Tuesday, May 4, 2010

Odd life

She was 73 when she was diagnosed with Mantle cell lymphoma, a blood cancer. It filled up her whole abdomen. She had problems with alcoholism and it wasn't felt that she could tolerate the kind of chemo that would cure her. At a tumor meeting, we decided we would try a milder kind of chemo and see how she fared.

After one cycle of chemo, she stopped eating and almost didn't get out of bed. It worked on the cancer, so we gave her one more cycle. Saturday, her family called twice to the doctor on call, telling us she had pain and nausea. My colleague told them to give her some more pain meds and keep her at home. I had the pager Sunday and they called in the morning, telling me she couldn't keep her pills down but her pain was better. It told them to keep at it at home with the pills for pain and nausea.

Later that day, I admitted her. She was in complete renal failure and was dialyzed. This evening, she started vomiting and pooping blood. Her three kids and husband were there, as she was starting to lose consciousness from the blood loss. The surgeons took her down for a gastroscopy but she couldn't breathe properly and she was put on a breathing machine.

We decided enough was enough and pulled her breathing tube out. That was two hours ago and she is still in there with a beating heart. She will almost certainly die tonight, in no pain and with her family there. The truth is we killed her with our chemo, but with the fate that awaited her, had we let the lymphoma grow, perhaps it was for the better.

So here I sit at 2:30 am, with my bed waiting in the call room, blogging. Whenever I have had to guide a family through the dying process, it's been an emotional experience. I think I have gotten good at it by now. I still find myself close to tears when the family members start crying, but I suspect even the most senior doctors do.


SteveQ said...

That's the part of the job that kept me out of medical school. When you have complete clinical detachment, you're not human any more; it's supposed to be hard.

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