Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. They are retired and have spent the past several years traveling together. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy’s past medical history includes a knee replacement. Their support system includes Julia’s son, Neil, and Lucy’s niece, Nora.

My name is Julia Morales and I just turned 65-years-old. My life has not been a traditional one. I have always believed in following your dreams and being true to yourself, that’s what my parents taught me. When I look back over my 65 years on this earth, I feel happy and proud with what I have accomplished, and I don’t need any pity. Of course I was shattered when I learned I had lung cancer four years ago. But I fought a good fight. I followed all the recommendations my doctor had for me. I did the radiation and all the chemotherapy. I even got complementary treatment from a naturopathic doctor. It’s just that we all know it’s not doing any good anymore. I’m ready to stop all the treatment and just let go. It hurts to breathe, it hurts to move. Everything hurts. But like I said, I don’t need any pity. I’ve had a really great life. Would have liked to stick around a little longer, but I know it’s not to be. Still, I think my folks would be pretty proud to see what I’ve done. They got married young, right out of high school, and my Dad left Ohio to go off to war. He left Mom behind and fought in Europe for two years. My Dad was a strong person, he landed on the beach at Normandy and lived to tell about it. My mom worked hard in a factory while he was gone, and when he got back they had me, their only child. They did so much for me. Whatever I was interested in, they encouraged. We were a close family, took a lot of trips together, that’s how I got the traveling bug. They wanted me to go to college to be a nurse, or a teacher. I went because they saved money and encouraged me. But I never really wanted to be a nurse or a teacher. I got a degree in business instead, and ran a small nursery. My folks were happy because I was happy. Then when I was about 50, I got tired of the business end of it, so I sold it to a young couple, and continued to work for them. I loved the place and the job. Still do. Just haven’t had the strength to work for the past six months. I had a few relationships in college, got married for a short time right after I graduated. Had my son, Neil, he’s 42 already.

But that didn’t last. We got divorced when Neil was little, I raised him on my own. I still talk to my ex on occasion. He remarried, though I never did. I had a few relationships, and always lots of friends. I met Lucy over 20 years ago when she moved in next door. We’ve been together ever since. We’ve traveled all over in the past 20 years. She would never have gone without me doing the planning, but she’s enjoyed it as much as I have. We’ve been to Japan, Italy, Ireland, and all over the US. She has a bad knee and had surgery, she’s a little unstable and I worry about that.

We had to stop taking the long trips. I’ve been pretty healthy too, until this cancer. I smoked for about 10 years, after college. Then I quit. We didn’t really know then that it was dangerous.

Nobody knew. I was surprised when I got lung cancer. At first we thought I had pneumonia. But it never got better, and after the bronchoscopy they found lung cancer. I did the radiation treatment and the chemotherapy. For some of it I had to be in the hospital a few days, which just about killed me. Never did like hospitals, ever. But the treatment makes you so sick you want to die. And the bad thing is, it didn’t cure the cancer. We tried a few different treatments but no more. Nothing good came out of it. I just felt weak and sick, and the cancer got worse. I’m ready to stop all this. I just want to be here in this house that I love. I’m comfortable here. Lucy is here, and she understands. She doesn’t like to see me so sick either. She does a good job taking care of me, and we’re doing OK. My son Neil would like me to try more treatment, but even the doctor says there’s not much more they can do, besides keep me comfortable. I’m tired, and I’m just ready to let things happen naturally. Do you think that’s giving up?”

Discussion Questions

1. What are Julia’s strengths?

2. What are your concerns for this patient?

3. What is the cause of your concern?

4. What information do you need?

5. What are you going to do about it?

6. What is Julia experiencing?