Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

by Patricia Yarberry Allen, MD | bio

My mother-in-law, Natalie McIntyre, is my idol. Eighty years old, she comes from strong, Depression-era Swedish-American stock. She is an autodidact on a level matched only by the likes of Abraham Lincoln.

Her passion for social justice, theology, Jungian psychology, the Saturday afternoon Metropolitan Opera performances (she listens on the radio), politics, conversation and great food cannot be described with words, only witnessed with awe.

In the fall of 2007, around Thanksgiving, Natalie lost her verve. She found daily activities required more energy than she had. She soldiered on — out to dinner, playing with the cats, listening to music, managing her home and extended family — but she became exhausted so easily. It didn’t make sense to her.

Natalie has had long-standing and well-managed coronary artery disease, so the worsening fatigue and shortness of breath was assumed to be, well, just the heart getting weaker. The lung doctor did a CAT scan of her chest and told her that nothing had changed. The heart doctor recommended an expensive and invasive test, a coronary angiogram.

She had this test six years earlier at a wonderful Midwestern hospital and diagnostic center. It was determined at that point that she was not a candidate for the surgical treatment recommended by her local medical team. Besides, she had already decided she was not going to be operated on.

I had not seen my mother-in-law for a few months since a nasty cold kept me away at Thanksgiving. I had spoken to my husband’s sisters since then and understood that something was really not right. So, as a family, we decided to seek an opinion about these symptoms and the recommendation for further cardiac evaluation.

My husband and I met his parents at the swank hotel on the hospital campus. We had a superb lunch, and I had the opportunity to care for my mother-in-law during her three hours of testing prior to the visit with the cardiologist.

I began my medical career as a nurse’s aide in a small hospital in the Kentucky town where I grew up. I know instinctively how to undress, bathe and comfort those in distress and care for those who feel uneasy about loss of dignity or independence. Natalie was in a wheelchair for the journey between hospital wings between each test. I undressed and gowned her each time. I wore her 100-year-old bishop’s cross between the tests. She was very tired, but she always found a way to notice each person’s effort and kindness.

At the end of the day, we expected to have the recommendation from the cardiologist, followed by dinner and all of us leaving for our distant destinations. There were four of us present in the room when the doctor came in after reviewing the exams.

“So,” he said to my mother-in-law, “Exactly why did you come back to see us?”

“I have this terrible fatigue that is getting worse and now I am short of breath when I walk,” Natalie said.

“Well,” he replied, “that is understandable since you have a significant anemia, and it appears to be new.”

“What is the red count?” I asked with considerable anxiety.

“Seven,” he replied. I jumped up and went to the computer and found even worse news. White cells and platelets way below normal. This was not going to be a simple consultation about managing a worsening heart problem.

The doctor told my mother-in-law that she would be admitted to undergo more blood tests and perhaps a bone marrow aspiration. She would be given some blood transfusions, and we would have an answer within a day. She had a very dreary hospital meal and a restless night.

Very late the next day, the leukemia expert came to call. He had reviewed all the tests and had brought a yellow pad and pen. He gave the autodidact her tutorial in leukemia.

He outlined the treatment options with clarity. He chose his words carefully and with compassion but never veered off that narrow winding lane of medical truth. He discussed the unfortunate factors that age and pre-existing heart and lung conditions would have on the grueling treatment of acute myelogenous leukemia, her diagnosis.

He explained the risk of death from the in-hospital treatments (high) and the possibility of remission from treatment (low). Alternatively, he said, treatment could be arranged in her community so that she could be with friends and family.

“Does anyone ever agree to this?” Natalie asked him.

“Well, yes,” he said. “Many do.”

“Well, I understand you just fine, young man,” she said to this senior consultant. “But I will be going home after the transfusions are finished. This kind of treatment is not for me. I have had a wonderful life, and I intend to enjoy every day I have left.”

He explained that she could leave the next morning and that he would recommend a leukemia team in her area, along with a supportive care group.

“I am not eating this hospital food,” Natalie asserted. “I will have dinner sent up from the fabulous restaurant in the hotel in the building right next to this. And, I am having a glass of wine with my dinner.”

“You can’t do that,” the somewhat shaken specialist said.

“Yes she can,” I interjected. “You have just told her that she has leukemia and she has made a decision to have no debilitating treatment. She has a glass of wine every night with dinner. There is no contraindication to a glass of wine with a blood transfusion.”

I could see that this really nice guy had no interest in picking a fight with the two of us.

“I won’t get in your way,” he said.

My first job was to get the restaurant menu and wine list so that Natalie could make her important choice for the day: appetizer, entree and the best glass of wine to accompany them. Then I took the orders from my stunned father-in-law and husband and dealt with the manager of the restaurant. I wanted a waiter, china, silver, linens and champagne glasses. I wanted them all in an hour when we would gather in that hospital room for dinner.

“She has just been told she has leukemia, for God’s sake,” I said to the restaurant staff.  “I am giving her what she wants, and I need your help.”

Red roses adorned the windowsill and the night sky was blinking with city lights from low-rise buildings. The heavens were visible to us as we sat down to dinner. Natalie had a transfusion of life-giving blood in one arm, and in her other hand she held a glass of her favorite champagne. We toasted to sunshine and champagne.

My heroine is home now and has renewed energy. She made all the calls to the many who love her. She had quiet talks with her adoring daughters. Her trainer and hairdresser came to the house. She went to church this last Sunday, the Episcopal Church that has been so central to her life. Dinners are planned with care. Music and movies at home continue. The family grieves but has joined her in this courageous journey, finding meaning in every moment.

I will always treasure that vista out the hospital room window, champagne glasses raised to celebrate life with a woman who knew who she was and how she would live.

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  • Willse Elizabeth May 21, 2009 at 3:10 pm

    Snif… Found this in the archives while I was doing site updates, and got all choked up. Gorgeous writing!

    Reply
  • Barbara Thornbrough February 5, 2008 at 9:08 am

    Dear Dr. Allen,
    What a great story this is for all of us who have had to battle with family and Dr’s who do not wish to respect the wishes of a terminal patient. This celebratory tale is a tribute not only to Natalie but to you, Dr. Allen for accepting a life altering and difficult decision.
    I raise my glass to you Pat and to Natalie for your wonderful relationship and for the courage you both showed in making a heartbreaking decision a time of inner peace and joy.
    Cheers and thanks for the story. Barbara Thornbrough

    Reply
  • Lorraine DeLuca February 2, 2008 at 12:13 am

    Dear Pat,
    I am sorry that your mother-in-law and your family had to hear such devastating news. Natalie is a wise woman and she is lucky to have such a wonderful daughter-in-law. I only wish that my father had made the same decision by choosing no treatment for his cancer at the age of 84. The last few weeks of his life he suffered so. I still have trouble thinking about it. May she continue enjoying her dinners, her wine and her family for her remaining days. Thank you for sharing your story with us.

    Reply
  • Ellen Flamm January 29, 2008 at 9:11 pm

    I applaud you, Pat, for highlighting what I consider to be one of the best ways to let go of life: with loved ones around you, with the ability to make decisions for yourself, to be able to enjoy the beauty of life for as long as it lasts. I hope all those who love and appreciate her can enjoy, applaud and be with her as she makes her last journey. I thank you for making me clearer in my own resolve. I hope I am as lucky as your mother-in-law (and have you to stand by me.)

    Reply
  • Elizabeth Zarelli Turner January 28, 2008 at 9:45 pm

    Dearest Pat,
    May we all have the courage that Natalie has to say no to extending our lives when we have lived them to the fullest. But may we also have a Pat Allen in our lives who will bring us champagne, a fine meal, linens and fine cutlery. Or may we have a Pat Allen who, when we lose an infant son, will enfold us in that same love and care. Thank you once again from the bottom of my heart, Elizabeth

    Reply
  • Finele January 28, 2008 at 5:16 pm

    What a beautiful essay!
    my eyes are filled with tears
    of the sadness in loss
    of the fear of disease
    of your love so heartfelt
    of the joy in celebration
    of one’s life choices
    such eloquence in your expression

    Reply
  • Cecilia Ford PhD January 28, 2008 at 5:08 pm

    Dr. Allen’s comments about her brave and wise mother-in-law underscore how frequently many of us hang onto life, at the expense of truly living.
    Last year, my husband, at age 54, also received a diagnosis of acute myelogenous leukemia. Because the prognosis for people under 65 is significantly better, he decided to go ahead and tolerated 8 months of painful treatment, many of them in the hospital (and yes, I catered every meal–I’ve learned a thing or two from Dr. Allen.)
    I’m happy to say he has been in remission for 7 months and, though the future is uncertain, has reason to hope.
    Quality of life is important, as is the need for doctors to be straightforward about prognosis, since it is difficult to make an truly balanced decision otherwise. Medical professionals as well as patients are often afraid to discuss the specifics of a frightening diagnosis, but is very important to ask for as many details as possible.

    Reply
  • Elena A. Brim January 28, 2008 at 4:56 pm

    Thanks Pat for sharing this with me. Now you’ve made Natalie my role model. I honestly wouldn’t know what to do faced with such a decision. Hopefully, I never would.

    Reply
  • elaine lafferty January 28, 2008 at 1:13 pm

    What an extraordinary story of an extraordinary woman. Thank you Pat for a beautifully written and inspiring tale of dignity and courage.

    Reply