I FINALLY CRIED.

  1. A little less than a year ago, a young Soldier in his early 30s was admitted to my team at the hospital for sudden onset intractable vomiting.
  2. His CT scan in the ER showed a mass at the head of his pancreas.
  3. I sat down with him to painstakingly explain to him and his wife that this was ominous and most likely cancer.
    I was holding back tears the entire time because pancreatic cancer has such a poor prognosis and I knew this was the most likely cause.
  4. After biopsies the next day, the pathologist called with bad news.
    My patient was holding his 6 month old son when I had to confirm to him and his family that he had pancreatic cancer. Why is it always the nice guys?
  5. His eyes welled up with tears, but with strength he said to me, "Okay, doc. What do we do next?"
    That's just the kind of guy he was.
  6. We held hands and cried together.
  7. I felt helpless.
    And selfish for feeling that way when I couldn't begin to imagine how he and his wife, who was my age, felt.
  8. So often, our goal is to try to cure.
    In this case, I knew this would likely not be the case.
  9. We did a series of detailed scans to make sure the cancer hadn't spread anywhere, since this would make him a candidate for surgical removal.
    This was his best chance of survival, or at least his best chance at surviving more than a year with his wife and son.
  10. His initial CT scan was clear of any other tumors.
    But then the PET CT showed a mass in his liver. Our surgeons told us this prevented him from qualifying as a surgical candidate because his cancer was considered too advanced.
  11. We tried reaching out to multiple major cancer centers to see if any experimental treatments or surgeries were available.
    For a moment, there was a glimmer of hope. One of the centers said if his liver mass disappeared with chemo, they would consider operating on him.
  12. He said the news fueled his desire to continue fighting. This was good because he couldn't eat at all with the tumor blocking his digestive tract.
    We joked about how mean of a trick the Gods were playing on him, since before joining the Army, he was trained as a classical chef. We talked about food while the IV nutrition pumped into him overnight, every night for weeks. We both lied and convinced each other he would stop feeling hungry at some point, even though he kept losing weight.
  13. After his initial chemotherapy, the liver mass was gone and the pancreatic tumor shrunk significantly.
    We were all hopeful and elated at the possibility of a surgery. Bonus: it shrunk enough to allow food to pass through his intestines, so he could eat again.
  14. But none of us were prepared for what happened next. Unfortunately the cancer center backed out of performing the surgery.
    This was the worst day for everyone involved. My patient, who had been very strong until this point, broke down and cried on my shoulder. He said, "I just want this thing out of me." We had many tough conversations that week, the hardest of which was shifting gears from trying to cure him to making him as comfortable as possible so he could spend time with his wife and son. This was the hardest conversation I've ever had to have with a patient, especially since we bonded over the last few mos.
  15. We were all crushed. Even his oncologist (a former Army Special Forces Operator, former Army Ranger and generally stoic guy), who dealt with this kind of news all the time, broke down and cried.
    My patient's amazing wife remained a pillar of strength through the whole process. I have never met anyone else with so much poise in the face of such great adversity. I have so much respect for her & am in awe of how graceful she has been through this entire process.
  16. Despite the lingering sadness and dread, there were happy times, too.
    I remember months earlier during a particularly dark time that my patient confided in me that he needed to make it at least until his son's first birthday. Well, he made it; a few of months ago, his son turned one. They saw me in clinic for the well baby visit. We did normal stuff like vaccines and gush over him walking and saying "dada." He had a little stranger anxiety with me and kept running back towards his daddy.
  17. Then, the communication became more sparse for a little while, usually a sign that families are spending every second of every minute together because things are getting worse.
  18. Over the last two months, my patient was in and out of the hospital with complications until he decided it was time to pursue hospice care at home.
  19. This last Thursday evening, I was informed that he passed at home, comfortably, surrounded by his family.
  20. I felt numb. And then I quickly pushed all my other emotions aside and told myself I was glad that he was no longer suffering.
    Because it was true and because that's how we all tell ourselves we are supposed to feel.
  21. Today, I received an invitation to his memorial service.
  22. And I finally opened up my heart and just cried.
  23. I cried for the loss of a brave man who gave up his comfortable life to put on boots and a uniform and deploy to support his nation in war.
  24. I cried for the loss of a loving husband, who tried his hardest to look past his own needs and support his wife during the worst thing they'd ever experienced.
  25. I cried for the loss of a doting father, who wouldn't get a chance to see his son graduate college, get married, or start his own family.
  26. I cried for his wife, who lost her best friend and all of her dreams for their future together.
  27. I cried for his son, who will know his father through photos, videos and stories that only scratch the surface of his being.
  28. And I cried for all those who poured their hearts and souls into caring for this young man and his family, because I understand the defeat they feel at not being able to save him.
  29. Be thou at peace, Sergeant.