Mrs. B: The Second Patient

The second patient in any disease is the caregiver.

Mr. B

Mr. B was a major executive in one of our town’s key industries and exuded confidence and gravitas when I first met him in the clinic with his wife. He was inquisitive and questioning about his therapeutic options, and asked incisive questions including other centers where he might be treated that I would recommend. He did note he’d prefer to stay in town, of course, since he’d prefer to be home and not interrupt work. I asked what his surgeon had told him about his disease, and what his expectations were.

“He said that I had bad cancer and that I’d need a lot of treatment,” I asked if the surgeon had talked to him about the prognosis. “Not really. He just said it’s a bad cancer. But I know it must be very bad if I need treatment as severe as radiation and chemotherapy treatments”.

After pausing, I noted that neither the radiation oncologist nor I, would be able to cure his disease — a malignant brain tumor. We might be able to stem the tide, but it would in all likelihood come back. And then we would be faced with less certain therapies.

Without any hesitation, he said, “Well, then we’d better get started!” It was an amazing response, said with pragmatic confidence.

That’s when Mrs. B noted, “If anyone can beat this, he can. I’ve seen him do some amazing things.” To which Mr. B just nodded.

Interlocutor

Regretfully, Mr. B did not do particularly well with radiation therapy. Radiation has different degrees of effect on people — some tolerate it with just mild fatigue; others exhibit tremendous fatigue with at times depression; others get significant fatigue and irritability. Mr. B had the last. His mood swings were severe, and he was one day angry at everyone and other days depressed and silent. During each daily visit to the radiation suite, his wife would be by his side, supportive of his moods, warning the technicians of what to expect, and trying to assuage the situation in any way she could.

Mrs. B confided in my nurse, “Sometimes he just wants to give up, and then sometimes he blames the entire world. But it’s really mostly to me — he’s used to tempering things with the outside world.”

If this was tempering, noted my nurse, she’s really taking the beating at home.

Endurance

When Mr. B started on chemotherapy his moods seemed to stabilize. With each course, his stern countenance and gravitas returned. But it was clear that his wife was wearing down; she began to look haggard, and clinically her fatigue was palpable.

She spoke to my nurse often, always without either Mr. B or myself present.

“Everything that he thinks or feels is different, he worries about; he’ll wake me up 3, 4 times a night to ask if he looks different, or because he’s thought about something that’s happening. I haven’t had a good night’s sleep in weeks.”

Two jobs

After Mr. B’s second round of chemotherapy, his cancer came back, heralded by a seizure with weakness in his right arm. We changed his treatment regimen and sent the patient to physical therapy to try to maximize his right arm function as best we could. Understandably Mr. B was extremely frustrated, and he stopped going to the office — his wife related that he was too embarrassed to be seen as weak.

Mr. B’s wife would go back and forth as messenger and communicator during her lunch break and after her job, noting that, “I have to keep him sane.”

I asked my nurse if we needed to have social workers involved in the situation. She replied that of course that would help, so of course, both of them would refuse. Sighing, I left it at that.

Fortitude

Mr. B’s tumor recurred again after the next round of chemotherapy, and as I walked into the room to discuss the results of the MRI, I noted that Mrs. B was in very bad shape. She was disheveled, with dark circles under her eyes; her hair was barely combed, and she was wearing very casual clothes — the first time I had seen her in jeans, not the dresses or skirt that was her usual. Mr. B now appeared a shadow of his former self — dressed in loose-fitting grey sweats, unshaven, no longer the confident executive I had seen 11 months earlier; his right arm weakness now also involved his left leg, and he needed a cane to walk.

“What’s next, Doctor?” asked Mr. B after explaining to him the results of the last scan. I could see his wife was fighting back tears — but I wasn’t sure whether this was from the discussion, or the obvious strain and fatigue she was enduring.

I told him that there were several clinical trials that were available, both locally and on a national basis, and these would be the ones I would recommend.

“Let’s do the local one,” said Mr. B. “It’s too hard to travel anymore,” and he glanced at his wife with a degree of affection, that I haven’t ever forgotten. I thought I saw a teardrop from Mrs. B, but then she turned away.

Forgiving

Mr. B didn’t make it to the next clinic appointment to set up his clinical trial therapy. He died later that week at home, with his wife by his side. She had weathered the storm with him, being the constant companion on a difficult ride, which had now concluded. The last I heard from my nurse, was that she had had some guilt at the end — she was happy that the journey from hell, called cancer, was over, but was overwhelming sad that a pillar of existence — her husband, was now gone.

And yet, without her, Mr. B would never have been able to weather the storm himself. Her unwavering strength had carried him along.

It is, unfortunately, not an uncommon scenario. I have always been grateful my nurse and Mrs. B had such a great rapport.

In all the diseases we as a health care team encounter, it is the second patient we must always remember needs care as well.