Sometimes It Won’t Get Better

She came to my office complaining of right hand weakness and severe, constant, distressing pain in her right shoulder and arm. As I examined the shrunken muscles in her hand and reviewed the data from her chart I began to feel a pit in my stomach. The patient was hoping that I would give her good news, but good news was not what I had to give.  I braced myself for the awful task of smashing her hopes forever.

“Please tell me that this will get better,” she pleaded. I looked into her frightened eyes and wanted so much to tell her that everything would be okay, and that she would get better. But I knew that she would not.
The brachial plexus is colored yellow in this image. (

“Let me explain what I think is going on,” I offered. I then spent a few minutes showing her a diagram of the brachial plexus, a network of nerves in the shoulder where the nerves to the hand come from. “This is where the nerves are injured,” I said, pointing to the lower trunk of the plexus. “This could be one of two things, and both of them are related to your history of breast cancer. The damage is either from the radiation therapy to your shoulder five years ago, or it is from the cancer cells growing back in that area. The fact that your cancer has returned within the past few months suggests that it is more likely the second possibility.” Both of these diagnoses are bad, and neither one will get better, but she had the worse of the two.

“How do you treat it? Can you make it better?,” she asked.

I looked into her eyes for several seconds, then shook my head and looked away. “This is a problem which cannot be fixed. We can help with the symptoms – we will do whatever we can to control this pain – but I cannot stop the disease.”

She stared at me for a long moment. “I’m sorry,” I said, as the tears began to fill her eyes.

But she was a fighter, a 5-year cancer survivor who knew how to get into battle mode, and she wasn’t going to give up so easily. “What if I exercise my hand?,” she offered. “Can I get the muscles to grow back?”

Again I shook my head. “A muscle won’t grow back if its nerve is dead.”

There was another silence, then more tears. “This is not what I wanted you to tell me!,” she complained.

“I know, and I’m so sorry,” I apologized. Again I emphasized that the way we could help her the most was with pain control, and I arranged for an urgent referral to a pain specialist. I tried to smile and project hope for the patient, but she was crying and I was hurting inside for her. As the tears fell down her cheeks I was smitten by my own powerlessness, my impotence to stop her disease or even to stop her sadness. She begged me to take back my diagnosis. “I hope I am wrong,” I said, although I was confident that I was not wrong.

After the visit was over I walked with heavy heart down the hall to my office, fighting to keep control over my emotions. I’m not the kind of doctor that normally hugs his patients, but I wanted to hug this one. I wanted to show her that I was a human being who cared about her suffering, and separate myself from the doctor who had just dropped a ton of bricks on her. If the doctor in me could not help her, then maybe the human being in me could.

I saw her once more about a month later, and her pain was not much better. Our discussion was more or less a repeat of the first visit. She never returned to my clinic after that, and she died less than two months later.

This is a severe example of a common theme I discuss with my patients all of the time: some things just can’t be fixed by medical care. Medical technology is amazing, and better than it has ever been in the history of the world, but it is not omnipotent. It gave this woman an extra five years of life, but it could only delay the eventual outcome of her illness, and once the disease returned there was nothing to stop it. Cancer is just one example of diseases which can harm the body in unrecoverable ways. Some problems are mild, like the scar that I still have on my hand from the burn I got when I was a kid, but others can be severe and disabling for the rest of your life. An amputated limb will not grow back. A bad stroke will leave a scar on the brain which will never heal back to the way it was before.

Doctors want to help people and fix things, but we are frequently confronted by our own limitations. I could not stop my poor patient’s pain, her tears, her sorrow, or her death. But there is someone who has promised to fix all of these things, in this life or in the next. “And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away” (Revelation 21:4). May that day come soon for you and for me!

Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.

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