1. Jain, Nitin MD

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I had finished seeing patients for the day, and had just reached my office late in the afternoon. It had been a long, grueling month attending on the inpatient ward, and as I finally sat down at my desk, one email caught my attention.

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Mr. CS, a quiet, caring robust gentleman, now in his mid-70s, who was my long-standing patient of over 3 years with acute myeloid leukemia, had just decided to transition to hospice care. He had been in the hospital, battling leukemia and multiple infections for over 6 weeks. This was not an unexpected outcome. I had talked to the patient and his wife previously about hospice as his leukemia was not responding to treatment. He was a fighter and wanted to get on with the next round of treatment. And that's what we did.


However, he landed in the hospital with yet another infection. His condition deteriorated over time, and he was now bedridden. His leukemia was worsening, and everyone, including Mr. CS himself, could see the writing on the wall. This was a losing battle. There were daily ups and downs. One day-the leukemia numbers were better, next day worse, next day stable. But we all knew this was not going to go well. The end was near. I have seen it many times before.


I quickly replied to the email that I will see the patient right away. When I reached the patient's room, the hospice team was talking to the family, and in the next hour or so, he was to be transitioned to the hospice care. I waited for the hospice team to leave the room. As soon as I entered the room, the patient's wife started crying. She asked the patient to guess who was there. He looked at me. I was wearing a mask; so I tried to say my name. Before I could do that, the patient said "I know who is here."


Mr. CS's wife kept crying. I thought she was crying as the hospice team had just left their room. But no. She was crying upon seeing me. She mentioned that they missed me. They missed me for the last 2 weeks that I couldn't visit them in the hospital. Though they didn't say it, I could hear what they didn't say. Why didn't you come to see us more often? Did you forget us? Did you forget us because you knew the end was near?


I went on with a brief speech about how leukemia is winning the battle but the patient fought it hard; how we all, including other members of the clinic team, enjoyed taking care of him. His wife expressed gratitude to me and for the clinic team as well. Mr. CS, a man of few words, kept quiet. His wife asked me how much time would we expect Mr. CS to be in hospice. She said she was told it could be days to weeks. I said that no one could say how much but those numbers were reasonable. As I said my final parting words, and was about to step away one final time; the patient, who had been quiet during most of the conversation today, said "Please come to visit me."


NITIN JAIN, MD, is in the Department of Leukemia at The University of Texas MD Anderson Cancer Center, Houston.

Nitin Jain, MD. Niti... - Click to enlarge in new windowNitin Jain, MD. Nitin Jain, MD