“Just Do It” — Nike

“Try not. Do … or do not. There is no try.” — Yoda, The Empire Strikes Back

“You must do the things you think you cannot do.” — Eleanor Roosevelt

”When you have exhausted all possibilities, remember this: You haven’t.” — Thomas Edison


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“Never give up. Never give in.” — Ihadcancer.com

The aquatic center where I swim for exercise has an Olympic length pool. Aspiring swimmers from club teams, high school, and junior Olympics all train there. So it does not surprise me that the large electronic activity board has a revolving display of inspirational quotes. The latest one is the title of this piece, “You can if you think you can.” When I read it, I immediately thought of a patient with stage IV lung cancer.

Case

A nonsmoker, 55-year-old Jane came into the emergency department (ED) less than 2 months earlier with shortness of breath. She thought her cough was the lingering effect of a bad cold until she started to struggle to breath. She told the doctor in the ED she was sure her cold had morphed into pneumonia. She had planned to see her own doctor the next day until her symptoms abruptly worsened. It was late on a Sunday when she realized she could not wait until the morning.

One of the first things she said to me was that the ED doctor was even more surprised than she and her husband were when tests revealed a mass in her right lung that nearly blocked it entirely. Further tests showed the mass was not just in her lungs, but had spread to her bones and liver. She didn’t know it at the time, but she was dying before she ever had a chance to start treatment.

But start she did. Unfortunately, even though she’d had 2 rounds of chemo, she became short of breath and was hospitalized. That was when I met her. In the course of the time between diagnosis and her return to the hospital, barely 2 months, her cancer had spread widely. Her right lung was essentially nonfunctional and her belly was filled with fluid. She could not lie flat because she could not breathe in that position. She felt terrible. Her difficulty breathing made her anxious. The stretch from carcinomatosis in her belly combined with the metastases to her ribs and pelvis kept her in pain. Our team walked into the room to meet her and she said, without any prompting, “I don’t want to be on any machines.” She was unable to string more than 5 or 6 words together before she experienced SOB, yet she managed to convey her wishes in a crystal clear fashion.

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The gravity of her situation was difficult to accept when she did not otherwise appear to be sick. She hadn’t been ill long enough to have lost significant weight and become cachexic. Her hair was a lustrous gray, enviable in color and still thick. It was knotted in a braid down one shoulder. Her husband shook his head when she said she did not want to be connected to machines.

“You can’t give up, darling. You can do it; I know you can.” I watched her smile at him, and it was clear that she saw and accepted his struggle. She reached over and patted his hand.