She fought to live in face of certain death

Diagnosed with cancer, Dr Desiree realised how little doctors know about some patients desire to live

She preached the gentle gospel of her profession, persuading patients to confront their illnesses and get their affairs in order and, above all, ensuring that their last weeks were not spent in unbearable pain. She was convinced that her own experience as a cancer survivor — the disease was first diagnosed when she was 31 — made her perfect for the job.

In 2008, while on vacation in Boston, she went to an emergency room with a fever. The next day, as the doctors began to understand the extent of her underlying cancer, “they asked me if I wanted palliative care to come and see me.” She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a two per cent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more. She force-fed herself through a catheter and drank heavy milkshakes to keep up her weight.

Over the last decade, palliative care has become standard practice in hospitals across the country. Born out of a backlash against the highly medicalised death that had become prevalent in American hospitals, it stresses the relief of pain; thinking realistically about goals; and recognising that, after a certain point, aggressive treatment may prevent patients from enjoying what life they had left.

Desiree had gone into the field because she thought her experience as a patient would make her a better doctor. Now she came face to face with all the ambiguities of death, and of her profession.

She remembered patients who complained to her that she did not know them well enough to recognise that they were stronger than she had thought. Now she discovered that she felt the same way about her own doctors. “I think they underestimated me,” she said.

She came to question the advice she had been giving. She thought about quitting. “I just decided I have to believe in what I’m saying,” she said.

Desiree Dougherty was the overachiever of a modest family, the daughter of a sheet-metal worker and foreman and a nurse in Rockland County, about 30 miles north of New York City. She was 5-foot-1, with a wide, warm smile, a cascade of blond hair, blue eyes and a figure that turned heads. She loved the colour green; Pink Floyd; and sentimental books and movies, like Richard Bach’s novel ‘One’, about life’s choices, and ‘Pretty Woman’.

She met her future husband, Robert Pardi Jr, on her first day of college at Stony Brook University. She wanted to be a doctor; he wanted to make money. She began an MD-PhD programme at Mount Sinai School of Medicine in Manhattan at age 24. In 1998, she was halfway through when she decided to take a few months off to join her husband in the United Arab Emirates, where he was working as a portfolio manager.

It was bad news

She needed a routine health screening to obtain a visa to remain in the country, and opted for a more thorough exam. At the hospital in Dubai, she later explained, the custom was for doctors to talk to the husband, even when the wife was the patient.
So her husband came home early one afternoon, and instead of taking her out for Turkish coffee and sweets, sat her down and said, “I’m afraid it was bad news.” Further tests showed she had breast cancer. She had just turned 31.

When a doctor in Dubai suggested she wait a bit before getting a mastectomy, she would not hear it. “Off, I want it off!” she insisted.

After the mastectomy and months of chemotherapy, she was told the cancer was gone. Determined to try anything that might prevent a recurrence, she underwent a stem-cell transplant in 1999, before they were found to be ineffective for breast cancer. She had her other breast removed protectively.

Then what she had been dreading happened. During her residency, her cancer returned, invading her liver, and she was treated with drugs and surgery. Even after that, she was never fully in remission.

Chemotherapy had become a regular part of Desiree’s life, scheduled every Friday. In between, she tried to cram in her work; trips to Bash Bish Falls in Massachusetts, where a friend had a country house; playing with her Yorkie; and being “Auntie Mame,” as she put it, to her niece Jessica.

In the summer of 2008, she and her husband took Jessica to Boston for a weekend. After a day of whale-watching and visiting the ducklings in the Public Garden, Desiree woke up with a high fever. Her husband called an ambulance. She was admitted to Massachusetts General Hospital, and it soon became clear how far her cancer had spread.

A doctor asked if she would like a palliative care consultation. She was shocked; she interpreted the question to mean that she had been identified as someone who was dying, and she did not think of herself that way. She had crossed to the other side of the mirror, from doctor to patient, and she no longer saw an orderly path to death.

Months of constant chemotherapy followed. It kept her alive, but destroyed her appetite. Once an athletic 125 pounds, she had dropped to a sparrowlike 85. She lost her hair and wore a pixie-cut wig.

She and her husband tried to counter her weight loss. She snacked frequently. If she had an urge for a Big Mac, she would call her husband, who would rush to McDonald’s and deliver it to her office. He spent hours looking up high-calorie foods online, then made 1,100-calorie milkshakes laced with Brazil nuts, almond butter and Nutella spread. For several weeks, she received nutrition through a port in her chest while she slept.
Based on her symptoms, the standard medical advice, she said, would have been that she could no longer tolerate chemotherapy, that it “was going to become more of a burden than a help,” and that she should start to think about how she wanted to live out her remaining time.

But she did not want to stop even when she had exhausted standard chemotherapy regimens. So she turned elsewhere.

She said she thought of all the times that her own patients had argued that she was underestimating their capacity to get better. “Then am I writing them off too soon?” she mused. “When they do say, ‘Well, you don’t know me. I can, blah-blah-blah,’ that’s what I said, too, in my mind. ‘You don’t know me.’ You don’t know my husband, for sure.”

She feared that she could no longer, in good conscience, tell patients they were going to die when she refused to accept that her own death might be near. “And so I felt like, I feel like, if I now go and tell a patient what I used to tell patients, or what they would have told me, then I’m being hypocritical.”

She was 41 when she died in her husband’s arms on Sept 6, after two weeks in the hospital, seven years as a doctor and nearly 11 years with breast cancer. Her eyes opened in the moment before she died, her husband said, but she seemed unable to see anything.

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