Private Lives: Personal essays on the news of the world and the news of our lives.
BOSTON — There wasn't going to be a happy ending. The patient had metastatic cancer and had just gone through her third unsuccessful regimen of chemotherapy. Now it seemed that everywhere we looked, we found disease. An X-ray of her belly revealed an obstruction in her intestines. A CT scan of her chest uncovered a pulmonary embolism. Her labs demonstrated that she had almost no white blood cells left with which to defend herself.
When she arrived in the intensive care unit, she was delirious. I asked her the usual questions, about her medical history, and whether she wanted us to do CPR if her heart were to stop beating, but she didn't answer. I was just setting the clipboard aside when she raised a hand and told me, in a moment of lucidity: "Doc, do everything you can. I need to make it to my daughter's wedding."
She was in a lot of pain. She had a tube down her nose draining her stomach.
"When is the wedding?" I asked.
"Next summer."
I blinked. I blinked again. She didn't — she was looking right at me. At this point, I doubted she'd make it through the hospitalization, let alone eight more months. I didn't know what I could say. I put the stethoscope against her chest and retreated into silence.
I met Stefanie, her daughter, the next morning. She was 24, but was only 8 when her mother's cancer was first diagnosed. Stefanie's mother had Muir-Torre syndrome, a condition that gave her a predilection for malignancies. So Stefanie had shared her home with cancer for many years, and had always seen her mother fight.
But she knew that this time was different. The oncology fellow who had been treating her mother as an outpatient was the one to tell her that her mother was dying. Stefanie broke down, but understood there was no use denying it. The dream of a family wedding under the summer sun turned sour.
Stefanie called her fiancé that morning. Crying, she told him the news. But he flipped the fatalistic script. Without hesitation he told her, "I want her to be there, too," and he proposed not only to have the wedding done sooner, but to have it done right there in the I.C.U.
Our team was used to dealing with all kinds of crises: Handling a last-minute wedding was not one of them. While having more than one opinion on a medical team regarding how best to manage a patient is fairly routine, we received no push back from anyone as we started to make arrangements for the wedding. Soon the whole medical team was involved. We sent a letter to the court to expedite the marriage certificate. A pastor and harp player were booked. The hospital cafeteria baked a chocolate cake, and the nurses brought in flowers. In just a few days, we were ready.
My job was to make sure our patient's pain was controlled while also avoiding the confusion that is a side effect of narcotic medications. But almost miraculously, she didn't need pain medications for hours and was fully aware of everything that was going on. Looking at the bride and groom from her hospital bed, she seemed more comfortable than I had seen her before. The whole day had an unreal feel to it; everything felt like it slowed down. The sun shone through the windows and glistened on the bags of fluid. For once in the hospital, there were tears but no pain. It felt as if, after all these years of chasing our patient down, even the cancer took a break.
The next morning, the family decided to transition to hospice. No intubation, no CPR — nothing that would prolong life. It was all about trying to make the patient comfortable. (And yet, four months later, she is still alive, and doing as well as can be hoped in hospice.)
In today's outcome-driven, efficiency-obsessed medical world, it's easy to forget that healing patients isn't just about treating diseases and relieving symptoms. There are things doctors and nurses can do, meaningful interventions — like helping patients fulfill final goals or spend quality time with their families — that cannot be documented in a discharge summary or be converted into a blip on a screen.
As a physician, I never liked the word "miracle." I preferred to think in terms of "medical outliers." And yet that day of the wedding did feel like a miracle. Physicians often share their patients' sorrow, but rarely their joys. No, we had not discovered the cure to cancer, but we felt that we had achieved something powerful — freeing, if only temporarily, our patient from her disease.
One of the nurses, smiling through her tears, spoke to me after it was all over. "It was magical," she said. "None of the patient alarms went off."
Haider Javed Warraich is a resident in internal medicine at the Beth Israel Deaconess Medical Center and the author of the novel "Auras of the Jinn."
A version of this article appears in print on 03/20/2014, on page A27 of the NewYork edition with the headline: A Wedding in Intensive Care.
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