“No one wants to have difficult conversations for fear of seeming hard or mean. Yet, that is exactly what happens when the conversations are avoided or circumvented. People who wish to curtail or even stop treatment don't feel they have the authority to decide.”
-Posted in an online forum in 2017
She came to see me because her neighbor almost dragged her in. She was a widow. She lived by herself in a neighborhood that had seen better times. It had been more than a decade since she had seen a doctor. Her only friend, the lady next door, noticed that she did not go out quite as much; that her once meticulously cared for garden sprouted weeds; that the frequent baking and distribution of home- made French pastry had come to a halt.
She was no taller than five foot two. She was quite overweight, but she walked stiff and erect, so that she looked taller and leaner. Her striking asset: beautiful bright red hair, which could not have looked any prettier fifty years earlier. An impressive, elegant, self-confident woman who was used to taking care of herself.
She was French. She told me that she had lived in Paris during the German occupation. As I gained her confidence, I was able to extract (without much effort) her fascinating story. She was a beautiful young woman. At some point after the German invasion, she was recruited to work for the resistance movement. She "befriended" enemy officers (because I did not want to embarrass her, I never asked about the extent of her involvement, but it was not unusual for these women to offer sexual favors in exchange for military secrets). At times she was able to extract valuable information that was useful to her friends in the resistance. She put her life on the line numerous times, and there were several close calls.
When the Allies took over Paris, she was brought in to be debriefed, or thanked, or both. One of the American officers in charge was as impressed with her hair and her personality as I was many years later. One thing led to another; eventually they married and moved to St. Louis.
I asked her if she felt some form of letdown, to go from the thrilling (if dangerous) life of a spy in Paris to being a sedate Midwestern housewife. Yes, she missed the croissants and the music, but she felt that she had done her share, and she was ready to settle down.
They had no children. Her husband worked at a large local corporation. They were frugal and responsible. Shortly before he was due to retire, he collapsed on his way to work. He never made it to the hospital.
She continued to care for the house, and the garden, and to keep in touch with what went on in the homeland. But she overate, and eventually stopped taking her walks. The last thing to go were her flowers. This is when her neighbor pleaded with her to come see me.
The news was not good. She had diabetes, high blood pressure, and elevated blood lipids. Her knees were worn out. As I sat facing her, rolling out the long list of findings, I noticed a look of defiance spread over her face. It seemed to me that her hair had turned a deeper shade of red.
No; she was not about to go on my stupid diet or take the dumb pills. She would not check her sugars at home. She would continue to live as she was: if she died then so be it.
I decided to retreat. I remembered my trips to Paris, and the French tunes that my father used to sing to put us to sleep. I wanted to be friends with this woman. I decided to approach her through that angle. I mentioned Yves Montand and Edith Piaf; I told her how to this day I got shivers any time I heard the first few lines of La Vie En Rose.
Her face was transformed.
"They had a love affair, you know."
I do.
"He would not get a divorce to marry her. He was Catholic."
I did not know about that.
I saw that the door to her soul had flown wide open. Within five minutes we were fast friends, and by the end of her visit she agreed to four prescriptions, a diet, and blood sugar monitoring equipment. As she got ready to step out of the exam room, I placed my eyes close to hers and sang:
"Quand Il me prend dans ses bras..."
"Il me parle tout bas..." she responded. We laughed. She hugged me and left the room with a smile.
Subsequent visits were a partial success. Her blood pressure and lipids came down, but she could not comply with her restricted diet. She told me that food was the only thing she had left. In retrospect, I realize that I may have been more successful if I had known more about French food in general and cooking in particular. But she functioned, and her flowers came back to life, as did the deliveries of French pastry to her neighbor. At the end of each visit (which I very much looked forward to) we repeated our Edith Piaf imitation. There was one day when we sang the whole song for my staff to hear.
A few years after we met, she called. She needed to be seen soon. She complained of palpitations and shortness of breath. Her heart rate was fast and irregular. A cardiogram confirmed that she had atrial fibrillation.
I explained the nature of her problem. I told her that she would need to see a cardiologist, and that she had to take a blood thinner to reduce the likelihood of stroke. The look of defiance returned, and again her hair seemed to turn a darker, brighter shade of red.
"I'm not doing it."
Her lips quivered.
I tried smiles, and references to Paris. I even tried the song, long before its usual place as a curtain call. To no avail. I finally told her that she would have a stroke; that she could be paralyzed.
"I don't care. If I have a stroke I die. This is OK with me. I take enough medicine. No more. Non. Jamais."
I don't think that she realized that she had reverted to French. I was forced to acknowledge that my elderly widow had turned into the teenaged resistance fighter that was such an integral part of her. I decided to cut my losses. I feared that she would stop all her medicine.
We agreed that she would continue her usual regimen. She allowed me to schedule an appointment in two weeks instead of her usual three months. She did not sing before she left.
Three days later I got a call from the Emergency Department at our hospital. My patient had not been seen outside her house for two days. Her neighbor became concerned and called the police. She was found lying on her kitchen floor, barely conscious. She was paralyzed on one side. She could not talk and was unable to swallow.
She was admitted to the hospital. She improved daily. After three days she was fully alert. She recognized me; she smiled. I asked her how she was; if she had any pain; if there was anything I could do. It was obvious to me that she understood everything that I said, but each time that she tried to form a word only babbling noises came out of her mouth. By my third question the angry look and the intense redness of her hair came back. She tried to throw something with her only functioning hand. She banged her fist into her bed.
I sat on her bed and held her hand in silence. I allowed her to cry. I waited a few minutes. I looked in her eyes and sang:
"Quand Il me prend dans ses bras..."
She smiled.
"Il me parle tout bas..." She was able to sing as well as she ever had.
"Je vois la vie en rose..." we continued.
She was thrilled. When we stopped singing, she wanted to tell me something, but the same senseless babble came forth. She could sing, but she could not express herself. The angry look came back, as did the pounding of the bed and the tears.
I told her that therapy was available; that it was early. I began to talk about the need for a feeding tube; that we had to feed her; that some people recovered function as the brain swelling decreased.
She hit the bed again and vigorously moved her head from one side to the other. That was not going to happen, I realized. She had a lot of fight left in her, but it would not be spent on being patient and holding on.
After I hugged her, I left the room. The nurse told me that she had refused all treatment, including IV fluids. Two days later my beautiful resistance fighter died.
I still think of her whenever I listen to our song.
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