I met such a brave woman the other day, and a brave family.

Fully aware of her disease, my patient told me calmly of the death sentence handed down to her by a higher court than human justice. Nothing just about it, this too young woman had not one but many ways to die all sitting and waiting within her like bombs ticking relentlessly.

She had come to the Emerg that day for a new pain, a different pain from her every day suffering. After clearly telling me that she no longer wished any extraordinary measures, including resuscitation or surgery, she allowed that she would like to know the diagnosis for this new agony. I treated her pain with analgesics, and ordered a scan.

The images were astounding. My lovely, sick, profound patient had a monster inside of her. A creature already known to be laying in wait, it had now grown into a true threat putting my patient’s life in imminent danger.

I came back into the room, met by my patient and her wife, who wanted to take her home to die in her own bed. In the most compassionate yet direct way, I explained what I had seen on the scan. I told them the story of her impending demise. I illustrated in colour the beast she was facing, because to do anything less, to hide the truth, would have been cruel and the wrong thing to do for this family.

I can barely express in words the way I, as a doctor and as a person, feel, when having to break bad news to patients and their families. To look good people in the eyes and tell them they are soon going to be separated from each other in the most permanent way, is heartrending. To explicitly tell a patient that he or she will die very soon, is harder than one can imagine.

And this death. This death would be agony. Of the four bombs set to detonate in this woman’s body, the growing goblin on the scan would certainly be the most painful and frightening way to go, for both the patient and her family.

I explained this. In quiet words, simple, straightforward. I asked, do you want to stay here, where we can make you comfortable, take away your pain as you pass? I told them I would leave the room and give them time to decide as a family. I involved the palliative care team to assist. By an hour later, the decision was made to allow the family and the patient to go home, armed with medications to take when the pain will become too much to bear.

Saying goodbye to my brave, kind, doomed patient with the grizzly bear in her belly tore my heart out. They thanked me for coming back in the room. I almost hadn’t, I had almost let them leave without going to say goodbye. But I couldn’t. This woman, her family and her story touched me, and I needed to look once more in their eyes. I knew I would never forgive myself if I didn’t say goodbye before she died. I needed to close the door that I had opened in my heart. But how do you do that? How do you express to a person you just met, that you’re heartbroken that they will very shortly die? How can such a strong connection be formed in such a short timeframe, within one encounter in a busy emergency department? Well, those bonds form and break every day in my world. I am grateful for this, because it teaches me humanity and grounds me on this earth. It makes me appreciate health and my family’s health. My patients’ suffering and deaths make my life somehow so much more worth living, if that makes any sense. Their pain and loss opens my eyes to appreciate the state of comfort and joy I experience in my own life.

So I said goodbye, I put my hand on her arm, I looked her in the eyes, and I wished her the best. And then they left, and I left, and our lives will never be the same.

2 thoughts on “The monster inside

  1. Dear Sara,

    What a beautiful, moving post—and on such a critical subject! Personally, I want to die at home, with my loved ones around me and have made this clear in a Living Will that is legally binding. I have such profound regrets at having allowed both my mother and Moshe to be hospitalized., but the doctors’ assurances misled me into taking their advice. You were wiser. May you be blessed for that.

    Love from Jerusalem,


    om: My Black Scrubs [mailto:comment-reply@wordpress.com] Sent: Wednesday, January 23, 2019 3:18 PM To: aliceshalvi@gmail.com Subject: [New post] The monster inside

    myblackscrubs posted: “I met such a brave man the other day, and a brave family. Fully aware of his disease, my patient told me calmly of the death sentence handed down to him by a higher court than human justice. Nothing just about it, this man had not one but four ways to di”


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