If I Could Only Have A Hotdog

Clashing wills with a patient generally calls for a medical divorce.  It would be appropriate for a physician to say, “It’s time I remove myself from your care and turn you over to another doctor.”  In truth in all my years of practice this never happened.   Once it should have but the patient was my cousin’s wife, Fern.  I loved her; there was just no way I could abandon her.

Fern was only two years older than I but, having started raising a family eleven years before me, she had played a senior role in my eyes.  Our lives interlocked in many spheres.  She became one of my wife Marcia’s best friends.  Every year the two spent many hours each day for three months fine-tuning Broadway musicals that Marcia had adapted to Hadassah themes.  For years the three of us sang in the synagogue choir.  We laughed together a lot and at low points we comforted one another.

My cousin Milton, Fern’s husband, was one of the most competent public figures I had ever known.  In addition to being a superb optometrist, he was the editor of the prestigious national optometric journal and simultaneously president of our synagogue, Hopewell Jointure School Board, and the Beaver County Community College.  It was not unusual for him to have three meetings in one day and chair them all with aplomb.  I obviously admired Milt greatly, which allows me at this late date to be candid about the disagreement I will describe.  Besides, he’s no longer around to take umbrage.

Being the physician to family members is fraught with potential problems, not the least of which, because of wishful thinking, is the possibility of overlooking significant illnesses.  (I can confess to missing my own wife’s pneumonia though I had enough sense to ask a colleague to examine her; he, in turn, made the diagnosis and put her on the right tract.)

Therefore it was with some trepidation that I started my study of dear Fern when she presented with back pain.  From her story I early suspected that it was not the common garden variety of musculo-skeletal disease. Testing by means of ultrasound of her abdomen raised the possibility of a tumor of the pancreas.

With Fern and Milt’s consent, I referred her to the Presbyterian Hospital in Pittsburgh under the care of my gastroenterologist brother, Bob.  Within days a surgeon performed an abdominal exploratory operation; the diagnosis was inoperable cancer of the pancreas.  This carried a death sentence.  Occasionally radiation therapy was used but it really had little to offer.  The same was true for the early chemotherapeutic drugs.  Fern would die within a year.

Bob accompanied the surgeon to the family waiting room and nodded in agreement as the surgeon spoke to Milt.  “I’m sorry.  I have nothing to offer your wife.  No one does.”

Without a moment’s hesitation Milt took control.  “In that case, Bob, can you get me a key and show me the way to the hospital’s medical library?”

Milt spent the next four hours researching every entry related to pancreatic cancer.  Without any input from Bob or me, Milt made his decision.  He called a “scientist” doing immunological research on cancer therapy in the Bahamas.  Two weeks later he and Fern were on a plane in search of the “Holy Grail.”  At least that’s how I perceived Milt’s gesture.  Although I did not approve this turn of events – I wasn’t even certain that the scientist was legitimate – I did not fault Milt; decades later “immunological research” has become credible and is beginning to impact on patient care.  I trusted that, at least, Fern would enjoy the tropics.  

When Fern’s condition slowly deteriorated, Milt brought her home.  He thereupon embarked on a variety of therapies scorned by conventional cancer specialists but nevertheless pursued by what would now be called “alternative medicine”. Their treatment consisted of injections of worthless Laetrile, high colonic irrigations, and a very low-protein diet.  Fern went along with Milt’s frantic efforts to prevent the inevitable.  Understanding my cousin’s need to do something, not to stand idly by while his wife was dying, I reluctantly went along with these charades.  Sad to say, Milt was contemptuous of all offers for counseling that might have helped him adjust to the somber reality of Fern’s impending death.

I was appalled by Fern’s appearance when I last visited her at home.  Her voice was weak as she lay in what would soon be her deathbed.  She was deeply jaundiced from blockage of her bile ducts and she was literally just skin and bones.  Fortunately she was free of pain.  With a whimsical smile she half pleaded with me, “David, if only I could have a hot dog.”  I resisted going out to buy her one, knowing that Milt was clinging desperately to the low-protein diet.  I had such an urge to crawl in bed with Fern just to hold and comfort her – and myself.

Three days later Fern lapsed into a coma.  Milt finally relented, restraining himself from starting high calorie intravenous infusions.  Fern was dead in two more days.  Poor Fern.  How she had yearned for mutual consolation with Milt, something Milt couldn’t handle.  And lastly, she had been denied the opportunity to say goodbye.

I have often wondered if I had sought a replacement for myself, a physician less emotionally involved, would the situation have been different?  Could Milt have been brought to appreciate Fern’s need for support with her dying process rather than being bypassed as he fought her disease?   My lame excuse was that I was certain that none of my colleagues could have thwarted Milt’s steamroller approach any better than I.  Thirty years later I find that stance untenable.