I helped someone avoid a terrible death last Thursday. Don, a 31-year-old Home Depot salesman, had been suffering from cancer for eight years. Although he didn’t yet realize it, he had entered the active phase of dying when I met him on the 14th floor of Parnassus Hospital as he returned for his second admission in as many weeks. I was his palliative care physician, brought in to help manage his pain and crippling symptoms.

The previous week, Don’s thorax had been hastily punctured with bilateral chest tubes as his acute dyspnea workup revealed new malignant pleural effusions. I met him 2 days after the tubes had been pulled. His effusions had re-accumulated, and then some. Don, a former Marine who served two tours of duty in Iraq, was gasping for air. He was also suffering from severe nausea and constipation, and held a basin up his mouth to catch the vomitus from his constant retching. His belly was distended, his face was gray, and his head was bald. A tall and broad-shouldered man, he had lost all his bulk; the angel he’d had tattooed on his shoulder to mark his fifth anniversary free of cancer had shriveled. His wife kept gently wiping the spittle off his face.

Don’s parents had flown to his bedside three days earlier. Together with his wife, they were supporting him through what they believed would be a six month battle to keep him alive long enough to enroll in an experimental trial testing a new melanoma drug.

His doctors privately had their doubts that he could survive the six months, but had supported the patient’s decision to “fight ’til I’m in the grave.” He was just 31, newly married with a lovely wife, and willing to do anything that might help his chances for survival. Treatment after invasive treatment had been tried over the previous several months of his rapid decline, but to no avail. In addition to Don’s extreme shortness of breath, he suffered excruciating pleuritic chest pain with every breath at the site where last week’s chest tube had been. The nephrologist had also been called to evaluate the cause of his recent onset of acute renal failure. Don’s father, a tall and commanding military professional, pulled me into the hall and asked me, “Where are we at this point?”

The question was vague and could have meant that he was wondering what the next treatment would be. But his eyes told the truth. This father could not continue to witness his son’s suffering. He was starting to doubt that the cancer could be beat, which was causing him to lose faith in the treatment. Until now, he had been supporting his son as he went through a battle, with injuries and casualties accepted as a necessary part of any war. But now he was starting to question whether there was a benefit to the suffering. If there wasn’t, he needed to move to a defensive posture and stop the pain.  (…) Read Full Article Here

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