This week I had to break bad news to a 93 year old lady who had been pinning all her hopes on more treatment for her recurrent cancer. Hormone therapy has kept the beast under contol for several years.

Six weeks ago she was independent, only needing assistance to make the bed and have meals prepared for her. She was walking to the dining room, enjoying company of others, and managing her own medications.

We did an advance care plan, and knowing her medical history we talked about the fact that she was still fit and well, but that her tumour marker was rising and she could be a candidate for further treatment.

She gave ma a bit of cheek, told me she didn’t need my services yet, and had no intention of needing them in the near future. We parted friends, mission accomplished, and hoped we would not have to see each other again for a long time.

As I left the room I said “see you soon”. She replied “I really hope not!”.

Two weeks later incontinence became a problem and some bleeding. She told me she had ‘pressure’ and ‘discomfort’. And the dreaded constipation. The blood test showed a large rise in her tumour marker. We talked about what this could mean.

“I’m not ready to die yet”, she said.

We arranged a CT scan. I expected the worst, she hoped for the best. I still thought she was well enough for single agent chemotherapy for symptom management. Her oncologist agreed with me.

Unfortunately the results were not good. A week after the scan I visited and we used modern technology to connect with the oncologist. Together, we broke the bad news. She was now not well enough for chemotherapy.

Thanks to COVID19, and our new ways of working, she had the best of both services. A caring oncologist she has known for many years, available and visible, even if on the other side of town; and a palliative care specialist by her side offering support and to step in to provide symptom management.

I feared she would deteriorate quickly, and may only have weeks left to live.

As I left the room I said “See you next week”. She replied “Do I have to wait that long?”.