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By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” will be published in the May issue of AJN.

Years ago, long before I was a nurse, I read The Sheltering Sky, by Paul Bowles. He speaks of the tendency of people to take life for granted, and says that in the unpredictability of death there lies a presumption that everything is limitless:

“Because we don’t know when we will die, we get to think of life as an inexhaustible well. Yet everything happens only a certain number of times, and a very small number really. How many more times will you remember a certain afternoon of your childhood, an afternoon that is so deeply a part of your being that you can’t even conceive of your life without it? Perhaps four, five times more, perhaps not even that. How many more times will you watch the full moon rise? Perhaps 20. And yet it all seems limitless.” 

Lately, especially at work, that quote has edged forward and lingered with me. The ICU I work in is primarily devoted to trauma, but there’s been a recent shift in patient demographics. Last week I took care of only one trauma patient—an athlete who’d had a bike accident—and then three patients with cancer in varying stages.

The patient I’m most haunted by is a 65-year-old woman who had arrived in the ER with pain and weakness and would be leaving the hospital with a stunning diagnosis of stage IV cancer, and with numbered days. When I last spoke to her she’d just met her new oncologist and was waiting to be transferred out of the ICU.

“I’m going home,” she said. “I’m going to be with my family and sit on my porch. I’m having a glass of wine.”

She was declining the treatment options laid out by her physician. In regards to time, with no guarantee of quantity, she was opting for quality.

I asked her if she was scared.

“It is what it is,” she said calmly, shrugging. But she didn’t meet my eyes. 

I’m comfortable caring for trauma patients; their afflictions, though tragic, somehow make sense.  There’s usually a pretty clear cause and effect type of relationship between the accident and the injuries sustained, and most of the crises are loud and dramatic.

Cancer, on the other hand, seems to me to be the opposite of trauma. It leaves me unsettled, with a niggling awareness of an unpredictable and insidious enemy. Confronted with it, I’m not sure how I’d come to terms with such an illness, but I might well choose exactly the course of action my patient did. I’d waste no time—I’d go immediately home and jump headlong into the exhaustible well of life that Mr. Bowles spoke of. I’d start counting every moonrise I had left to see. 

But I’ll do that anyway; it doesn’t take a death sentence to seize what’s here, now.

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