into a respectful doctor-patient groove.
We develop our own dance moves—we cha-cha nice, even steps as she sees our infectious disease consultant and is dismayed at their dismissal. We do the mambo as I agree to refill medications prescribed by the specialist she is seeing in the US for her condition. We waltz her over to the sleep clinic to help with her sleep medications that are worrying me.
It definitely takes two to tango in the doctor-patient relationship.
Hop, skip, and jump forward in time—it’s 2020.
The worst of Covid closures. Virtual medicine dominating—and we have a phone call.
It’s nerve-wracking because you can’t do a dance over the phone. Remember trying to have Zoom room parties? Terrible.
Diarrhea—not very long, all the reasonable advice is dispensed and appropriate follow up made. She does her steps, I do mine, albeit separately. She steps towards me with a phone call that it’s worsening, I step closer with an urgent colonoscopy referral. Wait, this is going faster now—she’s in emerg, reasonably wondering could she get the colonoscopy done sooner rather than later.
I am driving home when I get an email from the subspecialist who assessed her in the ER. Why am I looking at my email while driving? I can’t answer that.
My heart sinks lower and lower as I see words—jaundiced…. pancreatic mass… urgent referral to surgery.
I feel a weight at the back of my head and neck.
The subsequent visits are the surge of fighter spirit—a quick recovery from surgery, her mood and affect are positive. She is practically doing the can-can.
Then chemo starts and fatigue spreads its dark cloak around her, blocking all the light. We are in the middle of a lockdown—one of the tightest phases.
She tells me: “I’m so weak I can’t lift a spoon to my mouth. I wish someone could come feed me.”
Yet no visitors are allowed. She lives alone, and her immunosuppressed state only distances potential caregivers even more.
Insomnia plagued so many people during Covid lockdowns, even in the best of circumstances.
But how could sleep medications compete with noise of Covid/Cancer/Chemo? I imagine it sounding like someone hitting a metal pot with a large spoon.
I wept as I saw the note from a psychiatric admission. She was sent by her therapist when she said wanted to die from the lack of sleep.
Remarkably, in hospital she restabilized and climbed out of the pit on a ladder built out of a dazzling cocktail of five different sleep medications prescribed by the inpatient team.
Pancreatic cancer does not end well, but I want to end this story with an image I like to remember her by.
Just prior to her starting second line chemotherapy drugs, which led to hair loss and significant weight gain, I saw her in the office for a follow up visit.
She swept in bursting with excitement as she told me about how she was just crossing the street and this cute, much younger guy was totally checking her out and she flashed a flirty smile back at him. I’ll never forget how she looked and sounded that day—her hair flowing under a jaunty raspberry-coloured beret, fantastic sparkle in her eye. We giggled like schoolgirls.