Sometimes it’s the doctors, not the families, who can’t let a patient go.
My elderly patient had lived much longer than seemed possible at the time of his cancer diagnosis. Ten years later, though, his relapsed lymphoma had become medically unstoppable.
The palliative care team was called in to manage his growing confusion and discomfort, and to discuss what we call “goals of care.” That’s what palliative care does: It focuses on keeping symptoms under control for the seriously ill and, for patients who can’t be cured, addressing how they want to die, including the option of hospice care. Now that this patient’s disease could not be restrained, what did he want? He could no longer answer, but his wife and son, sad but cleareyed, chose to stop all treatment aimed at curing his cancer.
That evening, though, the patient’s primary care doctor came to the hospital, seeing himself, it seemed, as the cavalry. There was hope yet, he said: The patient needed rehab to make him strong enough for more chemotherapy, not palliative care and hospice. So the patient — disoriented and unable to speak — went to an inpatient rehabilitation unit. He died there, a few weeks later.Hearing this, his oncologist, standing beside me at the nurse’s station, cried, heartbroken that her patient of so many years would not rally one more time.
I’m sure the primary care doctor meant well, but there’s no question that his actions made the situation worse because he deprived the patient and his family of comfort at the man’s life’s end. And this was far from the first time I’ve seen something like this happen. Such situations arise in part because modern health care still embraces a false dichotomy between curative treatment and palliation, between making a patient healthy and relieving his or her pain.
For the rest of the essay by oncology nurse Theresa Brown, go to: opinionator.blogs.nytimes.com/...tor-who-cant-let-go/
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