I suspect many of us have “special” patients.  People with whom we have a unique “connection” or bond.  Perhaps it was due to sharing a happy moment in their lives...or delivering grave news.  Maybe it was the smile or hug they offered you when you had a difficult day.  Some of these people touch our lives for a brief time, while others develop a longer relationship with us.  All of these moments are special.

So it is with this in mind that I am dreading tomorrow.  I will be saying “good-bye” to a very special lady.  Some of you may remember my blogs months ago about “J,” my patient who, during a visit for a URI, made a last-minute comment about leg paresthesias—and the work-up ultimately led to her diagnosis of metastatic lung cancer.  She was the first woman I diagnosed with cancer in my Internal Medicine practice, and I have been privileged to know her and her husband for two years now.

She stopped her palliative chemotherapy two months ago, after more MRIs and tests showed progression of the cancer.  After some rehabilitation, she went into “respite care” at a local assisted living facility, as she was too weak to be cared for at home.  Her husband kept us aware of her status...and then one day, he left me a message.  He wanted to discuss her future care...and he had “some questions.”

I met with him for about one hour...and what I realized was that he was overwhelmed.  “J” had been the decision-maker...he had spent 20 months coordinating her chemotherapy...and now he didn’t know what to make of this next stage.  In August, we had talked at length about her end-of-life wishes, and I knew that she was amenable to hospice care after the chemotherapy was finished.  However, her husband could not make that final decision...that final step.  He was mired down with information from too many sources.

“What should I do?” he asked me.

I looked at him and realized that “J” had been right, months ago.  “He’ll need direction and to be told what to do,” she had said to me.  He was looking for someone to make the ultimate decision...to enlist hospice care.

I told him that, as we had all discussed in August, it was time to call in hospice for “J.” They would coordinate her care, handle her medications, be a resource to answer all of his questions, and most importantly, support “J” and her husband in the final stages of her life.

He looked relieved...and then told me that “J” had wanted to come to our meeting.  However, she was too weak to walk, and there was no time to arrange for transportation on short notice.  I told him that I would make the trip to her assisted living facility.

I had planned to go last week, but a severe case of bronchitis held me back.  This past week, I got a call from her hospice nurse.  She had taken a turn for the worse, and in her estimation, “J” will probably not last much past the New Year.  So it is now a priority for me to go.

I am doing this for “J” and her husband, but I also know that I’m doing it for myself.  I, too, need some closure.  Tomorrow will be very difficult, as I know it will probably be my last time to see her.  She has touched me with her grace and dignity.  And...I need to thank her for being one of those “special” patients.

Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA.  Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings.  She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs.  She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health.  She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.

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