Joe Corcoran, a fourth -year medical student at LKSOM, was on his family medicine rotation in Lancaster and spent two days performing hospice visits. He was asked by his attending to interview one of the patients about the impact the disease had on her life. The attending urged him to turn the interview into a narrative medicine piece, which he did, and Still Life was published in the Journal of Lancaster General Hospital. As Joe says about the experience, "In medicine, there is a stereotype that hospice, like palliative care, means death and dying. This patient clarified that to her, hospice meant a chance to live and be fulfilled. I found that to be a very powerful clarification. The soon to be Dr. Corcoran always tries to be creative and inventive in his writing, and this is no exception. -- Michael Vitez
When we knocked on the door, we didn’t know if Janet would answer. We figured she was probably home – the sounds of midday Fox News were creeping out from the crack between the door and the carpet – but Janet had a history of not answering the door for faces she didn’t recognize. And at this point in her life, fighting a war on multiple fronts against age, endometrial cancer, and dementia, there were more and more unfamiliar faces.
But when Janet did open the door, she did so with a kind of warm, bewildered smile that implied Well sure, it’s nice to see you, but who are you and why are you visiting little old me? And the “little” and the “old” described her pretty well, but she wasn’t the kind of “little old” that you might mistake for frail. She spoke loudly and forcefully, and chuckled in between run-on statements, as though she found our questions, her answers, and the whole situation really, quite amusing. After introductions were made and remade, Janet invited us in and told us where to sit. She chose the couch for herself, and settled down, nearly camouflaged by its floral fabric and sunken in its deep cushions. Although she didn’t recognize our faces, the setup of us all perched around her on the couch must have triggered some sort of muscle memory. Janet fell right into her routine, describing the events of the last week and how she was doing, and how she felt about how she was doing, and how she thought we ought to feel about how she was doing.
Oh, I’m alright, she began. No pain at all now. At night the pain is always there, but I don’t do anything for it. She chuckled at that, somewhat proudly and with a sort of forlorn acceptance that I heard in her voice several times over the next hour. They offered me chemo ya know, but I didn’t want it. If I have six months, I figured I wanted to be half decent for all six. And being 80-something… 83 or 84 I think, I figured what’s the use? Again, the chuckle. But it’s certainly taking its damn time isn’t it? I assumed she meant the cancer. Taking its damn good time.
Hanging on the wall behind Janet’s head, a 3-footby-3-foot painting of a tall, stern-looking man and a short, quizzical woman caught my attention. The colors were dark and drab, and the clothing conservative, yet the characters had been painted with such incredible detail against a dim background that the man’s sharp cheekbones stood out from across the room. Seeing my interest, Janet informed me that it was a depiction of her grandfather and grandmother, which she had painted as a gift for her parents nearly 30 years ago. The man’s brow was etched with such a nest of wrinkles that I wondered if he had ever smiled, but with Janet chuckling in the foreground, I realized that his endless creases might just as easily have been a product of laughter.
Janet began to speak slowly, painting her story with long, twisting and delicate brush strokes as she analyzed the progression of her disease. It was easy to imagine her sitting in front of her easel observing a still life, and deciding how best to capture the essence of a thing and depict it on paper. It’s a bit oblong now, she said of her tumor, and the lymph nodes… well, that’s where the cancer is hiding. She didn’t complain of symptoms, but instead described the changes as though she were just bearing witness. My leg has swollen and my toes… just little sausages now aren’t they? Even the cancer, the relentless shadow lurking in corners and under floral sofa cushions – the adversary that etched such deep lines on the faces of her subjects – became personified. It’s spread to the stomach, but who knows if it has settled in there now, or is just shaking hands and passing through. Her face had darkened with the admittance that her cancer was spreading, but she laughed forcefully, squeezing light into a dim situation by focusing on living rather than dying. With pride she told me I’m gonna be 87 next month… never thought I’d make it to 87 – that’s old isn’t it? And just for a moment, the shadows melted away.
We moved on to talking about her pills. Again, she described them skillfully, picking each word like an artist selecting colors from a pallet. I take one of the little white ones in the morning, the circular ones that taste like chalk, and then I take that with two of the blue oblong ones. Despite the number of pills, she didn’t need reminders on what to take, she just needed to know the trade names so she didn’t get into a tizzy. The pills are ingrained in my brain darling, she said with annoyance. Just don’t know why there have to be so many names. Her tone had switched – she was speaking at a faster pace, as though she were painting a very wide swath of sky with crude fast strokes, and had little interest in slowing down to paint the clouds. Ingrained in my brain, I just need them written down because otherwise I have to look at ‘em with a magnifying glass just to see how to take them.
As we scribbled the names on a scrap of paper, Janet continued to critique her life and disease. I’ve had a tough life, raised two kids by myself, lived in California two times and moved back to Pennsylvania twice. All by myself. Don’t know how I did it. I pictured her standing in front of a masterpiece at some art gala, humbled by the inkblots and wiser from the smears, but standing tall and proud because of the picture she had created. It was a picture with irony and suspense, and she began to speak breathlessly as though she needed to complete her canvas before the ink had a chance to dry. I moved back from California because there were too many earthquakes. Moved back to PA because I thought I missed the thunder but turns out… I didn’t miss the snowstorms. Moved back to Cali to avoid the snow but the sun was incessant. So here I am, back where I started. Her soft laugh had returned, and this time I didn’t hear remorse, only acceptance.
As the session began to wrap up, I was struck by how our visit might have been a casual conversation between friends, rather than as caregivers following up on a terminal diagnosis. Janet’s descriptions of her disease were vivid and abstract, yet by casting her life so brightly, she had dimmed the shadow of her cancer. She had distanced herself from her model to view it holistically, yet just as an artist may struggle with a self-portrait, her final product seemed incomplete. It was as though she had tried to paint herself but had subconsciously cut off a few pounds, left out the blemishes and abandoned the wrinkles that had made her other painting feel so lifelike.
Yet perhaps this had always been Janet’s intention. To focus on living, rather than dying. To laugh rather than cry. Perhaps this was how she wanted to remember these months, and how she wanted these months to be remembered. At the end of the day, Janet was painting her final canvas. And she was ensuring that it would be filled with colors, complexities, run-on statements and chuckles – just as her life had been.