She nodded along quietly, her husband's hand lightly palmed on her lap. Ms. Robbins had been through numerous chemotherapy sessions and two surgeries, the first of which left her without a uterus, Fallopian tubes, or ovaries. That was nearly three years ago. The second surgery left her without a large section of her bowel, part of her kidney, and a bunch of other ancillary tissue. Despite all of our efforts, the cancer had survived.
While the oncologist explaining that her recent PET scan showed progression of her cancer, Ms. Robbins and her husband nodded along. Her eyes shifted patiently from my preceptor to a glossy diagram of a uterus back to me as we described that we had run out of treatment options. The cycle continued like this for what seemed like an hour, but to my patient time in fact stood still. Her eyes began to tell a story as she came to understand her prognosis. They were devoid of fear, and sadness had washed away through the years that had passed since her initial diagnosis. She wasn't angry nor desperate; she and her husband were composed. When she finally spoke, she calmly asked, "My daughter is getting married in July. Do you think that my body will...um...hold up until then?"
Imagine for a moment that a fortune teller was able to tell you (approximately) when you would die. How would that change your plans for the year? How about your plans for tomorrow? Would it force you to reevaluate your priorities? During this visit with Ms. Robbins, the story told by her eyes described what it must feel like to have an expiration date placed on your life.
Ms. Robbins probably saw this day coming. Again and again, a new therapy held the promise of buying her more time, yet surgeries and toxic medicines did little more than to make her nauseated and weak. She's battled for three years, coping with the idea that an expiration date might soon be laid before her, and that day has finally come. The oncologist's response was short, "Well...if we try more therapy, then it's possible. But without any more chemo, I'd say maybe...three months?"
At that point, the gaze that I saw in the Robbins' eyes spoke not of bikinis, finances, favorite desserts, or dress sizes. Their eyes said one thing: I want to be with my child on her wedding day.
Every day I counsel patients on lifestyle change. Part of my success relies on tapping into the deeper reasons that they want to lose weight or improve their diet. For most people, weight loss is, on the surface, a ticket to feeling sexy in a bikini. But what happens when you achieve that goal? Think about it...what about your life improves when you lose weight? The bikini body might be good motivational start on your journey, but take a step back and consider the big picture.
We don't know enough about cancer to prescribe a lifestyle that will prevent it (entirely), but often times modern diseases such as cardiovascular disease, diabetes, and hypertension present with even shorter timelines. We are all close to somebody that has died of a heart attack or one of the other complications of metabolic syndrome. Ms. Robbins' battle with cancer is not meant as a tale to strike fear into your heart. After all, fear is a poor motivator judging alone from the fact that many heart attack victims don't change their exercise or dietary habits. Rather, it's simply meant to provide some perspective.
It's hard to imagine being told that you have only three months left to live, yet this is the reality facing so many mothers, fathers, and children today. A terminal diagnosis leaves no room for fear. It dissolves the ego and forces a family to focus on the present. I have experienced this in the gynecology oncology clinic where I work, and I am the son of a father diagnosed with a terminal illness. Regardless of your involvement, witnessing the re-emergence of that little spirit behind the shadow of our colossal egos draws perspective into the forefront.
And, from that vantage point, it is a lot harder to swallow.
Nathan Riley, MD, is a Resident OB/Gyn at Kaiser Permanente in Los Angeles. He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD. He can be reached at firstname.lastname@example.org. You can also connect with him on Google+.