Friday, February 4, 2011

Sister, Sister

Good day, everyone. Briefly, it is that time of year when the prestigious Medgadget Medical Blog Awards are upon us, and I have humbly been chosen as a finalist in the Best Literary Medical Weblog category for 2010. If you enjoy my blog and posts, especially from 2010, I would greatly appreciate your support for this award. Simply click on the highlight above and go vote for StorytellERdoc! As always, thanks for reading and especially for your support! Now, on to the post...

I rolled open the sliding glass door of Room 33, pushing aside the privacy curtain as I entered into the treatment room to see my next patient. By the nurse's triage note, she was a woman in her mid-thirties who presented to our emergency department with a history of leukemia and a recent complaint of bruising.

Running through my mental checklist prior to entering, I was hopeful that this patient was actively undergoing chemotherapy, which would be the best explanation for her bruising (low platelets as a result of her medications). If she was in remission and not actively receiving chemotherapy, however, the bruising could signify, among other things, a return of her leukemia. The bruising might just be letting us know that her bone marrow was ill and not able to produce healthy, viable cells.

Sigh. I thought back to Christmas Day a few years back when my mother, in remission from her leukemia, nicked her fingertip while cutting a dinner roll at the kitchen sink. A little nick of bleeding that we struggled to control. "It's back, Jim," Mom had said, knowing the truth, sadness creeping into her eyes as she watched me dress her cut. I, playing the dutiful son, reassured her that all would be okay when, in truth, it turned out not to be.

Stepping into this patient's room, then, I was prepared for the worst but hoping for the best.

Two women greeted me as I walked into the room--the patient, sitting upright on her cot, wearing a flimsy hospital gown and loose-fitting pajama bottoms, and a woman of similar age sitting beside the cot in a hospital chair. They were obvious sisters, resembling each other quite strongly. Especially when they smiled their warm smiles.

"Hello," I said, walking up to the patient and taking her hand in my gloved ones as I absorbed her appearance, "I'm Dr. Jim. A pleasure to meet you, maam." She was fatigued-appearing, trying to smile the listlessness from her face. Despite her attempts, she looked so very tired. Her eyes were hazel and apprehensive, closely watching me study her. Her skin was smooth, maybe a touch pale, and her cheekbones gaunt. Her lips were slightly dry. The hospital gown loosely hung from her shoulders.

I turned to her sister, introducing myself to her as well. As it turns out, she was the older of the two. She, like her ill sister, had hazel eyes that, perhaps, sparkled a bit more, reflecting her bigger reservoir of energy. Her skin was creamy rather than pale. Where her sister was gaunt, this woman's face was healthy, lacking her sick sister's bony jawline and cheekbones. Her smile, the obvious family trait, was as genuine as her sister's. Looking at her sister, it was easy to imagine what the patient might look like on a typically healthy day.

For all the similarities, though, there existed two glaring differences between these siblings. Whereas the healthy sister had beautiful, coarse chestnut hair, the patient wore a black and yellow bandanna to her eyebrows, obviously covering her hair loss. The other thing? The patient's arms and upper chest were covered by varying stages of bruises--older, yellowish-brown ones to younger angry, purplish ones. The ravages of battling a malignancy.

"Maam," I said to Lisa, the patient, "are you actively on chemotherapy for your leukemia or are you currently in remission?" I held my breath in anticipation of her answer.

Lisa hesitated before answering. "I guess both, Doctor Jim," she said. "I am currently in remission but still take maintenance chemotherapy." In many cancer therapies, there is both an "induction" phase and "consolidation" phase of chemotherapy. Induction therapy is the aggressive initial round(s) of chemotherapy, whereas consolidation (think of maintenance) typically is started after the cancer has been halted or significantly "beaten back" by the induction round.

"Do you know which chemotherapy regiment you are on, Lisa?" I asked, relieved and happy with both of her answers to my questions. Her bruising, I suspected, was most likely due to low platelets from her medicines.

She nodded her head no. "I can never remember the long names of them."

"Let me try," I said, "are you on ara-C and idarubicin?"

Lisa and her sister both looked at me with surprise. "Yes," Lisa said, "those are it. How did you know?" I briefly explained that I had some familiarity with leukemia and the agents used to fight it.

After interviewing Lisa as her sister sat bedside, holding her hand and contributing to Lisa's history, I learned that she had done beautifully with her induction phase of chemotherapy and had quickly entered remission after a few months. Thus far, she had only received one round of maintenance chemotherapy, the week prior.

The amazing thing? Lisa didn't even live in our hometown. She grew up here but was currently living in the South, having returned, with her doctor's permission, to visit her family for an extended weekend. She had no family to help her battle her leukemia in Tennessee and her coming home was the first time she got to see her immediate family since she was diagnosed. "That's alright, though," she said, "I know everybody's prayers are with me."

The supportive sister, sitting beside the bed stroking her ill sister's hand, suddenly burst into sobs. Gasping for air, she tried to talk. ", Leeessaaa, but...couldn't..."
What a pivotal moment. Obviously, the healthy sister carried a lot of guilt and pain around for not being physically closer to help her ill sister through her torments. Whether it be kids, a job, or other responsibilities, though, I can only imagine the heaviness the healthy sister endured with each mile she was separated from her sister.

Lisa reached over to her sister and rubbed her hand through her sister's thick hair. "Oh, sister, sister," Lisa said quietly, reflectively, "I know you want to be with me. Trust me, I do. But I'm okay--really, I am. Between my friends, I am well-taken care of."

"But," the healthy sister continued, her face now looking as listless as her sister's, "I want to be there, by your side. It's not fair."

"It never is," Lisa said, "but your daily phone calls and cards and endless prayers have been felt. I promise." Lisa lifted her sister's chin up so that she could gaze into her sister's eyes and slowly, before me, her sister's face gained back its strength and tranquility.

I walked out of the room, aware of the impact of what I had just witnessed. For all the tragic and heartbreaking illnesses that occur in the world, how many of the sufferers endure an unavoidable physical separation from their loved ones and must go at fighting their illness on their own? And can you imagine being a son, a daughter, a brother, a sister, a parent, or a best friend that has to sit on the sidelines, miles away, from someone you love who is suffering with a serious illness? It was obvious these two sisters would have preferred nothing less than to be geographically closer to one another to rely and lean on each other during Lisa's travails.

The magnified pain from both Lisa and her sister, as a result of their physical separation, was a reminder to me of how lucky my family was to be able to "circle the wagons" when one of us got ill. If only everybody could be so fortunate.

I wish that for you and your family if ever the time would come.

Lisa's platelets were low, just as we thought, and she was admitted overnight for several platelet transfusions. I promised her she would be discharged in the morning. She promised me she was going to talk to her sister, reassure her all was okay, and gingerly approach her about being her possible stem cell donor. "Lisa," I said, "that would be wonderful! You know your sister loves you and would be a donor in a heartbeat if your bone marrow matches. I'll keep you both in my thoughts."

And I do...especially for the lesson they taught me that day. Thank you, sister, sister.

As always, big thanks for reading...see you early next week. Jim


Katie Axelson said...

Is it still fair to vote (on every computer in the lab) if I haven't read the other finalists? Just kidding... I have nothing against biased voting.

It's one of those weeks when being away from the Homeland is hard. The obvious snow I wish I were able to enjoy and my dad is officially retired (or unemployed... pick your term of choice). I keep teasing my family because they haven't been down since August when I moved in. I've missed major life-events being away (Christina's Confirmation, two middle of the night ER visits, funerals, weddings, and holidays) being away. It's hard. But the faith of those here in Baptist Country help make it easier.

Happy Friday!
<>< Katie

coulrophobic agnostic said...

I hope things worked out okay for Lisa in the end.

Empress Bee (of the high sea) said...

looks like you are winning doc! good luck!

i am so glad her platelets were the cause of the bruising. my poor hubby, sarge, is bruised all over, bless his heart. he barely has to touch something to bruise. but he is in good spirits and we are going on a cruise the end of the month. the oncologist said to go!

smiles, bee

Anonymous said...

I voted for you! I love your blog and I've been reading it for a couple of weeks now. Keep up the great work writing and taking care of others! Hugs

Laura said...

tears...this is so beautiful. I have MS and live with my husband and kids in NH, while my family mostly lives in PA...and anytime something goes wrong for any of us we want to be physically present to help, but just can't be. It is hard, but like your patient Lisa said...the phone calls and emails and prayers are felt. My Mom had a fall recently, I can't go be with her, my brother in law has been quite ill with pancreatitis, I can't go down and help out with the kids...but we all stay in touch and travel to help one another when we can. Love is amazingly healing!

I haven't been by to read your blog in quite some time I'm so glad I saw a comment on Christine's blog that led me here:)

ps. I voted!

Karen said...

Another great post. It is so nice to have family close by, especially when there is an illness. The support means so much.

Holly said...


that's you.

myonlyphoto said...

Jim, another eye-filling-with-tears story. Thanks for sharing. Anna :)

Lyda said...

This story touched home in many ways. I could see myself and my youngest sister in that situation.....

She had leukemia (ANLL) and had been in remission, but it was a scratch from a birdcage at Christmas which signaled the return. Unfortunately, further efforts to get this monster reigned in failed. My wonderful, lovely sister passed away at the tender age of 26 the following May. Her daughter, who was 8 at the time, is now grown with children of her own. I remember the many times I sat in the ER with my sis much as your patient did with her sister. I moved in with my sister for 4 months, putting my job on hold and leaving my husband and young daughter in our home.

As I look back 20 years later, it was a very difficult time, but one that I would not trade for the world. Thank you so much for sharing this story. It brought tears to my eyes and struck chords deep within, both painful and healing.

Lynda Halliger Otvos (Lynda M O) said...

My younger sister died quite unexpectedly at 49 in Moscow Russia, two and half years ago. There’s a hole in my chest where my heart was that I somehow think is not going to heal. Every day is a struggle to just do the regular stuff without succumbing to the urge to melt into tears a dozen times in as many hours. Treasure your sisters--every day in every way.

Unknown said...

What a beautiful story.. You tell them so well.. Always manage to get a little emotion out of me haha. Thank you so much for sharing your experiences.