Walking Shoes

I knew as soon as I walked into the room that they had told her. The resident was sitting on the bed just opposite her, the intern stood at the end of the bed, and the medical student was leaning against the wall; all of them were quiet, gazing intensely at her. I hesitated, afraid I would interrupt.

Then I heard her sobs. She was sitting in a high-backed lounge chair, and all I could see was her bony left elbow resting on the arm of the chair. No one said anything; no one knew what to say. I realized that they must have just told her about her cancer.

After what seemed to me an eternity, her breathing slowed and the sobs diminished, but just when I thought her crying might stop, it would pick up again. We all could feel her emotion. She didn't try to hide it. The intern suddenly wheeled around and almost ran into me rushing out of the room, his eyes glistening.

Just as he left she spoke for the first time.

Are you sure?

The resident nodded, and with the nod he rubbed his eyes, trying to look as if he were in control. I sat down on the bed next to him and realized how very tired and old she looked.

She was thin, fragile, and slumped over, and there was a distinct but sick awareness on her face of what must be.

After a long silence, without even looking up, she said quietly, It just can't be! My doctors are so young. Her fist clenched and she said, No, no, I know it's not true.

I wanted to tell her that she was right, that it wasn't for sure. We had no tissue diagnosis, but I knew the evidence was strong, that nothing else could cause all her symptoms. The liver was diseased and there was that mass on CT scan. No, the diagnosis was certain. I couldn't even tell her that there was any doubt.

Then she admitted, Well, yes, I've lost 100 pounds, and her shoulders slumped a little bit more, and it seemed like all of the energy had been drained out of her. There was another long silence and more tears. Now the resident, unable to choke back his tears, quickly left the room. There were no tissues, so I grabbed a brown paper towel and blew my nose, then leaned forward and took her hand. Her shoulders stiffened and she looked up and gazed right into my eyes, then upward, and said, He, He won't let it happen. It's not true.

I was lost. I wanted to ease her pain. At least half a dozen thoughts went through my head. I couldn't decide what to say; nothing seemed to be right. I just sat there with her in silence.

She looked up again and said, He knows best, and again became silent. This time there were just silent tears. She turned away and faced the wall.

It can't be, are you sure? Her shoulders stiffened and then with a lot more energy she sat up straight and said, I have always done right. There must be a mistake. Pointing upward she continued, He won't let it happen. I know He won't. But even after she said this her shoulders sagged again and her hands became limp. Without even looking up she said with resignation, He knows best. She seemed unconvinced.

On the cabinet by the bed there were three pictures pushed together to make room for flowers. On the shelves by the bed were more pictures, more flowers. I was struck by how handsome her two sons and three daughters were. There was a large family picture with four or five grandchildren. She was holding one of them. I could sense by her expression in the picture that she had been the one who had been doing all of the giving, and I wondered if she could accept their taking care of her now. As she glanced up her eyes rested on the pictures too. There was a kind of softness to her face not there before, even though the tears were still streaming down her face.

I can't leave them, but they will be OK. He has taken my hand and is leading me.

Again she turned away and this time she spoke with more anguish than before. She whispered, No, not now. Please, please not now. But even as she was speaking the tears slowed and the dark tired face began to take on a different look.

She lifted her chin and her eyes turned toward me. Now she was smiling.

Why are you crying? she said. Then she extended her hand and raised her feet, showing worn sneakers. She said, Don't you see? I have my hand in His and my walking shoes on.

• Copyright 2004 by the American College of Physicians