At first, they thought the pain was just a side effect of her cough. Doris Roberts believed her medication was causing her abdomen to ache, while her son Rob assumed her heavy cough was hurting her ribs.
So Doris settled into a routine that last week of June: unpack a few boxes in the morning, as she settled into the new addition on her son's house she had just moved to from Virginia, and in the afternoon, lay down with a heating pad on her abs.
On the third of July, though, that routine was jostled as Doris slept later than usual. Her upset stomach intensified her pain, sending Doris and her daughter-in-law to the emergency room at Madigan Army Medical Center. She would never return home again.
Instead, the doctors admitted her directly into inpatient status; her white blood count was too high, and they found a lot of masses in her abdomen as well as her chest cavity, Rob said.
While the news upset Rob, his mother said, "Look, I don't care how bad it is; I didn't come all of the way out here to get taken out this quick, so we're going to fight it with whatever I have, and then some, so I need you to be the rock."
"I said, 'Okay, then that's what we'll do," said Rob.
He had already heard of the high caliber of Madigan's oncology team. "I already knew that if it was going to be cancer, that she definitely was going to be in the right place," he said. "I was very comfortable with that."
What followed was a week of tests and waiting for the results as his mother's health deteriorated. She left to go to hospice care while they were waiting on test results, but returned just two days later.
"She just totally crashed, nose-dived, and by then somebody had results … saying yes, it is indeed cancer," Rob said.
As an inpatient again, the Roberts met Madigan's palliative care team -- a group of physicians, nurses, social workers and chaplains who provide an extra layer of specialized care for patients with serious illnesses.
Dr. Diane Faran, a palliative care physician, whom Rob calls "one of the most caring doctors I've ever met," made a significant impact on the family. It was Faran who explained the reality of Doris' stage four terminal cancer.
"She explained they didn't know what type of cancer it is, it's everywhere, and it's accelerating and spreading at a massive rate," Rob said. Faran simply told Rob the truth, "This cancer is not going away; we can't even treat it. There is nothing that we can do but make her comfortable."
Faran went on to walk them through whether to put a do-not-resuscitate order in place. (Helping families through complex decision making is a part of palliative care.)
In fact, Rob said Faran and the rest of the palliative care team helped his family through all aspects of their's and his mom's needs. From social work to legal services to finding a chaplain, "There was no part of this process that they didn't cover, introduce me to the people, or had the people come up to meet with us."
As her illness progressed and Doris lost her ability to speak, Faran also taught them how to communicate with her and what else to expect. They learned that when her breathing got shallow, to check her pulse -- it was a much more reliable read on her status. If her eyebrows furrowed, it was a sign that she was in pain. If they asked her questions, she could answer yes by squeezing their hands, or with a nod or a blink.
When Doris' family members flew in from the East Coast, they gathered around her hospital bed. While Faran was explaining to Doris' brothers and son what the physical signs meant, Doris opened her eyes and looked around.
"She is looking to see who's in here, because she can hear your voices," Faran said to the family. Regardless of the medications she was on or her cancer, she assured them, "She is still very much here. Don't you guys not believe it."
With that awareness that Doris was still present, her family -- brothers, sons, daughter, grandchildren -- all said their goodbyes.
Chaplains visited, prayed with, and anointed Doris on her last day, July 25. The certified nursing assistants who took care of her asked to care for her body after she passed, too. Staff and family cried together.
"The level of compassion that was displayed the whole time my mom was here at Madigan -- you just can't put words to it," said Rob. "They were extremely professional but at the same time they were personal, they were human about it."
Rob spoke of the compassion provided to his mom from the ER to her inpatient floor care team to the palliative care team.
"I totally felt it was family taking care of family the whole time in this hospital," he said. "We morphed all of the doctors and nurses, the CNAs and the palliative care team -- they became a part of our family in this uncomfortable and heartbreaking moment in all of our lives."
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