STORY HIGHLIGHTS
Theresa Brown tells of dying patient who got much sicker from aggressive treatment
She says "fighting" serious illnesses can cause terrible agony, keep patient from family
Brown cites study suggesting palliative care offers better quality and longer life
Dying patients should not be pressured to go through drastic treatments, she says
Editor's note: Theresa Brown is an oncology nurse in Pennsylvania. She is a leading contributor to The New York Times' blog Well. She is the author of "Critical Care: A New Nurse Faces Death, Life, and Everything in Between."
The patient, in his late 70s, had survived prostate cancer and had a new diagnosis of leukemia. A few days before, he'd been healthy and fine, but now his white blood cell count was so high that it was clogging his circulatory system, making it hard for him to breathe.
We brought his white count down and relieved his shortness of breath. At that point, he could have opted for palliative care and gone home on hospice with a decent enough quality of life to enjoy what little time he had left. However, the patient, encouraged by h
This is a hard case. In his recent New Yorker article "Letting Go," Dr. Atul Gawande explains how the first impulse of doctors, patients and family members to "fight" cancer or other serious illnesses makes it very difficult to have honest discussions of what treatment can and cannot do.
I understand why physicians find these conversations difficult, why it's preferable to focus on the good we can possibly accomplish rather than the likely futility of the struggle.
But there's another story to be told in these cases, and it's usually the nurse who's the observer of that narrative: the suffering caused by these well-intentioned treatments. Chemo was risky for this patient because of his age and medical history, and the damage done was unbelievably bad.
The problems began when cells killed by the chemotherapy spilled their contents, overloading my patient's kidneys and throwing him into renal failure. The intravenous fluids he'd needed had been too much for his circulatory system, and he developed heart failure, too.
Watching this patient suffer ... because of what we did to him in the name of helping him was agonizing.
--Theresa Brown
RELATED TOPICS
End of Life Decisions
Cancer
Chemotherapy
Medical Treatments and Procedures

One morning, I came in with his pills, and he said, "You're doing too much. I can't take it." The next week, he was on dialysis, but it wasn't working, and his entire lower body was hugely swollen with fluid. That day, he accosted me with, "What the hell are you doing to me?"
Both times, I told the medical team what he'd said and asked whether it was ethical to continue chemotherapy. Several members of the team shared my concerns, and as a group, we talked the situation over with the attending doctor. Our view was that the treatments were eroding the patient's quality of life with little promise of good in return.
The attending physician, whom I know to be conscientious and caring, disagreed, as did the patient's family. When the doctor prodded the patient, saying, "You want to keep going, right? Right?" the patient himself concurred, "Yes, let's keep going."
So the chemo finished. Then, blood began to appear in the patient's urine. His bladder was brittle because of the radiation treatments he'd had for prostate cancer, and because of the chemo, he had too few platelets. Without enough platelets, that fragile tissue would not stop bleeding, but it also formed blood clots in his bladder that caused excruciating pain.
Watching this patient suffer, not from his disease but because of what we did to him in the name of helping him, was agonizing. He'd wanted to "keep going," to "keep on fighting," but what did he really mean?
Always when I hear these phrases applied to oncology patients, I think of Peter Weir's 1981 film "Gallipoli." The film portrays two Australian sprinters, Archy and Frank, who enlist together during World War I and end up fighting the Turkish army at the Battle of Gallipoli.





Paris escort girls any man desires. | Outstanding experience Dubai escort lists for those who wants vip. | Vip escorts Warsaw for anybody