Linda's Legacy

I stood outside the exam room reading the chart of a new patient and inwardly groaned -- a young woman referred by a surgeon for pre-operative chemotherapy -- 38 years old, inflammatory breast cancer, hormone receptor negative -- bad prognosis. I entered the room and met Linda; tough, hard and scared were the first things that came to mind. Linda had short blond hair, a square jaw, callused hands, and work boots. She was accompanied by her sister and a friend. I went through the usual doctor rituals -- history, physical, discussion of treatment options and finally a mutually agreed upon treatment plan. However, throughout the encounter there was a subtle sense of mistrust. I wasn't quite sure where I stood.

Linda and I got to know each other very well over the next two years - monthly chemotherapy, surgery then radiation, then recurrence in the other breast, more chemotherapy, more radiation, and finally a bone marrow transplant. Several months after the transplant the breast cancer came back -- we both knew that the "endgame" had been reached.

Throughout her illness the one constant issue of discussion was how she could continue to remain working. Linda worked third shift in a local factory; hard, physically demanding work, it was her sole source of income. The loss of financial independence was her greatest concern -even greater it seemed than overcoming the cancer. For the most part she succeeded, working through virtually all the treatments. Linda never talked about her family, except for the one sister who sometimes came to clinic. Linda was lesbian, she did not have a current lover, but she did have a group of close friends, at least one always seemed to be with her in clinic.

It didn't take me long to figure out that Linda was a wounded individual. Something in her past had made life very difficult for this very intelligent and insightful woman. Linda had an edge, a veneer of toughness that was palpable. At first I thought it was connected to her work, but I really didn't know. Over time the edge she brought to clinic softened, trust emerged, an occasional smile, a laugh and sometimes a mischievous twinkle would appear in her eye. Linda had a presence - hard to explain, but all of us who worked with her came to recognize it. During the two years I knew Linda, the other doctors caring for her -- the surgeon and radiation oncologist, the clinic nurses -- all would stop me in the hallway and make a special point of asking, "How's Linda?" There was something special in the way she touched others.

Linda accepted the end of her disease in the same way as all the events of the two years, with dignity and grace; she wanted no heroics, expected no miracles. When she could no longer work Linda moved to central Wisconsin to live with her sister. Home hospice services were begun and I continued to be involved in her care, albeit at a distance. One month before Linda died she called me and said she was coming to Milwaukee and wanted to meet me in my office, my regular office, not the clinic. I hadn't seen her in several weeks. The changes were obvious, dyspnea from a recurrent pleural effusion and ascites, sunken cheeks. We made small talk for a few minutes and then she reached into a bag. She had gifts for me: a two inch tall ceramic wizard -- as she handed it to me she said. "This is to remind you that you are not a wizard, that you cannot cure all your patients," (the wizard still sits on my desk), and a bag of marbles, "so that you will never lose your marbles." She also asked me something no patient prior or since has ever asked, "I would like you to say the eulogy at my funeral." I was a bit stunned -- gulped, nodded and said that I would be honored -- I hadn't a clue as to what I would say.

Linda died peacefully, surrounded by her friends and her sister. I met them at the funeral home an hour before the service and paid my respects. It was then, the hour before her funeral service, that it all came together for me. I was introduced to her parents and her other siblings. Linda had never spoken of them. Her friends took me aside and explained -- Linda had been ostracized from her family because of her sexual orientation. Her family had only been in rare contact with her, even up to the day she died. I didn't know how much of that was Linda's wish or her family's -- it really didn't matter. Now it all made sense; the edge, the toughness, the desire for financial independence -- what had been unspoken for so long was now clear.

Six years went by and then the most extraordinary thing happened. Our palliative care nurse told me that a long-time clinic patient, a woman with sickle cell disease, had recently died, and wasn't it great that two months before she died she had received the annual gift from the clinic nurses. "Annual gift, what annual gift?" I asked. She said, "You know, the one that has something to do with one of your former patients." I had no idea what she was talking about. I went looking for the clinic nurses and they told me the story.

The year after Linda died, one week before Christmas, a group of Linda's friends came up to the clinic and handed over several hundred dollars to the nurses, asking that the money be given to a needy clinic patient as a Christmas present. The nurses were to make the choice, preferably a single, working mother. Every year since then, the same friends, at the same time, arrive with the same gift and the same instructions. No hype, no fanfare, just a simple gift of charity; a gift laden with meaning and memory of Linda.