by Kelly Parsons, MD

“It’s never as bad as you think.”

“Excuse me?” I turned to the middle-aged woman, standing next to me at the coffee service in my hospital’s cafeteria.

“It’s never as bad as you think.” Plain white blouse and pressed tan slacks. Clear plastic tubes—nasal cannula—snaking from her nostrils and behind her ears to an oxygen tank on the floor at her feet. The tank was tucked into a rolling luggage bag decorated with colored polka dots.

“I had a CT scan today,” she said. “My son usually takes me. But today he couldn’t. I was so worried! So I prayed to the Lord this morning that everything would be okay. And it was! I got down here just fine, and I got my CT. It wasn’t so bad.” She poured creamer in her coffee. She had tremors and nearly spilled the creamer over the side of the cup. “It’s never as bad as you think, doctor.” She looked at me, and her smiled tugged at the nasal cannula.

Had she read my mind?

I’d had a long day, and it wasn’t over. A moment earlier, I’d been feeling very sorry for myself, and thinking: yeah, things were kind of bad. Looming work deadlines; trivial grievances; perceived slights.

This woman’s lungs were failing her from any number of possible diagnoses—cancer, pulmonary fibrosis, emphysema. She needed bottled oxygen to breathe. And she was happy about a CT. About getting a CT. She didn’t know the results. For all she knew, her condition had worsened, and her doctor would soon be calling with bad news.

But results would be for a different day. Today had been a good day.

Because she’d gotten her CT.

And it hadn’t been so bad.

I was ashamed.

I smiled, stammered my agreement and wished her a pleasant evening.

“You too,” she called after me as I headed for the checkout line. “I hope you have as wonderful a night as I’ve had a day, doctor.” She waved cheerily. My own smile widened.

I was still grinning as I walked outside, headed toward my next meeting. The early evening was warm and clear. I was still ashamed. But the woman’s unprompted kindness had brightened my mood, and dissipated my cloud of self-absorption.

It’s never as bad as you think.

I stopped in the failing light.

And I thought of Beth.

It’s never as bad as you think.

It was exactly the kind of thing Beth would have said.

Beth: my friend and colleague for the better of a decade. Healthy, active, and fit as she’d edged toward sixty. She’d dated Tom Selleck briefly during the early 1980’s, in Hawaii, where she’d worked as a scrub nurse. She loved to tell that story. Such a gentleman, she’d say. She kept a picture of Magnum PI taped to the cover of a three-ringed binder in her office.

She’d never smoked a day in her life.

The pain began in her back and soon spread to her hip; a nagging pain that worsened with standing and movement. Her doctors had expected the MRI to show, perhaps, a herniated disk—certainly not the tumors that riddled her spine. CTs and biopsies confirmed the diagnosis: aggressive adenocarcinoma of the lung with numerous skeletal metastases.

Stage IV lung cancer.

A death sentence for most.

Beth knew that.

Did I mention that she’d never smoked a day in her life?

The chemotherapy, advanced immunotherapy, and radiation worked, for a time. The tumors shrank. The pain receded. After her hair fell out, she favored wigs and colorful headscarves. She complained good-naturedly about the steroids, because they made her feel puffy, and swelled her feet until she couldn’t wear her favorite shoes.

The irony was not lost on her: healer had become patient. Perhaps that’s why the first thing she wanted to do once she felt better was to go back to work. Nursing was her calling; caring for cancer patients her passion.

She could no longer stand all day. Working in clinic was out of the question. We instead assigned her to phone triage. It made her so happy, consoling patients over the phone. Some knew of her diagnosis, others didn’t. Beth seemed to sense who would benefit from her own experience and who would not.

Cancer can be devious. Cancer can be relentless. Beth’s was both. It shrugged off the treatments and returned to dismantle her, piece by piece. Beth didn’t so much fight the cancer as disavow it, focusing her waning vigor on those around her. She worked the phones; took patients to lunch; celebrated her daughter’s engagement; drank wine with friends. The more the cancer took, the more she gave. And as her body shrank, the bigger she seemed to grow.

When she could no longer walk, she could no longer work. Reluctantly, toward the end, she gave up even the phone.

It’s been nine months since Beth died. When her patients, the ones she comforted as she herself was dying, return to our clinic, we hug, and cry together, and celebrate Beth. That is her legacy.

Bodies wilt. Organs weaken. Limbs cease to respond. But Beth, and the woman in the cafeteria, reminded me that selflessness endures; and that compassion provides dignity and grace long after the body cannot.

I’ve never suffered from a life-threatening illness. I don’t profess to possess the wisdom of those that have. My time will come. I hope when it does, I’ll remember.

It’s never as bad as you think.