Things hadn’t been going so well in recent weeks. Our patient had needed to come in for treatment which helped one of their issues, but came at a great cost. Pain was made much worse for most of the day after the treatment was given. This was on top of a high background level of pain already. I suspected our patient downplayed their pain. They were well versed in putting up with significant amounts of pain. There was no questioning their toughness and strong determination.

I said to them, “anyone else would not have been able to handle what you had in the past year. Most people would’ve stopped treatments after the first two cycles, but you had more than ten cycles. I think you have stayed alive through sheer will power alone.”

We had come to the point where, “First Do No Harm,” had to be considered. The treatment we had provided had made the symptoms worse, it had increased the suffering experienced. The entire management plan needed to be reassessed, with the patient and their spouse. A meeting was scheduled for the next day.

We had met the spouse once before about two months ago in outpatient clinic. In the intervening time our patient had lost too much weight. They had trouble sleeping. They had trouble waking. They couldn’t eat much. Their gut was not functioning well. Small jobs around the house would need to be followed by long rest periods. They no longer felt safe to pick up the children from school.

They had handled the pain up to this point. They could take it if it meant more precious time with their family. Our patient wanted to feel like themself, to be as normal as possible. Their sense of wholeness had been under attack for many months, and they had fought hard to stay alive. Now it felt different, the total exhaustion had caught up with them. The pain was getting much worse.

The patient’s face looked calm and serene. I’m sure they would be a formidable opponent to face around the poker table.

“I know you’ve been putting up with pain. You’re in pain at the moment aren’t you?”

“Yes.”

“How much out of 10?” I guessed 4/10.

In a calm steady voice, “8/10.”

“8/10! We need to do something about this. Will you let me help you? I need you to be honest with us and to let us know how bad your pain really is. We really want to help you, but need your help in order to get the doses right for you.”

“Okay.”

“We’re going to prepare some pain relief for you, we’ll talk more later.”