THE C-WORD

The fingertips of my right hand have been trained, over the past few years to pick up subtle irregularities in the examination of a patient.

The sensory information gained from these soft pads of palpatory precision, communicate via amazing electro-chemical pathways along my nerves, to send a message of alarm or calm to that central processing unit in my skull.

As doctors, we usually begin our examinations by using these sensitive fingertips of ours to feel pulses.

It's probably the first thing one learns to examine. I remember practicing on my fellow students after our first clinical skills tutorial, and bragging about who had the lowest heart rate and could thus claim supreme athletic fitness.

Such a simple thing, feeling a pulse.

And yet, at it's most basic of functions, it is an ultimate determinate of life, or death.

Lub-dub, lub-dub.

A rhythmical, cyclical affirmation of life, beating a constant reminder into my fingertips that, "Yes doctor, I am alive, don't give up on me yet."

Except that this time, the pulse lied...


She was logged in the book as "???oesophogeal cancer???"

That question mark prefix:

Mostly an indication that the diagnosis is still being worked up.
Often a symbol of hope that our suspicions are unfounded.

I drew the curtains, armed with my cheery and hopeful, yet concerned bedside manner.
The one I've developed over the years to try and lessen the terrors of being in a state hospital and the threat of a disastrous diagnosis.

But I was no match for the enemy that confronted me.

I was physically shocked. My years of service have brought me face to face with the destructive forces of disease and trauma, yet I have never been this physically moved.

There it was.

Present.

I did not need to touch her to know what I instinctively felt.

Cancer.

I could hear it cackling at me, callously thrilled to have so viciously ravaged her body.

So confident in its permanence that it willingly revealed itself, showed its hand, tortured me with its unquestionable impending victory over her life.

She lay there, motionless, except for the slow sad movements of eyes sunk deep into the despairing depths of her skull.

In a defeated and very small voice I introduced myself to her.

She responded after a few seconds with only a painful exhalation.

Touching her made me shiver with horror.

Her skin, like old leather that has been trodden on and left outside to be battered by the rain and sun, was stretched unwillingly over her skeleton. I looked at it listlessly collecting in the hollow that used to be her abdomen, and watched it tiredly continuing on its journey over her chest - her nipples the only hint of the breasts that fed the three children huddled around her bedside.

Her arms and hands were like the branches of a dead tree...thin, dry, reaching hopelessly into space.

I knew then that I had no weapons against such an advanced and evil adversary.

I could feel her spine when palpating her abdomen.

I was sickened.

And before feeling it, I saw her abdominal aorta pulsating, valiantly carrying on the physiological fight, regardless of the inevitable surrender.

Why did this lady only present to us at such a late stage?

Because she is poor? Because she doesn't speak English?

Why did the initial slow deterioration of her life not warrant ear-splitting sirens summoning sympathy and support and treatment?!

But it was too late for all of that. The cancer had metastasised.

Any further medical intervention would have been cruel and inhumane, and would only prolonged her torturous demise into death.

I gently informed the family of the very poor prognosis, and let them know that she would most definitely stay in hospital for the night while we tried to find a placement home for terminal care.

When her husband left, he bent over the skeleton that used to be his wife and kissed her forehead. He then turned to me and placed an old washrag and a bar of soap in my hands.
"This is her washrag." he said. "I'm the one who washes her every day with this washrag. Can I leave it here? Will someone wash her while I am away?"

Choking back the tears all I could manage was a nod of the head.

I handed over the washrag to the nursing staff, and finished my shift, dejected.
By the time I arrived the next day, she was gone.

But what remained with me is cancer's destructive power and our frightening inability to conquer this terrifying disease.