Abstract
A moving story about the nature of the doctor‐patient relationship, this narrative describes a letter of gratitude from a breast cancer patient, written shortly before her death.
Roberta's photograph stared at me from the local newspaper. The news of a young mother who died of metastatic breast cancer (the article spoke of a “long disease”) had shaken the small community of F. The funeral was an emotional event during which many chose to make a donation for cancer research, and the entire village seemed anxious to show its affection to her husband and two young children.
Four days before, I had received a phone call from Roberta's husband, who wanted to let me know that her condition was rapidly deteriorating. He said that she wanted to stop her home‐based treatment and preferred that she be admitted to the local hospital. Indeed, shortly thereafter she was brought to the closest hospital, where she died a few hours later.
Roberta was 35 years old when she first came to our clinic for her first breast cancer treatment. Two years later her breast cancer had metastasized to the bones and liver while she was undergoing adjuvant hormone therapy. She was an extremely gentle and polite person, always premising her gestures with “please” and “thank you.” Her husband, Roberto, had the same gentle nature, almost as if their psychological affinity was symbolized by the fact of sharing the same name.
Aware of the unfavorable prognosis of her disease, Roberta never said more than a few words during our conversations, and as we spoke of the worsening of her own clinical situation, she would only ask if there was still any possibility to control the disease. At the time of our last encounter, she had been off of treatment for about a month. She didn't ask me any questions at that time. I proposed a paracentesis to alleviate large ascites, and she replied “okay,” in tears.
About 2 weeks after her death, her husband called me to ask for a meeting, which we set for the afternoon of the following day. I was expecting a painful conversation, filled with questions, such as “Are you sure that we have done everything possible? Why didn't we try this new drug?” However, when I walked in the waiting room I saw that he was with their two children (10 and 7 years old), who politely stood up and shook my hand.
He introduced me to his kids as “the doctor who cared for mum,” and their shy but confident smiles warmed my heart. But the surprises were not finished. He handed me a letter that the family had found in Roberta's wallet 2 days after her death. The sealed envelope simply read: “To Dr. Giorgi.” Her husband said, “I did not know anything about this letter, so I did not open it. If you think it's appropriate, then you can read it to me.”
At this point I was really confused. In front of me there was Roberta's husband, with their kids, giving me a closed envelope containing a letter written just a few days before dying. What should I do? Open it later, read it calmly, and then discuss it with her husband? Read it out loud in front of the family? I opted for a compromise solution; I would read it silently and then decide on the basis of the content what to reveal to them.
The letter read like this:
Good morning doctor. If you read this letter it means that I am not there anymore. Forgive me for my friendly tone, but I am doing it to show my gratitude to the guardian angel who took good care of me over these past few years. What can you do with this whole thing…it went like this, so fast. I began to fully understand what was going this past September, when the last therapy had no effect, except to make me lose my hair (and hope with it).
But I do not blame anyone: not God, not the doctors and not my husband, who convinced me to do the last chemotherapy cycle and who gave up everything to be with me on this difficult journey. Dear and sweet doctor, I will always carry you in my heart, for all the energy and passion you showed while trying to defeat this bad disease. For all the times you answered our messages even while on holidays, for all the times you rejoiced with us when there were some encouraging news, for all the times you relieved my pain. In heaven I'll take care of you and all your colleagues in the clinic that became for me like a second family. I do not know what else to write, I start to get tired. Will I get to live my next birthday? My husband says that I will celebrate this one, and the next and the next again. What a fantastic man! He was never good at telling lies. Doctor, thank you, thank you very much. I will always love you.
I hardly managed to hold back the tears. Roberta, knowing that she was going to die soon, had found the time and the strength to write to thank me. This realization made me feel guilty and inadequate; I did not understand what an extraordinary person I had been interacting with and did not know what words to use now with her family. I read most of the letter to her husband and children, and then I decided to make a copy that I gave to Roberto. The meeting had become very emotional, even for the children, who had listened in silence. We said goodbye and promised to keep in touch.
That evening, at home, I told my husband about this episode. In cases like this, both of us being oncologists provides a special kind of support in sharing the emotional load and living through the saddest moments of our job. While I was telling my husband about the meeting with Roberta's family and the letter, I realized how privileged I was to have been her doctor. In a way, I learned more about my work and the relationship with my patients by reading those lines than in many training sessions on the doctor‐patient relationship.
Although Roberta called me her “guardian angel,” it is her letter that provides me with both comfort and a stimulus, especially during the most complex and challenging aspects of our everyday work as clinical oncologists.
Two days later, her husband sent me a message thanking me again for everything and said that he will read the letter to his children so that they can understand how great the relationship between their mother and her doctor was. Sometimes, when talking about my work with people of different backgrounds, I hear the phrase “you must be used to the death of your patients. At the end of the day, for a doctor all patients must be the same.” It is really difficult to explain that, in fact, each patient is a new chapter in a book that is written together, day after day, page after page. Some chapters are short and bitter; others are difficult to write or full of empty spaces. But sometimes there is a chapter that makes you a better person.
As Anatole Broyard said [1], “In learning to talk to his patients, the doctor may talk himself into loving his work. He has little to lose and everything to gain by letting the sick man into his heart. If he does, they can share, as few others can, the wonder, terror, and exaltation of being on the edge of being, between the natural and the supernatural.”
Disclosures
The authors indicated no financial relationships.
Reference
- 1.Broyard A. Intoxicated by My Illness. New York, NY: Fawcett, 1993:57. [Google Scholar]