Nessun Dorma and Socks
“For me, music making is the most joyful activity possible, the most perfect expression of any emotion.”
Cabot’s Story:
Cabot wasn’t feeling well that morning and asked his wife to tell the palliative care nurse practitioner knocking at their door to please reschedule the visit. While relaying this message, his wife looked a bit like (an exhausted) deer in the headlights. The nurse practitioner (NP) suggested that it might be all the more important for her to see Cabot, assess him and hopefully be helpful. Cabot may have wanted to delay the visit, however, his wife Emma looked worried and in clear need of support. She welcomed the NP in while wondering how her husband would react.
Cabot was in the back bedroom which was crowded with extra dressers, a desk, and bookcases filled to overflowing, with barely enough room to circle the bed. It had been a long night he explained, because he was experiencing “severe” pain in his hip from prostate cancer that had spread to his bones. There was a new prescription for an opiate in the house, but he said he was reluctant to try it. After discussing how the pain was impacting his sleep, ability to function and mood, he agreed to take it while the NP was there and could monitor him. The NP squeezed in a small folding chair and sat down next to him for the visit.
As the medication took effect, Cabot began to look less tense and started to tell his story. He described frequent trips to a major medical center for his cancer treatments and that these trips were getting increasingly burdensome for both him and his wife. Emma was managing his complicated medication regimen, as well as the cooking, cleaning, laundry, and errands. There was no extended family, but they had close friends who would visit when they could to help out. He understood that his cancer was progressing given the results of his latest scan. What would happen, he wondered aloud, if he stopped his treatments? Would that mean palliative care or hospice or home care services? Who would be there? Could he stay home? Could he stay out of the hospital? How much time would he have? Different options were discussed and considered.
When talking with patients about their medical history the NP would frequently ask: “What still brings a smile to your face?” There were a few reasons for this. One, it was a way to offset the usual questions regarding medical “problems”, distressing symptoms, or loss of function that often emphasized the negative, the “take aways”. In addition, the answer to this question could offer a glimpse into what continued to bring meaning and connection to a person’s life as they coped with a serious medical condition. When Cabot was asked what made him smile, he had no immediate response. Then he said that he felt like he could get up now and go to the bathroom. So, the NP joined his wife in the kitchen to review his medications. Emma shared her sadness about her husband’s decline, however, she was also relieved that they were finally talking about it. She expected that they would need a hospital bed soon and wanted some advice on where to put it.
The Rest of Cabot’s Story:
When I returned to the bedroom, Cabot was standing at the foot of his bed, still in his underwear, looking at his laptop. “Come see what still makes me smile”, he said. Then he started to play a YouTube video of Luciano Pavarotti singing Nessun Dorma and while we listened, he began to weep. I wrapped my arm around him and we stood side by side until the last breathtaking note. An intimate moment that is hard to capture in words. A short time earlier we had never met and now teary eyed, and arm in arm, we were sharing Nessun Dorma.
We planned to meet again at the end of the week to re-evaluate Cabot’s pain and to talk more about the goals for his care and what the next steps could be. As I was leaving, Cabot began to yell out from the back bedroom “Emma, give her a pair of socks!”. It turns out that Cabot distributed socks out of his house and had boxes of them. I politely declined, and his wife arched an eyebrow and insisted that I “best take a pair”. After a few more visits, and a couple of pairs of socks later, Cabot and his wife made the decision to stop his treatments. His advance care directives were updated with a MOLST (medical order) form that included Do Not Hospitalize. Cabot and Emma felt that hospice, along with a caregiver to help with housekeeping and meal preparation, would provide them the ongoing support they would need to honor his wishes to stay home and to die at home.
Every time I put on a pair of his wool socks, I think of Cabot, Emma and Nessun Dorma. How lucky was I to share that moment in time?
(Watch Pavarotti’s face following the last note in the video below – he is transcended.)