This is the third and last story I am going to tell you about cancer patients. The diagnosis takes place in a doctor's office. The walls are painted in a comforting beige. Dolores, a patient in her late sixties, is sitting on the left. The doctor, wearing a white coat, a stethoscope hanging around his neck, is sitting on the right.
The doctor and his patient, Dolores, are leaning toward each other, engaged in conversation. He is doing most of the talking. She listens. And she asks a few questions. Imagine the expression on Dolores' face: her forehead is tense, and her eyes are focused on the doctor as she is carefully listening to what the doctor is saying. He is talking in a soft voice, but he brings upon her terrible news. It is a new diagnosis - she has bladder cancer.
The treatment - Bladder cancer tends to recur. The doctor may remove a tumor but then, several months later, the tumor can come back, at the same place, or in a different location along the urinary system. For each treatment, Dolores is put to sleep, the doctor looks through a cystoscope into her bladder and removes the new tumors. And Dolores is pronounced free of cancer, until a new tumor arises, and so on, and so on.
Shahar Madjar, M.D.
A portrait of Dolores - Her hair is dyed and is carefully combed, she wears her makeup tastefully, her dress is red and bright. A smile lingers at the corners of her eyes, a smile of confidence that indicates that she had lived a life that could fill the pages of a novel. From the way she compliments the doctor on the dimples in his face (dimple-face, she calls him at times, making him slightly uncomfortable), he deduces that she had won the hearts of many. But looking at her face, the doctor can also see sorrow, and worry, and pain. And determination, and hope, to keep living.
The decision - After years of treatment, a new tumor was found in Dolores' bladder. It was unlike any of the cancers that were previously removed. The new cancer was small but its cells were more aggressive, it invaded deeper into the wall of the bladder. It could not be removed without taking the whole bladder out. This type of surgery is extensive, with significant risks of complications. Moreover, without a bladder, Dolores' urine would have to be diverted to an opening in her abdomen (called a stoma) where it would be collected in a plastic bag. After receiving the news, Dolores decided to avoid surgery. She was fully aware that without surgery the cancer cells would multiply, invade deeper and farther and send metastases to her lymph nodes and bones. She knew that her life would soon end.
The final scene - Dolores is lying down in a bed in a large hospital room. Dolores' son is with her. Dolores' boyfriend is in the room too. They sit on both sides of her bed, holding her hands. The doctor comes in. They talk about the winter that will never end. He asks about her pain. She says that she is lucky to have her son and her boyfriend next to her, and "now you, my doctor, dimple-face, you are also here," she says. And then, as if she could read her doctor's thoughts, she says "do not worry, you did what you could do, dimple-face, we all did what we could do, this is life."
Invictus (Latin for 'unconquered'): Dolores died several days later. She lived a full life. She confronted her cancer with dignity and bravery. Her decisions throughout treatment, even the decision to have no more treatments, were brave. She died without pain, or fear, surrounded by the people she loved most. Her obituary may read "she lost the battle with cancer." But her doctor will forever remember her as if she, herself had written the last paragraph in the poem "Invictus" by William Ernest Henley: "I am the master of my fate: I am the captain of my soul." Her doctor will remember her as Dolores, the Invictus.
Editor's note: Dr. Shahar Madjar is a urologist at Bell Hospital in Ishpeming. Read and comment on prior columns by Dr. Madjar at DrMadjar.com.