An Interdisciplinary Case Discussion on "I was Bleeding for My Sins"
Ms. Watson is a 43 year old African-American woman who on a Saturday evening presents with heavy vaginal bleeding to the emergency department at a Boston hospital. She had noted spotting between cycles for over 6 months, but now the bleeding had increased to the point that in the past week she has been soaking 3-4 pads per day. She notes worsening shortness of breath to the point that she is now short of breath with any activity, as well as generalized fatigue. She does not have a primary care physician.
Ms. Watson notes that she lives in Dorchester with one of her 3 daughters (ages 24, 22, and 20) and 2 grandchildren. She works as a clerk at a grocery store, and her daughter (with whom she lives) works nights as a nursing aid at a nearby rehab facility. Ms. Watson often provides childcare for the 2 children while her daughter is at work. She routinely attends a local Baptist church.
In the ED she is examined by the ob/gyn resident on call who finds a large cervical mass. A CT scan of the chest, abdomen and pelvis shows a large cervical mass extending to the parametria, mild right hydronephrosis, and enlarged lymph nodes suspicious for metastatic disease. Her hematocrit is 19, but other routine labs are normal. She undergoes vaginal packing, receives 2 units of packed red blood cells (PRBCs) and is admitted for further evaluation and management of presumed cervical cancer. Pathology reveals HPV positive squamous cell carcinoma. Based on the patient’s staging (IIIB), cure rates are on average 32% with timely completion of treatment being critical to cure.
When the oncology team arrives to discuss the diagnosis with Ms. Watson, several visitors are in her room (3 family members and 4 members from her congregation, including her pastor). All but her oldest daughter, however, leave the room for the doctors’ visit. There is a Bible on her table, and multiple religious greeting cards are propped on the table and window sill.
As the oncology attending – Dr. Kearny – begins to present her recommendations, Ms. Watson interrupts to say, “You might not think so, but God is talking to you all of the time.” Dr. Kearny appears bewildered and pauses. Ms. Watson continues, “You’ll be listening to God right?” Taken aback, Dr. Kearney responds, “I don’t hear him talking to me.”
“You might not hear him but he is always talking to you,” Ms. Watson states, “He is always talking to all of us. All you have to do is listen.” Dr. Kearny is a highly accomplished academic gynecological oncologist with more than 20 years of medical experience. She attends religious services on special occasions and considers herself slightly spiritual. After a long pause, Dr. Kearny says, “Okay” and resumes her presentation regarding the treatment program she recommends: 7 weeks of radiation with concurrent chemotherapy.
Ms. Watson starts her treatment in the hospital and is then discharged home to continue as an outpatient. In the following weeks, she begins to miss her radiation therapy appointments. When she does come, often late, Dr. Kearny urges her to come regularly, emphasizing that delays in therapy can reduce chances for cure. Ms. Watson listens, but one visit she asks, “Doctor, are you religious?” Dr. Kearney explains that she does not consider herself ‘religious’. “That’s not what I’m asking,” Ms. Watson responds. “I’m asking, do you know Jesus?” Dr. Kearney laughs uncomfortably and says, “I’m your doctor, not a priest, so it isn’t really important what I believe, right? My job is to focus on getting your cancer cured.” Dr. Kearny then asks Ms. Watson about side effects of her cancer treatment.
After many delays in therapy, Ms. Watson completes her initial course of treatment. She then begins a form of brachytherapy where radioactive seeds are placed, under anesthesia, against the cervix. She remains in the hospital for several days during the treatment.
Despite severe discomfort, she takes only minimal pain medications. The night nurse, Angela, is distressed at seeing her ongoing pain and unwillingness to take adequate pain medications. Knowing Ms. Watson’s faith is very important to her, Angela asks the chaplain to see her. This is the first time Ms. Watson sees a chaplain during the course of her therapy, as she had declined chaplain visits during intake for both hospitalizations. She is assigned to Betsy, a middle-aged chaplain ordained in the Unitarian church who happens to be on call that evening. Betsy finds Ms. Watson’s room filled with visitors, and Ms. Watson turns her away, saying she didn’t ask to see a chaplain.
Betsy returns the next day to find Ms. Watson alone. This time Ms. Watson accepts Betsy’s offer to talk about, “how she is doing”. After some small talk in which Ms. Watson describes looking forward to being out of the hospital in two days, Betsy turns the conversation to the patient’s faith. Ms. Watson then describes having grown up going to church, but says that she “didn’t know Jesus”. She got into drugs in her late teens and early twenties, at which time she had her three children from two different fathers, both also drug users. She tried many times to end her drug habit, without success. Then, when she was 29 years old, and social services agents were on the verge of taking her 10, 8, and 6 year old girls from her, she experienced a profound spiritual conversion. “Jesus saved me from the grip of the devil,” she recounts. “When I came to him, I was that sinful woman at his feet, just crying, crying tears on his feet.“
Ms. Watson then tells the chaplain of something she experienced just before her cancer diagnosis:
“God has been preparing me for a while. And church, it was just in my bones. ‘I’ve got to go to church! I’ve got to go to church!’ June 4th was Pastor Johnson’s special Sunday celebration and I got blessed with the Holy Spirit. Just six days after that, that’s when everything came out [reference to cancer diagnosis]. That is how good God is. And I still have him in my bones. Got to go to church Sunday! Got to go to church Sunday! I go to hear the Word and it feels good. I might not be a member of my church but I go to hear the Word. I was brought up on church as a little girl and it feels good. It is in my bones and deep down in my soul now.
She then added, “Now, I’m paying for those old sins. Even when the blood first started coming, I knew I was bleeding for my sins.”
Ms. Watson notes that she lives in Dorchester with one of her 3 daughters (ages 24, 22, and 20) and 2 grandchildren. She works as a clerk at a grocery store, and her daughter (with whom she lives) works nights as a nursing aid at a nearby rehab facility. Ms. Watson often provides childcare for the 2 children while her daughter is at work. She routinely attends a local Baptist church.
In the ED she is examined by the ob/gyn resident on call who finds a large cervical mass. A CT scan of the chest, abdomen and pelvis shows a large cervical mass extending to the parametria, mild right hydronephrosis, and enlarged lymph nodes suspicious for metastatic disease. Her hematocrit is 19, but other routine labs are normal. She undergoes vaginal packing, receives 2 units of packed red blood cells (PRBCs) and is admitted for further evaluation and management of presumed cervical cancer. Pathology reveals HPV positive squamous cell carcinoma. Based on the patient’s staging (IIIB), cure rates are on average 32% with timely completion of treatment being critical to cure.
When the oncology team arrives to discuss the diagnosis with Ms. Watson, several visitors are in her room (3 family members and 4 members from her congregation, including her pastor). All but her oldest daughter, however, leave the room for the doctors’ visit. There is a Bible on her table, and multiple religious greeting cards are propped on the table and window sill.
As the oncology attending – Dr. Kearny – begins to present her recommendations, Ms. Watson interrupts to say, “You might not think so, but God is talking to you all of the time.” Dr. Kearny appears bewildered and pauses. Ms. Watson continues, “You’ll be listening to God right?” Taken aback, Dr. Kearney responds, “I don’t hear him talking to me.”
“You might not hear him but he is always talking to you,” Ms. Watson states, “He is always talking to all of us. All you have to do is listen.” Dr. Kearny is a highly accomplished academic gynecological oncologist with more than 20 years of medical experience. She attends religious services on special occasions and considers herself slightly spiritual. After a long pause, Dr. Kearny says, “Okay” and resumes her presentation regarding the treatment program she recommends: 7 weeks of radiation with concurrent chemotherapy.
Ms. Watson starts her treatment in the hospital and is then discharged home to continue as an outpatient. In the following weeks, she begins to miss her radiation therapy appointments. When she does come, often late, Dr. Kearny urges her to come regularly, emphasizing that delays in therapy can reduce chances for cure. Ms. Watson listens, but one visit she asks, “Doctor, are you religious?” Dr. Kearney explains that she does not consider herself ‘religious’. “That’s not what I’m asking,” Ms. Watson responds. “I’m asking, do you know Jesus?” Dr. Kearney laughs uncomfortably and says, “I’m your doctor, not a priest, so it isn’t really important what I believe, right? My job is to focus on getting your cancer cured.” Dr. Kearny then asks Ms. Watson about side effects of her cancer treatment.
After many delays in therapy, Ms. Watson completes her initial course of treatment. She then begins a form of brachytherapy where radioactive seeds are placed, under anesthesia, against the cervix. She remains in the hospital for several days during the treatment.
Despite severe discomfort, she takes only minimal pain medications. The night nurse, Angela, is distressed at seeing her ongoing pain and unwillingness to take adequate pain medications. Knowing Ms. Watson’s faith is very important to her, Angela asks the chaplain to see her. This is the first time Ms. Watson sees a chaplain during the course of her therapy, as she had declined chaplain visits during intake for both hospitalizations. She is assigned to Betsy, a middle-aged chaplain ordained in the Unitarian church who happens to be on call that evening. Betsy finds Ms. Watson’s room filled with visitors, and Ms. Watson turns her away, saying she didn’t ask to see a chaplain.
Betsy returns the next day to find Ms. Watson alone. This time Ms. Watson accepts Betsy’s offer to talk about, “how she is doing”. After some small talk in which Ms. Watson describes looking forward to being out of the hospital in two days, Betsy turns the conversation to the patient’s faith. Ms. Watson then describes having grown up going to church, but says that she “didn’t know Jesus”. She got into drugs in her late teens and early twenties, at which time she had her three children from two different fathers, both also drug users. She tried many times to end her drug habit, without success. Then, when she was 29 years old, and social services agents were on the verge of taking her 10, 8, and 6 year old girls from her, she experienced a profound spiritual conversion. “Jesus saved me from the grip of the devil,” she recounts. “When I came to him, I was that sinful woman at his feet, just crying, crying tears on his feet.“
Ms. Watson then tells the chaplain of something she experienced just before her cancer diagnosis:
“God has been preparing me for a while. And church, it was just in my bones. ‘I’ve got to go to church! I’ve got to go to church!’ June 4th was Pastor Johnson’s special Sunday celebration and I got blessed with the Holy Spirit. Just six days after that, that’s when everything came out [reference to cancer diagnosis]. That is how good God is. And I still have him in my bones. Got to go to church Sunday! Got to go to church Sunday! I go to hear the Word and it feels good. I might not be a member of my church but I go to hear the Word. I was brought up on church as a little girl and it feels good. It is in my bones and deep down in my soul now.
She then added, “Now, I’m paying for those old sins. Even when the blood first started coming, I knew I was bleeding for my sins.”