Friday, December 31, 2010

"Cinderella"

How many times had I seen "Cinderella" walk down the hallway heading towards the small kitchenette behind the nursing station, with a microwavable pizza in her hand?  Probably, too many to count.  So frail looking, wearing a wig to cover her bald scalp, pushing an IV pole with her free hand.
      As I sat at the nursing station charting another medical note, I was amazed at her resilience.  I had seen a lot of suffering in my work as a physician assistant, but there was something about "Cinderella's" suffering which I could only describe as magical.  She had survived two protocols of intensive chemotherapy which should have put her leukemia into remission, but it didn't.
      "Cinderella" had been diagnosed with acute leukemia.  This meant her bone marrow cells which should have been producing normal blood cells, had instead transformed into cancerous cells. 
      "Cinderella's" hospital room was filled with stuffed animals, shelves of junk food only an adolescent would eat, and several pictures.  One picture that struck me was of "Cinderella" and Chris her "Prince Charming" in an earlier, happier time.
      At first glance, I didn't recognize "Cinderella" as being the young woman in the photograph. The photograph showed a beautiful, thin teen-ager with long silky blonde hair, youthful skin, wearing a stunning prom dress.  Next to "Cinderella" in the photograph was Chris.  He appeared tall, dark haired, proud and immaculately dressed in his tuxedo.
      I had a difficult time imagining Meredith (or "Cinderella" as I tended to call her) as being once so beautiful.  My perceptions had been distorted by seeing her on a daily basis in the bone marrow transplant unit, bald with hardened skin.
      When the intensive chemotherapy did not work, she went through a bone marrow transplant in hopes of being put into remission.  But this created additional problems.  Her brother’s bone marrow cells which had been infused into her, started to attack Meredith’s organs.
      As if this were not enough, Meredith had to deal with the desertion of her family members, and their denial of her being so ill.  One day shortly after I had begun working on the unit, I noticed a 3 x 5 card taped to the front of Meredith's chart.
      I asked one of the nurses nearby, "Why is Chris' name and phone number listed as the first person to contact on this card, instead of her parent's?"
      The ICU nurse replied, "Chris lives closer, and he's so much more of a support to Meredith, than her parents.  They never visit and live sixty miles away.  If I didn't know better, I'd swear, Chris is an angel in human form.  I don't know of any other guy who'd stick by his girlfriend the way he does."
      "Well you're right about Chris!" I stated.
      Meredith was a mere nineteen years of age, and all she had going for her now was her childlike faith in God, and Chris, her angelic suitor.
      Meredith had met Chris several months prior to her diagnosis of acute leukemia.  Chris was Meredith's 'Rock of Gilbralter,' while Meredith's childlikeness portrayed her innocence.  Chris’ presence, and knowing that Meredith had once looked like a fairy princess reminded me of Cinderella, hence my nickname for her. 
      Day after day the medical team I worked with, would make attending rounds and talk about Meredith at length. 
      One day the oncology attending said, “I want to try Meredith on high dose prednisone, I want to give her 5,000 mg a day for three days.  Maybe that will begin to halt her disease process.”
      One of the physicians-in-training spoke up and stated, “That’s an extremely high dose of steroids.  Do you really think it’s going to make any difference?”
      “I’m not at all sure, but what else do we have to offer?” asked the attending.
      “Nothing, as far as I know,” spoke the physician-in-training.
      Despite her poor overall prognosis, Chris stood steadily by her.  He would come to see her in the ICU every day after he finished his college classes.  He brought her groceries, stuffed animals, and news of the outside world.  Many times he would take her out on a pass and they would go for walks outside the hospital, or get a pizza before he would have to bring her back.
      As time went on, I learned Meredith had been a vocalist, and she'd occasionally sing in her room, in tune with some gospel music which was playing.
      Meredith's thick hospital chart was indicative of how ill she was.  Physicians-in-training rotated through the unit, and yet Meredith stayed.
      Finally after being hospitalized for six and one-half months, Meredith was discharged.  She wasn’t any better, but we knew Meredith needed to go home one last time.  We told her she could not go to her parent's home which was a farmhouse, due to it being harvest season.
      So she was discharged to her aunt's house, who lived nearby.  Chris continued his daily visits.  We saw her in our out-patient clinic three times a week, checking on her medications, and assessing her.
      About three weeks after her discharge, Meredith showed up in clinic with a hacking cough and a fever of 102 degrees.  An x-ray was taken, revealing she had a lung infection.  We sent her to the lung specialist who did a bronchoscopy.  The biopsy came back loaded with fungus.  Meredith was started on an anti-fungal medication.
      Every other day Meredith came back to the clinic, to be seen by us.  I saw her during several of these clinic visits.
      "Hi, Meredith, how's it going?"
      "Not too bad.  The new medication doesn't bother me too much, and I'm still able to eat.  Oh, by the way, (pointing to the woman sitting nearby) this is my Mom."
      "Nice to meet you.  I've seen you in the clinic the last couple of times with Meredith."
      "Yes, I'm now coming with Meredith to all of her clinic visits.  It makes for a long day commuting back and forth between here and her aunt's house."
      I perceived a calmness in the room.  I could tell peace had finally been made between the two of them, and her mom was slowly becoming more supportive of Meredith just when she would need it the most.
      Christmas came and went.  I knew this would be Meredith's last Christmas.  I could only hope she had enjoyed it.  A few days later I heard Meredith had a stroke due to a blood clot that had formed in her lungs.
      She was hospitalized in her hometown.  Her parents advised the physicians there to just make her comfortable.  A few days later Meredith quietly passed away.  Her nine month struggle with cancer was over.
      After Meredith’s funeral, Chris continued to pursue his bachelor's degree.  Several years later I heard he had finished it and was working full-time in his chosen professional field.
      I know he will never forget Meredith, nor will I.  "Cinderella" and her "Prince Charming" will live on in my memory as a beautiful love story.  Remembering the two of them together gives me hope that there are other 'Prince Charmings' out there for any woman who needs one. 


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