The shutters come down.

Remember the patient I talked about with possible metastatic breast cancer to the brain?

Well, it might be breast cancer. It might be something else. Uncharacteristically for our facility, pathology is taking a long time with this one--reviewing slides and frozen specimens, sending bits of them out to different labs--in an attempt to figure out just what the hell is going on and how to treat it.

Meanwhile, the patient's lost quite a lot of weight and is still unable to swallow. She had a G tube (a tube that runs through the skin into the stomach) placed the other day for supplemental feedings, but she's been so nauseated that she hasn't been able to tolerate them. Her voice is almost gone--dysphonic and scratchy, so she talks in a whisper. She has pneumonia in one lung, since everything she tries to swallow heads down the wrong tube.

I've seen patients with metastatic brain cancer or even gliomas live for a couple of years after diagnosis, enjoying a fairly good to excellent quality of life. This is not going to be one of those patients.

When the doc found the lump in her breast--two months after a clean breast exam during her annual physical--the first thing the patient said was "it's gone to my brain." At that, the shutters came down.

You can tell when it happens. It's not necessarily that the person turns their head away or refuses to make eye contact or participate in care any longer. Sometimes they seem all right at first, and it's only after talking to them for several minutes or interacting with them through a shift that you notice something's wrong.

It's not depression. It's the decision to die. Or maybe it's the decision that nothing that you or the doctors or they themselves do will make the slightest difference. Either way, their eyes get shuttered. You watch them slog through day after day without hope or interest or the slightest bit of pleasure.

In this case, it's pissing me off royally.

This woman has (of course) a loving partner, a good career, dozens of caring friends, a *good* life. I say "of course" because it's always the people with everything going for 'em that get the worst prognoses.

I'd like to light a fire under her ass and get her to fight. Just a little. I can see that she's tired, that she isn't feeling well...but the total unwillingness to even entertain hope has got me peevish.

Nurses and doctors live on hope. We're the kings and queens of denial, when you come right down to it. All the treatments that we order and perform, all the surgeries, are based on the knowledge that, statistically, this thing has worked to solve that problem, and we hope it will on you, too.

When somebody just plain gives up, we tend to take it as a personal affront. It's a defeat of sorts. We spend our days fighting against death and disease and all that noble b.s., and we assume that the people we're working with and working for have some interest in the outcome. When that person doesn't, it's hard to understand.

Hoping is hard. Slogging through is harder.

For the next two days I'll be thinking about this woman, about her dogs and cats and other family. I'll be wondering if she'll be there when I get back and if she is, what fire I can kindle under her hopeless butt.

Queen of Denial, that's me. Sometimes you win, sometimes you lose...and in this business, we tend to lose badly and take it hard.