The art of medicine includes balancing knowledge with wisdom, facts with compassion, and blending the scientific with the subjective.  I have yet to give anyone really bad news, but I have had to face a few times when there was a chance of really bad news.  Questionable bloodwork, a suspicious mole, an ovarian cyst that shouldn't be there.  Bumps, lumps and rashes are usually pretty obvious, pretty easy.  Once we get into the mysterious and immeasurable, the something's just not right, it gets a little dicier.  Good patient communication, trust with the doctor, an open mind on two sides, and persistence.... hopefully unlock the door and reveal something not too bad. 

The sister in law of my friend is dying.  Today I got the call that chemo is killing her faster than the cancer, which is about as bad as it gets.  The good doctors of Mayo have suggested she stop and move into hospice.  The cancer isn't responding at all, if anything, growing stronger with each round.  Her body is breaking down with infections and heart failure, the tumors grow.  She is a young mother, and married to the brother of my friend.  I have known this family long before she was in their lives.  And now, I will know them a long time after she leaves it.   I haven't seen her in some time, since before the diagnosis last year, she has kept to herself and we aren't close.  In the past, a little moreso, when life overlapped us more often.   I have been keeping up, from the fringes, careful not to impose on the delicate privacy of a family falling apart from within.  

I am close enough to her inlaws that I can call their cell phones and get an update, detailed, on everyone.  We are now in the fourth generation of family with each other, as I have been watching their grandchildren grow up.  I have watched as her beautiful boys have gone from toddlers to young teens.  Now, these two young men are having to accept, finally, their mother won't be surviving after all.

I may be a scientist, a physician, the person who can explain the minutiae of labs and tests and physiology, break it down into small bites, arrange into meaning, and take out the scary part.  My friend called today, in tears, asking me how the doctors could have missed it for so long?  Years of something's just not right met with a raised eyebrow, and it's all in your head, you probably have mono.  Years of misdiagnosis that led to a very late, and very too late, discovery of a very rare lymphoma.  And now, no chance to survive.  I don't want to be the one to soften this blow, to say there is nothing more they can do, there is nothing they could have done.  Maybe they should have found it.  Maybe is too late.  For my friend, I must say, this was a one in a million chance.  And, it probably was.  

I want to give them hope, that there is a chance, any chance, things can turn around.  Taking out the poison and let her body fight back, and survive, and somehow kill this thing that has lurked in her genes for years, a Loch Ness of disease.  Little sightings along the way that have been spooks, shadows, there and gone.  I want to not be chiming in with their father, a physician, as he dryly recounts the details and distances himself from the pain.  His son is losing his wife, his grandsons, their mother.  I don't have anything to offer but I am so sorry, I am so sorry, I am so sorry.  I have run out of science, and have only hope to turn to now.  

I know miracles have been known to happen.  I don't care for anecdotal evidence, I care for stories of mad chance meeting the edge of life.  I don't know how to harness these, and lasso them into the care plan for patients.  I can only give the best of all possible outlooks, and a plan B for when it is not so good.  Today, tomorrow, this week, I will be showing up as a friend, not a doctor.  A friend who sat at her desk today, between patients, crying because the call has actually come.   I am so sorry, Jeannie.  I am so sorry.