It started as one of those typically crazy call days in early November 1995, when I was paged—another admission. As I hung up the phone, I was annoyed. "Why is this patient coming in now?" The E.D. doc said it was a patient who should have followed up in the clinic weeks ago, but didn’t. Now she was coming for evaluation on my shift. However, within a few days of admitting this patient, my annoyance turned to admiration, as I discovered what a rare person she was. I could not know then how much Sandy would teach me about the strength of the human spirit, the will to live and knowing when to ‘let go.’ She taught me to accept, that much as we may want to, we cannot ‘save’ every patient.

Learning to ‘let go’ of the desire to do more was a lesson reinforced many times during training, but never so poignantly as with Sandy’s case. At first her love of life and her young age, 37 motivated us to try everything—Chemotherapy, Radiation Therapy, Therapeutic Touch, Reiki, Humor, and Prayer—to stop the metastatic lung cancer. She was a very special person. When admitted for chemotherapy treatments, she would wander the hospital wards looking for other patients to cheer up. She would arrive at her Radiation Treatments dressed to the ‘nines.’ Those who met her had difficulty believing the reality of the metastatic disease process raging inside her. I had tear-filled eyes, when I told her the treatments were not working. The metastatic disease was growing, despite all the hopes and treatments. It was a terminal disease. We could only let go of the desire to do cure and aim for palliative treatment.

By this point, I realized that my role was to support her belief that she would beat the disease. Once she lost sight of that goal and admitted defeat to me, she would lose her will to live and the fight. The closest Sandy got to acknowledging the severity of her disease  was a question posed while looking out her hospital window into the mountains behind Santa Barbara. She asked, "Doesn’t it look like you could just walk out this window and into the hills?" I knew then she was starting to let go.

The last time I spoke with her was a Thursday evening in late April. She was struggling with what it meant to be "on hospice, " asking, "Wouldn't you want to do everything to live?" I didn't know what to say. I knew there was nothing else that medicine could offer except comfort care. The disease was end-stage. I could only be a friend on the other end, listen, and just be.

It ended the following Monday, on my last call day as a resident. I was in the emergency room admitting a patient when the outside phone page came. The visiting nurse told me that Sandy had died. As she always made an impression when she arrived, I knew Sandy would make an impression when she departed. At first I was overwhelmed with tears, until I realized the irony of the situation. My last call day—another crazy, hectic call day— and to have this favorite patient and friend die. I smiled when I realized that her timing ensured I would remember the date of her death!

I felt for sometime afterwards that I hadn’t done enough. In hindsight, reviewing her treatment, I realized we did as much as any one could have, maybe more. When I started treating Sandy in early November, I did not believe she would live until Thanksgiving. Yet, she was able to fulfill her wish and visit her family in the Midwest for Christmas, before returning home to continue treatments. I believe that the combination of therapies, both medical and adjunctive, helped extended her life for 6 months. It took a bit longer to recognized that I had given her the greatest gift that I could—being her friend and physician. By listening, holding her hand, giving her emotional support, I helped her find the strength and the courage to make the ultimate transition and ‘let go.’ In return, this rare patient taught me the importance of taking the time to connect with the person behind the disease. In caring for her, I learned how to help others find the strength and the courage to ‘let go.’ This lesson is one shared many times since with other terminal patients, their families and my own family.

In her memory, and those of other patients that I have lost, I created the Journey of Hearts website http://www.journeyofhearts.org. What began as a way for me to deal with these losses is now a multi-award winning website, devoted to the issue of loss, that has seen over 100,000 visitors in almost two years. The many deaths of patients served as the motivation and provided me with the background necessary for creating this unique website. The website has also served as another way to pass on the important lesson of learning to ‘let go.’

This article was originally published in the Spring 2000 issue of Female Physician.