At the time, she was an intern in a Family Medicine Residency Program where I was teaching. I was a relatively new faculty member. She came to me because she had to tell a patient and the patient’s husband that the patient was dying of cancer, that there was nothing more to be done. The ill woman was forty, married, with a son, age ten. The intern wanted help planning this painful conversation. I tried to provide her with some structure, reminding her to inquire about how the patient and husband were doing, to speak slowly and without medical jargon, to pause so that the patient and her husband had time to digest what the intern told them, to listen, to answer questions as clearly and honestly as she could.
We went to the hospital together where I met the couple for the first time. I was struck by how young the woman looked, despite her brittle body and her gaunt face. Her husband sat silently in a chair beside the bed, his eyes dark and tired. Their son was in school. The intern began just as we had planned: “I have some news I want to share with you. The treatments are no longer effective. I’m afraid nothing more can be done. When you die, it will be from this cancer.” At first the patient ignored what she was told, then she broke into tears, then she asked the resident to tell her again, then she and her husband held each other, then we were quiet for a long time, then they cried for their son, then they cried for each other, then we did all of it over again, and again.
There was no plan for this. No protocol. Nothing could illuminate the cavern of darkness that lay ahead. The best that the intern and I could do was to enter the darkness with them. Thereafter, we collaborated in their care as closely as possible, often seeing them together for their appointments.
Psalm 139 in the Old Testament says the strangest of things: “If I say, ‘Let only darkness cover me, and the light about me be night,’ even the darkness is not dark to you (God), the darkness is bright as day; for darkness is as light…” For years I thought the psalmist was talking about the familiar image of light shining in the darkness. With more life experience and a closer reading of the psalm, I understood it differently---Sometimes darkness itself is the only light afforded us. It is inescapable. It is something we will all face. And when we enter there, all we can do is hold onto whoever is willing to go there with us. And that experience of holding on or being held is sacred, even when the light it casts may seem invisible.
The woman and her husband came to see me for psychotherapy regarding her imminent death. What did she have left to do in life? What did they want to say to each other? How were they coping? What did they fear? What did they hope? How do you say goodbye? And how should they tell their son? They planned together how to talk with their son, something they wanted to do alone with him at home. As I recall, their conversation with their son mirrored the conversation that the intern and I had had with the couple. The woman died within six months. She had urged her husband and son to continue to see me, which they did for a short while afterwards, the husband finally saying he felt they were handling things as well as could be expected.
The intern continued as their doctor. I never saw them again, but I have never forgotten them and our journey together.