Rich_by_the_Bay
Moderator Emeritus
This week, I lost two young patients to advanced cancer.
One was a 28 year old woman with stomach cancer (very unusual at that age). Her young husband and she had discussed her preferences for cardiac resuscitation ("code") status and it was requested that she not be coded. Her parents felt differently, and tried to trump the husband, who was her legal surrogate and was in compliance with her advanced directives (her living will). They waxed and waned and fought to the end. At one point a parent challenged a nurse who was giving morphine to the patient, thinnking it was intended as euthanasia (it wasn't). I empathized deeply with the husband, but also understood the parents' inability to accept the inevitable. After she died, the parents and husband went their separate ways, consumed by grief and bitter at one another. My team and I shed some tears privately and all involved felt awful.
The second was a 39 y.o. woman with a history of childhood cancer that was "cured" with radiation, but that radiation probably caused - decades later - a lymphoma and then breast cancer. She had clearly requested no resuscitation, her family was on board all the way. She received terminal sedation, meaning deep sedation not sufficient to affect vital functions in itself, but deep enough to have her sleep deeply, yet able to awaken when the dose was decreased for brief visits with her family. I don't think she had much physical pain. Family attended her death. It was indescribably sad but peaceful and everyone seemed accepting and also relieved. My team traded hugs and condolences with a grateful grieving family, who thanked us profusely for understanding and respecting their wishes.
One was a 28 year old woman with stomach cancer (very unusual at that age). Her young husband and she had discussed her preferences for cardiac resuscitation ("code") status and it was requested that she not be coded. Her parents felt differently, and tried to trump the husband, who was her legal surrogate and was in compliance with her advanced directives (her living will). They waxed and waned and fought to the end. At one point a parent challenged a nurse who was giving morphine to the patient, thinnking it was intended as euthanasia (it wasn't). I empathized deeply with the husband, but also understood the parents' inability to accept the inevitable. After she died, the parents and husband went their separate ways, consumed by grief and bitter at one another. My team and I shed some tears privately and all involved felt awful.
The second was a 39 y.o. woman with a history of childhood cancer that was "cured" with radiation, but that radiation probably caused - decades later - a lymphoma and then breast cancer. She had clearly requested no resuscitation, her family was on board all the way. She received terminal sedation, meaning deep sedation not sufficient to affect vital functions in itself, but deep enough to have her sleep deeply, yet able to awaken when the dose was decreased for brief visits with her family. I don't think she had much physical pain. Family attended her death. It was indescribably sad but peaceful and everyone seemed accepting and also relieved. My team traded hugs and condolences with a grateful grieving family, who thanked us profusely for understanding and respecting their wishes.