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My Family Medicine Story

Brent Sugimoto, MD, MPH

 

Hideko‡ never asked for much during our visits. It was always one or two of her doting children who brought their 90 year-old mother in to get her annual clean bill of health. Hideko was of that generation seemingly built for more challenging times. Indeed, she had survived the Depression and a world war, lost her freedom during the Japanese-American internment, rebuilt her life after, and raised a family of three children. I suspect she came to our visits like she approached the rest of life—indefatigably cheerful and without complaint. Hideko still lived in her own home, although a daily helper suggested that both her mind and body were slowing down. In fact, a touch of senility probably loosened the reins on a mischievous side that shone through:

 

“You’re so handsome like always,” Hideko remarked but it sounded like pique.

 

“Thank you,” I blurted. Hideko’s daughter glanced up from her phone.

 

“It’s not fair,” Hideko groused and then paused. “Do you remember the last time we met?”

 

“Of course I do.”

 

“Oh, we had such a fun time!” She chuckled. “Like when we went out around town and we... I probably should be careful around the kids.” She glanced at her daughter.

 

“Mom, you never told me about your boyfriend!”

 

Hideko seemed to take satisfaction in my intensifying shades of red, so I was never sure how much of misremembering was actually impishness.
Some visits later, one daughter brought her mother in for constipation. Although Hideko had not had a bowel movement in several days, her spirits were unchanged, her appetite was fine and she complained of no pain. Her daughter agreed this was likely an ailment of growing older and we came up with a plan to help... Except it didn’t help. Hideko returned with no bowel movement in almost two weeks. Hideko seemed unbothered, but she was the only one.
Intuition told me to order a CT scan instead of an x-ray, and there I saw the reason: it was cancer. Several tumors crowded the liver, all likely metastases, with the largest pressing outward and impinging on the large intestine. This was incurable.
I called the daughter to come in to discuss the results. She agreed to come the following day.
I fretted about how this conversation would go. I had seen families fall apart in the ICU when there was conflict about the next step to take for a gravely ill loved one. I cannot fathom assuming the task of separating what I would want for my loved one from what she would want for herself—to be her voice, to read her mind in its former clarity, to make an irrevocable decision about her life.
When I walked into the exam room, all three children were waiting. Their focus pressed heavily into me as I explained the findings on the CT, their meaning, and about possible courses of action. I hazarded that the natural course would be measured in days to weeks. I tried to balance perspectives: while pursuing comfort would give up time with their mother, seeking treatment could mean relinquishing comfort and function. I curated my words to avoid painting any decision as right or wrong. I wanted desperately to keep my own feelings from the question so that the family could concentrate on this hypothetical—if Hideko had this information, what would she want?
The son spoke first, “Mom always did everything on her own terms. She would never want to live just to live.”
The other two nodded. Agreement.
One daughter offered, “Mom always loved coming to see you.”
“You mean, her boyfriend?” I quipped. They all laughed. The story had clearly gone around the family.
The children cried, and I cried with them; partly for their pain, but also for the love that the children shared together. I had to wonder about the example that Hideko lived because love does not spring from nothing. She must have taught her children the devotion I saw in that room. Her children’s devotion meant allowing their mother to live her life as she saw fit, even if it meant losing her a little sooner.

 

‡Not her real name