She had told her family about my promise to paint my fingernails to match hers. She had painted her nails to match my bright yellow scrubs. When I examined her fingers the nails were of many different colours. Some were yellow, others were black, pink, and red, all of them nicely painted. She showed her nails and she made us all laugh. This included both staff and her own family. I joked about needing help with nail-painting supplies, as I didn’t usually paint my nails. If I was going to do so then I might as well do my toenails. I shared with our audience that my yellow nails would go down well at the Brazilian Jiu-Jitsu club I belong to. We all shared some more laughs before we came to the serious part of the family meeting.

I provided a recap of what had happened since our patient was admitted. She arrived with terrible pain, nausea and constipation. These symptoms were controlled with adjustments in medication doses over the first week. Well-controlled pain came at a cost. Our patient became confused at times. We had to make dose changes but we wanted to persevere and bring down the pain levels as much as possible.

Overall the pain and nausea improved but the confusion episodes worsened. We tried to prevent further episodes to no avail. I talked about the ongoing changes in her situation. Old problems became worse while new problems developed. We were trying to play catch up with a disease process that wouldn’t stay still. She had been having ups and downs due to medication effects but mostly due to worsening cancer.

She asked me how much time she had left. This is always difficult to answer. I talked about it depending on the rates of change. If changes were occurring over months, then there might be months left. If changes were occurring over weeks, there might only be weeks left. We had been seeing changes occur over weeks. Her tears fell briskly to the floor, her family enveloped her in their loving care.

She asked about her cancer treatment. She didn’t think it was working. I thought it had been worth a go, and she had tried her best as the oncologist did. I didn’t think the treatment worked, as her condition worsened. She was becoming frailer and more fragile with each passing day. She did not feel like herself, there were times when she wasn’t mentally present at all. I encouraged her to sort out important things now while she could still think clearly. Legal stuff like her will.

I promised her I would paint my fingernails and toenails yellow. She promised to hold me to my promise. We all laughed.

During this family meeting there had been laughter, then tears, then more laughter and tears from laughter.