When Katya’s Russian doctors exhausted all treatment options, she boarded a plane in Moscow and arrived 36 hours later in our small American city where her sister lived. In the airport, hugs were exchanged, a few tears were shed, and then they drove straight to our emergency room doors. Soon after, exhausted and painful, Katya arrived on our oncology unit. She cradled her left arm at an odd angle. When I introduced myself as her nurse, she looked at me without responding. Her sister interpreted, explaining that Katya spoke no English. Gently, I helped Katya undress and noted a rotting smell exuding from her body. As the clothing came away, I saw the source of her misery. Protruding from her left upper chest was a grotesquely large, draining, cancerous growth.

For months Katya came and went from our oncology unit. The language barrier between us was significant, but over time we created our own language of signing, smiling, and occasionally laughing. When in doubt, Katya would talk to me in Russian. I, in turn, would respond in English. Neither understood the words, only the intent.

To say that Katya spoke no English was not exactly true. She knew two English expressions: “Thank you” and “I love you.” Soon after her arrival, she began sprinkling these expressions liberally between the gaps in our communication. At first I was surprised to hear her say, “Thank you, Reeger. I lufve you.” I wondered, did she really mean that she loved me? Was it appropriate for me to respond with, “I love you, too”?

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In medicine there are emotional lines separating providers from patients, lines meant to keep us objective, thereby protecting us from grief when life’s hardships unfold before us. However, given the fact that Katya and I only had five words in common, my concerns for objectivity versus love seemed existentially misguided. I could not struggle to communicate with Katya, then deny the use of the few words we shared in common, even if in so doing, I ran the risk of becoming emotionally vulnerable.

Initially, with radiation therapy, her tumor shrank, but then it grew again. A CT scan was completed. Katya understood that the doctors were worried that the cancer had spread, but because of the language barrier she couldn’t ask them. So she asked me. While pointing to her liver, she spoke rapidly in Russian, ending with what I assumed was the Russian equivalent of, “Well?” Even when speaking the same language, it is difficult to tell someone she has metastatic cancer. The irony was that our hard work of learning how to communicate had paid off, and now I was the one she turned to for the truth. I hesitated in responding, not wanting or even knowing, how to tell her.

She saw my reluctance but would have none of my sentimentality. She looked me hard in the eyes and then firmly pointed to her cancer, then her liver, and then crossed her arms over her chest, closed her eyes, and for added effect, stuck her tongue out the side of her mouth. When she opened her eyes, she saw my eyes had filled with tears. Quietly, we looked at each other. Finally, she simply said, “Okay.” Katya died peacefully at her sister’s home not long after. 

Fifteen years have passed, and now I am a family nurse practitioner. Over the years, I have learned many lessons about the art and science of medicine, but no education has affected my practice more profoundly than my experience of caring for Katya. Keeping an objective distance from the hardships before us does not protect us from grief. But neither does crossing the line of objectivity into emotional caring make the grief any worse. Given these facts, why not transcend the emotional barriers between provider and patient? What waits on the other side is not a lesser or weaker version of our professional selves, but rather a stronger, more balanced one, a professional who understands that even though the science of medicine is amazing, ultimately, what we all need is the art of medicine. Therein lies connection, and therein lies our universal need to give and receive human compassion.—Reeger Cortell, FNP-C, Medford, Ore. 

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.