After chemo in Qualimed I walked around Nuvali to catch up on my required steps for the day. It was a ghost town. I suddenly felt hungry and remembered that I had three pieces of left-over empanada in the ref. I asked Helliza, HTGOF, Smoketh, and Frichmond in our Viber group how to heat it, salivating as I anticipated ramming all three in my mouth at the same time. Helliza said I could just throw them in an oven toaster. But these empanadas are boisterously stuffed, I argued. Then you should poke holes in them so that the heat can penetrate the stuffing, Helliza said, with more than a hint of exasperation.

As soon as I decided to run back to the car so I could go home and eat them, I saw an exchange in our family Messenger group that they were already gorging themselves on the empanadas that very moment. Not only were they gorging on it, they were fighting over it. For the record, those empanadas from Bannaple were not that great, but I guess during ECQ we just become more appreciative. I remember finding a neglected, totally disfigured Magnum in the freezer during ECQ Season 1, and it was the best ice cream I had ever eaten.

I then heard one of the stores or restaurants playing Our Lady Peace’s Innocent over the loud speaker. I like that song, made famous by David Cook when he sang it in American Idol back in 2008. There is a line there that goes “And while she wishes she was a dancer, and that she’d never heard of cancer, she wishes God would give her some answers, and make her feel beautiful”. It bummed me out again, getting reminded of some of my recent patients who had succumbed to the disease.

Just a few days prior my patient Mrs. Invisigoth had died from metastatic breast cancer. She was already in stage 4 when I diagnosed her in 2017. She worked as an HR supervisor in a government office. She was always game with whatever treatment I would offer her. Sometimes I would just rattle off options just because they were in the guidelines, not expecting anybody to take them for financial reasons, but she would always go for them: stereotactic radiation therapy to the solitary brain mets, microwave ablation to the solitary liver mets, years of pertuzumab therapy. They were by no means rich, but they were able to pull through.

Two weeks before her death she came to the clinic, poised to try another round of chemo. This time she was already jaundiced and too weak. I had already placed her on fentanyl patch and loads of morphine, but she would still be in pain. Years of forging a strong doctor-patient relationship that had transcended into friendship made it easier for me to tell her that I no longer think chemo will help her. She thanked me for the years that I had tried to help her, but that she could already see in her mind’s eye the angels welcoming her.

It was a rare moment. Usually the relatives left behind are the ones expressing their gratitude or their regrets. The patients’ families always tell me that I should no longer exacerbate the dying patients’ anguish by telling them that they’re dying. They already know this anyway. But I think there’s still value in hearing this difficult truth from their doctors. That we’ve taken this as far as we can, and we need to lay down our arms. That the physical body, with its multitudes of imperfections, can only suffer so much. That it’s time.

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