I think therefore I am? – We told you so

Photo by Alex Shute on Unsplash

Too young to be dying , only 32, with two toddlers 3 and 1 years old, she hadn’t even been a smoker. She had only had back pain, and on investigation last year, they found that she had metastatic lung cancer.

She came in with terrible pain, hadn’t been able to sleep for most of the week. Her partner, the father of the children, looked just as exhausted. Looking after her and the two tiny children. A tragic situation.

Pain difficult to control, breathing in a distressed fashion. She could barely leave her bed in the last two days.

Usual rule of thumb applied, if changing over months, months left to live, weeks – weeks, days-days, hours-hours.

Over the past four days, a change noted each single day. We estimated that she only had days to short weeks left to live.

We knew that she was supposed to go to Oncology, to have chemotherapy, but we thought she was too unwell.

We rang the Oncologist to discuss this, that we thought that she was dying, with only days to weeks left to live. We recommended that she not have chemotherapy, as we were concerned it would cause her more harm, than any potential benefit.

She and her partner were still keen for any treatments that were available.
She went with her partner to hospital, to have the chemotherapy as an inpatient.
She came back two days later, looking much worse.
She died two days later, we thought she had died earlier than she needed to.

After the third and fourth line chemotherapy options hadn’t worked, did the Oncologist honestly think that number five would work?

Was first no harm still in practice of was it a perfect storm of what people wanted?

Patient and family wanting to continue for this 32 year old mother, family not wanting her to die, young Oncologist wanting continue providing treatment, providing hope. Is this being kind, or providing false hope?

Could anyone/anything have stopped her from dying?

I don’t think so, she was dying and there was nothing that modern medicine could do about it.

So what was that all about, treat until the final breath is taken?

What are nails for? To keep the Oncologist from treating those who are already inside their coffin.

Not a funny situation at all.

False hope provided, but led to disappointment.

Well at least we tried, gave it the good ol’ college try.

How much time was she truly robbed off? Were two days stolen from her? Well the treatments have major adverse effects, can make someone feel lousy with effects and side-effects.

Was taking away two days of suffering actually doing her a favour in the big picture?

I don’t have all the answers, but even years later I wonder.

First do no harm – If a treatment is going to cause more harm than any good then seriously ask yourself, should I be doing this?

A line in the sand has to be drawn, this is it, we have reached the finish line.

You have important preparation work to do for yourself, you are needing to prepare for death.

You are given the opportunity to catch up with loved ones, during this precious time.
Put the pressure on just a bit more, phone calls please treat me, please don’t treat here.

Sometimes it is much easier to say Yes, then to say No.

We want to please our patient and their families. Keep them on-side with us, but at what cost?

Was she robbed off precious days with her little babies?

Does it really matter, she would’ve died anyway?

She had to be given the chance to make her own choice, and she did so.

A difficult choice, more treatment with a slight chance of working or nothing at all.

2 thoughts on “I think therefore I am? – We told you so

  1. James this is an agonising situation, which I have also seen many times
    I think in the end it’s the patient’s choice….. Even if it’s a choice that we don’t agree with, and which turned out to be “wrong” from a medical point of view (dying two days after being given chemotherapy is said to be an indicator of poor quality care)
    Perhaps the family will remember this as she died trying anything to stay with us? Even though the treatment may have actually shortened her life.
    So hard.

    Liked by 1 person

    • Sonia, Yes a situation that we all have faced often. I will always be supportive of a patient’s right to choose. I am not supportive of putting the onus of clinical decision making on patient’s and families unnecessarily. e.g. a 92 year old man asked to decide whether or not he wants to have AAA repair surgery. Guidance and recommendation from an experienced clinician is what is needed. “If it was my loved one I would recommend….” is a phrase that I use myself. There is no benefit to be obtained from providing futile treatments to a dying person, and it also means someone else might miss out on a treatment that might benefit them more. Always tough situations to navigate. No easy answers.

      Liked by 1 person

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