Facing a cancer diagnosis is tough, but what if you're already dying? drdonsdizon shares a touching story about a patient who taught him the importance of individualizing care in difficult situations. cancer healthcare patientcare
April 28, 2023
By the time she was hospitalized she was emaciated, though she appeared pregnant — a sign of the fluid that had built up in her abdomen. Imaging showed that her abdomen was filled with disease and her liver and lungs were nearly replaced with metastatic disease. As doctors, we like to believe that our decisions are guided by data: the randomized trials and meta-analyses that set standards of care; phase 2 trials that establish evidence of activity; case-control studies that suggest the impacts of treatment; and at the very least, case studies that document that"N of 1" experience.
I sat down and reviewed what I knew about her cancer and what I did not know. I went through potential treatments we could try and the toxicities associated with each. I made clear that these treatments, based on how sick she was, could kill her.She cried then, realizing what a horrible situation she was in and that she would no longer go back to her normal life. Indeed, she seemed to grasp that she was probably facing the end of her life and that it could be short.
Am I certain that this person will not benefit from intubation? Am I certain that she has only weeks to live? Am I sure that there are no treatments that will work?
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