Virginia 179 Lessons

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                 Lessons From the Practice

                                 DONALD W. HASSEMER, MD, San Juan Pueblo, New Mexico

Virginia's first husband died when he was 36 and she                      The most amazing observation about Virginia was her
      was 31. She had two young boys to rear, so she mar-             optimistic belief that she would not die of the "damned
ried again, to a man much older-for "security." Working               disease." When the estrogen blockers and the androgenic
and rearing yet another son never seemed to age her. Her              drugs stopped working and the disease progressed, she
second husband died, and she eventually married a third               took it in stride, shaved her chin, and told jokes about it.
time. I do not think she ever knew why she remarried, but             She made cakes and cookies for her physician and his
I know she regretted it. Her older sons left home, and her            staff. Interstitial pulmonary spread of the cancer made her
third son's relationship with her husband brought nothing             need oxygen even for the simplest household chores, yet
but turmoil and pain. She kept working and playing the                she remained confident that she was not going to give in.
peacemaker as best she could, but her son was destined                When the visiting nurses came to express their concern
not to have a father.                                                 that she needed to talk about death and dying, she tossed
    Her third husband died. She moved to Santa Fe, to get             them out, knowing what was happening and not yielding
out of the cold and snow of Wisconsin and to be with her              to the temptation to give up. Through all of this, she
other sons. In 1982 she asked me, "What is this lump un-              trusted her oncologist without question, knowing that he
der my breast?"                                                       was doing his best.
    "How long has it been there?" I asked.                                In December 1992, when she was 75, her sons and
    "Four months," was her nonchalant reply. Two days
later it was confirmed to be carcinoma, with positive axil-           daughters-in-law gave her a birthday party at which she
lary nodes. She underwent adjuvant radiotherapy, and                  absolutely glowed. Friends and family from far away saw
three years of symptom-free living followed.                          how, with resolution, grace, and dignity, she overcame
    In 1986, when she was 65 years old, during a routine              pain. They saw how she overcame dread and pessimism
echocardiogram for a workup for uncontrolled hyperten-                to live with whatever she had to face.
sion, a pericardial effusion was discovered that proved to                At 75, Virginia died.
be malignant. Bone metastases were found in her verte-                    After being with this special patient for the ten years
brae and ribs. She endured 18 months of chemotherapy-                 of her illness, I saw what physicians who care for seri-
three days each time of nausea and vomiting, followed by              ously ill, even dying patients, rarely see. Virginia-my
three days of dread. Her only complaints were about the               mother-was a woman with extraordinary strength, and
cost and the smaller clothing she needed because of her               yet each patient deals with their own mortality in
weight loss. Suddenly she seemed better. The chemother-               uniquely adaptive ways. We cannot impose our own set of
apy stopped, and her activities returned to nearly normal.            values on patients. If we do, we risk stifling the important
She volunteered at the Children's Museum and visited her              yet very personal resolve to go on. Let us never underes-
family in Missouri, Wisconsin, and Florida. She took up               timate the will to "go on living" as a powerful adjunct to
tap dancing and, wearing a leotard and tights, performed              our treatments. Listening can transform our interactions
routines with her newfound friends.                                   from mere caring to empowerment.

(Hassemer DW: Virginia. West J Med 1995; 162:179)
   Dr Hassemer is a family physician in Espanola, New Mexico.
   Reprint requests to Donald Hassemer, MD, Route 2 Box 285, San Juan Pueblo, NM 87566.

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