Secrets and Sickness: When a Medical Emergency Reveals a Wife’s Long-Hidden History of Cancer

Fridays usually put Jane in a good mood but, as we walked together, I could see that something was wrong. Jane was very tall and thin, and she walked with a lanky person’s loping stride. She’d slowed a bit now that she was sixty, but today she was straggling. Even at my customary “Jane-adjusted shuffle”—the unhurried cadence I’d adopted to match hers—I was outpacing her.

I slowed down and asked over my shoulder, “Are you okay, hon?”

“Yeah, yeah,” she replied without looking at me, “no problem.”

But there was a problem. Her face was ashen and her lips were tinged blue. As we turned the corner in front of the Dining Pavilion, Jane abruptly sat on a low bench that I had always thought was too small to be anything other than ornamental. I leaned over to get a better look at her. She was breathing rapidly and had the sort of bug-eyed, frightened look you see on the faces of asthmatics who are terrified by their inability to breathe.

“Hon, you look like you’re having some serious trouble,” I said.

No reply. Just more shallow panting.

I had never seen Jane like this. I had no idea what was bothering her, but her distress was palpable.

“Listen,” I said, “I don’t know what’s going on, but I think we should get you to the ER.”

The Farber doesn’t have its own emergency room but its warren of third-floor hallways and bridges were connected to Brigham and Women’s, the large general hospital next door. We could take that route to the Brigham’s ER.

Jane looked up at me and nodded. That was a shock. In all our years together, Jane never, ever wanted to see a doctor or have medical care for anything. The fact that she wasn’t arguing with me was unnerving.

There was no way Jane could walk to the Brigham so I looked around for a wheelchair. There were none to be seen.

“Some hospital,” I muttered to myself.

The Farber’s Dining Pavilion is in the same building as its outpatient clinics. The bench Jane was sitting on was next to the elevators that service those clinics, so I took her hands in mine, looked her in the eyes, and—trying not to betray my fear—told her that I was going to get a wheelchair and that I’d be right back.

I hurried to one of the elevators and jumped in just as the doors closed. I pushed the button for the seventh floor, the nearest clinic, and held my breath. When the doors opened, I ran out. My look of wild-eyed panic must have made the nurses think I was deranged. I scanned the clinic’s waiting area but, again, no wheelchair.

Now I was frantic about having left Jane alone. I needed to get back to her. Instead of waiting for an elevator, I found a stairwell and flew down four flights, telling myself that I’d figure out some way to get her to the ER.

When I reached the third floor, I sped down the same marble hallway where Jane and I had been walking just minutes earlier. Rounding the corner in front of the Dining Pavilion, I was met by a horrific sight. Jane was sprawled on the bench where I’d left her. It was far too short for her height, so her head and legs draped awkwardly over its ends. Her eyes were closed and she was moaning rhythmically and loudly. A small crowd had gathered but no one was doing anything. They all knew Jane—everybody at the Farber knew Jane—but they’d been turned to stone by the transformation of their colleague and friend into a distressed patient.

I didn’t know what to do either. This semi-conscious woman moaning loudly on the bench wasn’t just anyone. This was Jane, my partner of thirty years. What was happening? Was she dying? She sure looked like she was dying. I desperately wanted to help her, but I couldn’t suppress my fear and confusion long enough to think straight. All of the usual tricks we doctors use to create a self-protective distance between an acutely suffering patient and our own psyches—a space that allows us to make an objective, rational plan to help—weren’t working. They couldn’t work. This was Jane.

I knelt next to her and cradled her head. Her eyes stayed closed, and she just kept moaning. The sound was otherworldly and terrifying.

“We need to call a code,” someone said softly in my ear.

He wanted to summon the emergency rescue team that responds to cardiac arrests. My god, these people think she’s dying too. I wanted to do something useful but all I could think of was to stroke her forehead.

A moment later, I heard the announcement over the public address system: “Adult Medical Response Team to the Dining Pavilion.” What an odd place for a code, I thought, until I realized who it was for.

After what felt like an hour but was only a few minutes, the code team arrived with their crash cart—a cabinet on wheels containing emergency medications and equipment. Someone on the team gently nudged me out of the way as he put an oxygen mask on Jane. Even through the mask, I could hear her moan with each breath. Two members of the team laid her flat on the ground and a third put in an intravenous line. All my usual instincts in this setting—to help insert another IV, to start the electrocardiogram, to prepare the medications—felt wrong. Those actions were meant to help other people, not my wife. I stood helplessly to one side.

Code teams are led by senior physicians who bark orders, military style, to the troops. The leader that day was Lisa, someone Jane and I had known for decades. Lisa was authoritative and radiated competence but, every few minutes, she would look at me, her face betraying a mixture of concern, bewilderment, and terror. I could only muster a blank stare in return.

At some point during the resuscitation efforts, a small trickle of blood appeared on the right side of Jane’s neck just under her shirt collar. It looked like it was coming from her chest. Lisa pointed to it and looked at me with a raised eyebrow that clearly said, “What the hell is that?” I gave a slight shrug and a shake of my head as if to reply, “I have no idea.”

Did I know where the blood was coming from? Maybe… no… I’ll think about that later.

After ten minutes of frenzied activity, Jane was no better. She had lost consciousness—her moaning had stopped—and her blood pressure was low. She was getting fluids through her IV and oxygen through her mask, but she would need to be moved to the ER for more intensive treatment. For liability and, I suppose, good medical reasons, Dana-Farber’s policy was not to transport unstable patients through the hallways to the Brigham. Instead, a Boston city ambulance would have to convey her across the two hundred yards that separated the Farber from the Brigham.

With a sickening rush, I got it. It was a breast cancer—and it was enormous, a massive tumor that had turned black because it was infected and rotting.

Someone had already called the ambulance, and it soon arrived with lights flashing and sirens wailing. A minute later, two EMTs appeared and muscled aside the code team. With reassuring efficiency, they hoisted my unconscious wife onto a gurney and sped her into a waiting elevator. At street level, they loaded her into the ambulance and took off for the emergency room.

The EMTs said they wanted to transport Jane without me. I was too flummoxed to argue, but as soon as they drove away, I started worrying that she might die in the ambulance. Or what if she didn’t die? What if she woke up? She’d be terrified and I wouldn’t be there to comfort her. Those thoughts kept pinging around in my head as I walked alone through the third-floor hallways and bridges to the Brigham ER.

A lot of time had passed since I’d taken care of patients in the Brigham ER—I was now a researcher and administrator—and the hospital had undergone major renovations since then. So, as I emerged from the bridge connecting Dana-Farber to the Brigham, I realized that I had no idea where the ER was. It certainly wasn’t where it used to be. I was lost.

Someone must have taken pity on me and pointed me in the right direction because my next memory places me at a nursing station in the ER, just outside the treatment room where the EMTs had taken Jane. Looking through the open door, I could see her lying on a bed. The ER staff must have thought that she was in pretty bad shape because, in the short time it had taken me to walk over, they had inserted a breathing tube into her trachea and put her on a mechanical ventilator.

My wife was intubated and on a “vent.” This was inconceivable. I tried not to think about what would happen if she were to die; the implications were too horrible. I needed to get through this acute crisis first. Then I’d be able to think about the future. For now, I told myself, just put one foot in front of the other.

From my vantage point outside the treatment room, I had clocked the breathing tube and ventilator right away. What took a little longer to register was the thing on Jane’s chest. The ER workers had removed Jane’s clothes and partially covered her with a hospital gown, one of those “johnnies” that opens in the back. They were bustling around her, putting in more IV lines and hooking her up to a heart monitor. In their haste, they had left Jane’s chest partially uncovered.

Even at a distance of fifty feet, I could see a large, irregular black object on the right side of her chest. It was about the size of a football. Angrily, I wondered if some callous ER worker had left a piece of equipment there, using Jane’s body as a table.

No, that wasn’t it. The thing seemed to be attached to her, growing right out of her chest where her breast should have been.

What the fuck is that?

With a sickening rush, I got it. It was a breast cancer—and it was enormous, a massive tumor that had turned black because it was infected and rotting. Oh, my god, this thing is out of control and it’s killing Jane.

My head reeling, I started walking toward Jane’s treatment room when one of the ER doctors stopped me.

“Are you the husband?”

I swiveled to face him.

“Yes,” I replied.

“What’s the story?”

“Well,” I said, “she collapsed while we were walking to lunch. She looked like she was having serious trouble breathing.”

“I know about that,” he said dismissively. “We think she probably had a large pulmonary embolus,” a blood clot lodged in the vessels of the lung. “I’m asking about the mass on her chest. What’s her cancer history?”

Did I know anything about Jane’s cancer history? Maybe… not really… can’t talk about it…. I froze for a few seconds, a deer in the headlights.

“Sorry, I really don’t know,” I finally murmured.

I felt humiliated and angry that an old, ill-considered promise to Jane made it look as though I, her husband, knew nothing about the hideous cancer that was threatening her life.

I watched the ER doctor’s face as he processed my response. It took him a few seconds to figure out what to say next.

“Okay. Well, like I said, she probably had a PE. We’re guessing that it’s pretty massive because her numbers are terrible. Her pO₂is low, even on one hundred percent oxygen through the ventilator, and her pH is only six point eight.”

He was giving me Jane’s blood test results doctor-to-doctor, figuring that I would know what they meant. I’m sure that slipping into “professional communication mode” was a way for him to avoid having to think about the bizarre situation he had stumbled upon. But he was right: I did understand the numbers. Jane was having an even harder time breathing than anyone had realized, and her body’s metabolism was severely out of whack. Back when I was a clinician, I had taken care of a few patients with these kinds of numbers. They were all intubated in the intensive care unit, and they all died.

“We’re going to take her to radiology,” he continued, “for a CT-angio.” They were planning a CT scan plus an angiogram to look for the pulmonary embolus. “If there’s a clot, we’ll try to break it up with TPA”—a drug that dissolves clots, it would be the fastest way to try to restore blood flow to Jane’s lungs—“but if that doesn’t work, we’ll have to take her to emergency surgery to remove the clot.”

Emergency surgery? Things were spinning out of control. The rational part of my brain understood perfectly well what I was being told. Jane had become a big, complicated medical case that required an all-hands-on-deck response. We used to call this a “flail,” and there was no doubt that taking an unstable, intubated patient to radiology to perform a CT-angio would be a huge flail. And I was grateful that the team was willing to make the effort. But this was Jane. The ER doctor had the luxury of putting some of that handy psychic distance between himself and the patient. I didn’t. I was still stunned and felt like I was being carried downstream by a swift current that I was too weak to fight.

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