ERIC C. LAST
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me to continue to do anything I can, even though it’s not going to work.” I chose to respect the decision Tom and the oncologist had made. I said that I’d reconsider the decision over the next few weeks. About a week later, one of Tom’s daughters informed me that her father had been readmitted with dehydration. I promised myself that at my next visit with Tom I’d clearly explain that hospice care, which would help both him and his family, was an impossibility with continued chemotherapy. I would tell him that I would keep my promise to him to continue to treat him, but that his cancer was no longer something we should treat. We were making him sicker than he’d be if we concentrated on treating his symptoms. I never got to have that conversation. At Tom’s wake his family told me of his final hours. He was restrained in his hospital bed, struggling to get out, saying he needed to go home, saying he wanted all the tubes taken from his body. His agitation was calmed only temporarily by medication. He had developed gross hematuria, apparently caused by a bladder perforation for which surgery was being contemplated. A hospice nurse was introduced to them only the day before his passing, with no plans made for admission or transfer. At the wake I got to see a photo taken at the time of the anniversary cruise that had been so important to Tom. I got to see him smiling, surrounded by his family, apparently — for that moment — forgetting about the mass growing in his abdomen, the inexorable mitotic attack that would soon take his life. At what point do we say, Enough? Oncologists I’ve spoken with say that in America, as long as a treatment is available, we give it. And if a patient is given the option of one more treatment ... one more chemotherapy . . . a modified dose . . . all cloaked in the possibility of making things better, it is more than understandable that the patient will make the decision to try the treatment. I think there are two very different ways we can frame these conversations when it becomes clear that further treatment will be more burdensome than helpful; when treating the patient’s symptoms should take priority over fighting the malignancy.
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