Love, Loss, and Loyalty in Palliative Care

— The power of compassionate colleagues

by
Eve Makoff, MD



February 28, 2023

“I just can’t. I can’t,” Wendy, an RN, sobbed into my hair.

We barely made it out the door when our bodies collapsed together, puddles holding puddles. Our patient’s children, 5 and 7, had just left with their tiny gray backpacks, tiny soldiers off to the abyss. Pastel crayon drawings, with rainbows and stick figures, were taped to the pale-pink hospital walls: “Mom! Get well soon!” But she wouldn’t.

Wendy and I, an MD, were both divorced, with teenagers and young ones. Motherless children destroyed us every time. But at this moment, together caring for patients with terminal cancer, we let each other fall apart and picked each other up again. Armed with solidarity, sisterhood, with mutual understanding, we were able to move on.

Our jobs as palliative care providers didn’t care about what degree we had. Nurses, doctors, social workers, and chaplains blended together, creating a family of carers. Wendy and I secretly saw it as “mother’s work,” relating it to the way we tended our families that had broken at the seams.

As some children do, one of our “children,” a man named Bob, got a bit too attached.

Bob had advanced lung cancer. When he came to us, he just wanted to ride it out, to let the disease take him: “I’m an old fart, and I’m alone. Just let me go. I don’t want the damn treatment!” he’d said on our first visit. He was lanky with a goofy grin and thin white hair on his head. But then he told us about the cars he worked on and the woman he loved who he wasn’t sure loved him back: “I like being there for her, helping with her daughter. Joan gets so overwhelmed, you know?” We knew what being overwhelmed by daughters was like, Wendy and I.

“Isn’t that something to live for?” Wendy asked that day in the sterile clinic room. “I suppose it is now; I suppose it is.” Bob started the treatment, a pill for his cancer. And he demanded weekly visits with both of us, with hugs at the end and near-daily phone calls with Wendy. It was rare for her to show up at her desk in the morning without a light blinking, indicating messages — from Bob. And for me, copies of his favorite magazine mysteriously showed up every month in my office.

Bob had some good months. He visited his cars even if he couldn’t slide under them anymore. He had meals with Joan, her daughter. But eventually, he got weaker. The medicine had stopped working. Together, we helped him find comfort at the end of his life. Above all, we made sure he knew he wasn’t alone.

When we got the call he was gone we held each other tightly. For months we’d notice the empty clinic room where he usually sat, sometimes unannounced, willing to wait however long we took. Wendy noticed her phone was less busy. Our eyes welled up together. We’d lost one of our own.

Similar to medicine in the time of COVID, the practice of palliative care involves daily losses. It is impossible to trudge through the grief without sometimes succumbing to the devastation — the pain of letting go of those who touched us. What I learned working with Wendy was the only salve is a colleague, a partner, who gets you, who sees you, who wordlessly knows when a moment is too much to bear, and who lets you collapse. We weren’t in the habit of collapsing. We taught each other how.

When we met, reeling from recent divorces, we both felt alone as primary caregivers, as mothers to our families. But when we entered the cool spaces of the cancer center each day, we co-parented our charges in the best possible way. We divided and conquered. We took breaks if the emotions got too raw. We had each other covered. After feeling isolated for years due to shouldering the lion’s share of responsibilities, feelings, and hard choices regarding our children, we found a partnership at work that seemed inconceivable at home.

For various reasons, we both moved on after that year to other jobs and more nourishing relationships outside our work. But I am left with the sense that in that year, together with Wendy caring for patients who really needed us and caring for each other, I learned something about love that helped me move forward.

Eve Makoff, MD, is an internal medicine physician.

This post appeared on KevinMD.