“I want to see Christmas, doctor. Please!” begged Joy, a patient of mine with refractory leukemia. Translated for those without cancer, Joy meant she wanted to live until Christmas yet stay out of the hospital. I did not know if I could do it.
Chemotherapy options for Joy had been long exhausted. All that remained were almost daily transfusions to keep Joy from bleeding. An infection would be life-theatening – Joy was already running a low-grade temperature with a cough, despite taking two oral antibiotics.
Christmas week is the busiest week of the year for the cancer specialist. All patients in the hospital with advanced cancer want to be discharged so they can spend their last Christmas with their families. Usually we can get most patients home. I transfused Joy on Christmas Eve morning and discharged her from the hospital at noon.
It was not the shopping Joy hated to miss this Christmas. For two years, she was unable to walk the endless hallways of the mall without becoming breathless and was unable to tolerate the cold temperatures walking outside around the Old Port. It was not the decorating for Christmas that Joy hated to miss. Last year, she could only muster a small artificial tree in her living room and a creche on her dining room table. It was not the cooking Joy would miss. Fortunately, her daughter invited everyone in the family over for Christmas dinner. Joy knew she could not cook anymore, though she still managed to make the stuffing passed down from her mother that no one in the family said they could do without.
What Joy did not want to miss was being in church one more time with her family to hear the Christmas story. She sighed, “I don’t have any promise or hope for my life anymore, so I want to be comforted by what the Nativity means.”
Joy said she wanted to listen to the promise given by the angel Gabriel to Mary that she would give birth to Jesus though she was a virgin: “The Holy Spirit will come upon you, and the power of the Most High will over-shadow you. So the holy one to be born will be called the Son of God” (Luke 1:35).
Furthermore, Joy wanted to hear the hope engendered by Jesus’ life, death and resurrection: “For God so loved the world he gave his one and only Son, that whoever believes in him shall not perish but have eternal life” (John 3:16).
Though the week of Christmas is the busiest of the year for a cancer specialist, the week after Christmas is the saddest. All cancer patients want to see Christmas. Patients discharged the day before Christmas are often admitted the day after Christmas sicker than before. Others who have not dared to call before Christmas fearing I would put them in the hospital are usually admitted in even worse condition. The mortality rate the week after Christmas always appears to be the highest of the year.
I saw Joy in the emergency room the day after Christmas. She had a high temperature and was short of breath. “I’m not going to make it until New Year’s, am I?” she asked.
It was a question to which no one wants to hear an answer. I said nothing. As I was preparing to send Joy up to the cancer floor with orders for oxygen, fluids, antibiotics and transfusions, Joy sensed I was distressed about her medical condition. She said, “Don’t beat yourself up, doc. It was worth it, worth seeing Christmas. It was the best Christmas for me ever!”
Confused, I shook my head. Joy continued, “Usually Christmas goes by so quickly I don’t have time to appreciate what Christmas is really all about. But this year I was unable to do anything associated with Christmas that usually consumes my attention and energy. All I could do was listen to the message of Christmas. That made it the best Christmas for me ever, especially in my condition, and will keep me going no matter what happens.”
As the side-rails of Joy’s stretcher were pulled up and she was pushed into the hallway, she turned to me once more and said, “Will I be seeing you on the floor tomorrow?”
Joy knew the answer from my expression. However, she could smile and call out to me as she was rolled to the elevator: “It’s OK. I really mean it.” She had been comforted.
Dr. Delvyn C. Case Jr. is a hematologist/oncologist and consultant to the Department of Spiritual Care at Maine Medical Center in Portland.