On a sunny day in Philadelphia, a doctor tries to help a woman who wants more than medicine

In the corner of the room sits a tiny woman in an oversize blue hospital gown. Her short gray hair is flecked with subtle hints of the blonde she used to be. Large-rimmed glasses intensify her wrinkles and hone in on her blue-eyed stare. Sun spots scatter over fair skin, evidence of summers at the beach, I imagine.

I fixate on one such spot on the surface of her left hand, perfectly outlining a small, gold wedding band. Her back is to a window framing the beautiful summer day that neither of us will have the opportunity to enjoy.

“Good morning, I’m Dr. Silver. I’m new to the oncology service, and I will be taking care of you.”

“Oh, how nice,” she replies. “I hope you can cure me.”

No pressure, I think to myself.

The past year has been one hospitalization after the next, each an infection worse than the last. There are no treatments left to try for her cancer. All we can do is temporarily hold back the infection that eventually will be her last.

How, I think, can I explain this to a woman who just asked for a cure?

Just then, her son enters with a list of questions that I can answer. How bad is this infection? Who is on her care team?

And one I can’t: When can she go home?

With each question I look at my patient — but she stares ahead, silently. So I ask her a question of my own: “Are you understanding what your son is asking?”

“Sure,” she replies, “but I leave the decisions up to him.”

Each morning I walk into her room and her son is there, waiting with a new list, culled from what must be hours of research. I try to stay focused on his questions, rather than letting my mind wander to the seven other patients waiting to see me.

A week passes and, as expected, my patient is no better. We have no idea when or even if this infection will clear. We’ve had no success with discussing the big picture – how her life might end – with the son who finds refuge in details. And who can blame him. They haven’t seen terminal cancer the way I have, in the volume I have. And I’ll bet there are many great stories behind those sun spots.

At dawn, at the end of an 80-hour workweek, I am walking across Philadelphia’s South Street Bridge on my way to the hospital. Emotions on empty, and so worn down. I laugh as I remember it’s Saturday. I imagine all the picnics and beach trips and celebrations people are planning. I imagine how much my patient might enjoy a day like this.

This morning both the oncology and infectious-disease attending physicians are talking with her son, trying to communicate just how sick she is. Meanwhile, my patient is sitting in the same chair she has been in all week — back to the window, staring ahead.

I walk over, say hello, and perform my daily exam. While I listen to her lungs, I keep tabs on the conversation on the other side of the room. She snaps my attention back to where it should be.

“Do I have crackles?” she asks.

“What?” I’m caught off guard by her question.

“Do I have crackles?” She softly repeats. “Once a doctor told me that he listens for crackles to see how my pneumonia is doing. The other day I had crackles. Can you hear them?”

“Actually, I don’t hear a lot of crackles today,” I reply, which was true.

Her eyes come to life, amplified by those large-rimmed frames. I see her smile for the first time all week. “Thank you,” she replies. “I prayed last night. It must have helped.”

For the first time all week I feel I have actually done something to reach her. So I keep going.

“What is it that you want out of all of this?” I ask gently.

She looks at me, silent for a moment. Then the smile slowly comes back. “You know, I really want a good day at the beach.”

And all I could think about was getting her one more well-earned sun spot.

Michelle H. Silver is an internal medicine resident in the Perelman School of Medicine at the University of Pennsylvania. The opinions expressed in this article do not represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.