First published in Pulse Magazine, October, 2010, it was subsequently published in Medical Observer in March 2011, and re-published in a US paperback anthology of short stories in September 2012: Pulse–voices from the heart of medicine: More Voices: a second anthology [Paperback]
I tried to focus on the chart in front of me, but it may as well have been written in Russian. I’d been awake for thirty-two hours, and my brain, thick with fatigue, refused to cooperate. I knew I shouldn’t be working, but I was too proud, too stubborn, too something to admit that I wasn’t coping.
On the first day of my neurosurgical rotation, the resident I was replacing had told me, “Ten-to-fourteen-hour days, twelve days on, two days off. Say goodbye to your life for the next three months!”
I was prepared for the long hours, endless paperwork and ward-round humiliations. I expected that it might be necessary to take a leave of absence from my personal life. What I didn’t expect was that my personal and working lives would collide headlong.
As I sat there, not writing up ward-round notes, my boyfriend, Adam, lay across the hall in the neurosurgical ICU. Twenty-four hours earlier, he’d had a tumour removed from the back of his brain.
I’d met Adam in the Med School’s library when I was a final year medical student. We’d struck up a conversation while waiting in line for the photocopier. He had just been diagnosed with testicular cancer and was reading up on the disease. His warm brown eyes and infectious smile instantly attracted me, and his humour and glass-half-full attitude had me hooked from that first chat. We went out for coffee that evening and soon became inseparable. Adam was a down-to-earth country boy from outback Queensland who had a passion for competitive sheep shearing. He had a practical intelligence, a thirst for knowledge and a deep connection with and appreciation of the natural world.
For several months after his initial treatment finished, Adam and I had a fairytale romance. In remission and with a 98% chance of cure, my one-testicled Prince Charming, introduced me to many of the joys of life that I had been too preoccupied to notice. Deliciously spontaneous and enthusiastic, he helped me seize and savour each and every day. He would do things like whisk me away for romantic weekend getaways on a complete whim. One Saturday morning he said, “This weather is so good
today, it would be criminal to waste it. Are you up for a weekend down the Coast?” Before I time to even consider making plans, we were picnicking in the rainforest, luxuriating in a spa, and walking along the beach in moonlight, gazing up at the stars.
Those heady, carefree days did not last. Ten months after his initial diagnosis, while I was working as a neurosurgical intern, Adam ended up on my ward. He was diagnosed with an occipital lobe metastasis after having a seizure: the testicular cancer had spread to his brain. He often joked that growing a brain tumour showed just how far he’d go to see the woman he loved. For obvious reasons I wasn’t his doctor, but his being a patient on my ward gave us many opportunities to sneak in some time together. The silver lining of a very dark storm cloud.
The nurse’s voice penetrated my mental fog.
“Adam’s back from the ICU. Apparently he just got up and left.” She shook her head affectionately. “That boy is something else.”
As I approached Adam’s bedside, he smiled broadly, looking pale but lively, the bandages around his head somewhat askew.
“What’s this I hear about your walking out of intensive care?” I asked with mock sternness.
“That place is creepy–full of really sick people. I figured it would be much better to be back on this ward, and I knew a bed was being a held for me. So I grabbed my IV stand and walked here.”
“But you had brain surgery yesterday!” I protested.
Two days later, Adam turned up on my doorstep bearing gifts. He’d discharged himself from the hospital: “I didn’t want to be stuck in there when you were having your only day off in two weeks.”
He seemed invincible. Lance Armstrong, who’d survived a diagnosis of testicular cancer with metastases in the brain, abdomen and lungs, was his inspiration. Soon, however, it became clear that, for Adam, a cure was not going to be possible.
Despite surgery and several weeks of radiation therapy, Adam’s tumour markers steadily increased. In a matter of months, new tumours were visible on his CT scan. His doctors encouraged further active treatment. They removed almost all of his occipital lobes, destroying most of his vision. His visual fields were drastically reduced, leaving him only a tiny, blurry window through which he viewed the external world.
When the tumours appeared elsewhere in his brain they gave him further radiotherapy and chemotherapy. I felt the treating doctors knew, deep down, that the battle was rapidly being lost, but still they peddled hope like a drug to my vulnerable Adam, saying things like “It is unlikely to work, but it’s possible. We can try.” Adam had always said that he did not want to prolong the inevitable, but when push came to shove, he couldn’t say no when offered even a remote chance of cure. As a result, Adam did not have a good death. He spent most of the final weeks of his life in an acute care ward being subjected to unpleasant treatment regimes. Although at the time I felt powerless to do anything, I still regret letting this happen.
In medical school, they’d told us that we would learn more from real-life patients than from lectures and textbooks. Especially from patients we can’t fix. Patients who die. They were right. What they didn’t tell us was that watching a loved one struggle against, and ultimately lose his or her battle with, an incurable disease would teach us things that years of medical training never could.
Adam gave me a very special gift. Through our journey together, I learned that treating cancer is about so much more than trying to find a cure. It’s about more than trying to alleviate symptoms when a cure is not possible. It’s about more than whether the patient lives or dies. It’s about how whatever life left is lived, and ultimately, how one dies.
Adam has helped me to help countless others. He’s made me a better doctor. He’s made me a better person. I owe him so much. I can’t pay it back, but I am trying to pay it forwards. I’m sure he’d be pleased.
In loving memory of Adam Humphries, 14/03/78 to 12/11/00