Posts Tagged ‘malignancy’

At last, the geographic cure worked once.

July 18, 2012

We wonder where the time went

And thinks of the hours we spent

I always guess wrong

About just how long.

Nothing’s a hundred percent.

 

I tell my smoking patients not to try to quit by cutting down, first because it doesn’t work and second because it constitutes a slow torture.  Physiologically, a gradual nicotine dose reduction prolongs the agony of withdrawal while it makes the smoking habit stronger.  And people who want to ‘cut down’ haven’t made an emotional commitment to quit.

Observation confirms theory; in the 30 years since I finished residency I have met 3 people who quit smoking and stayed quit by cutting down, but I’ve met tens of thousands who failed. 

Thus I can’t say categorically that cutting down doesn’t work, I can say that other methods offer a much higher chance of success.

Recovering alcoholics and addicts will speak derisively of the geographic cure.  Active substance abusers will, sooner or later, try to blame their addictive behaviors on their surroundings and companions.  Thinking that the problem resides externally, they try moving to another place to make a fresh start.  On arrival at the new destination they find new connections and bars, and their abstinence collapses less than three months later.  No more than a year passes and they return, generally with their dependency having moving forward a notch or two.

Those people in recovery say the first person you need to fix is yourself.

Yesterday for the first time I met a person for whom the geographic cure had worked.  For reasons of confidentiality I can’t give details, but later that evening I mentioned the case to a nurse, declaring that every day I see patients I find at least one thing I’ve never seen before.  The nurse blinked and, deadpan, told about caring for a patient who survived a fall after a parachute failed to open.

Every known malignancy has at least one miraculous survivor; people who go decades with metastatic lung cancer are common compared to those who exit airplanes without a parachute and live.  Yet we now have dozens if not hundreds of cases of people who survived falls of hundreds or thousands of feet.

Over the weekend a family member asked how much time a patient had; I refused to give a number because I guess so poorly.  I recall one patient I looked at and thought, “Just hours now”’; yet another patient I firmly believed had months died in less than two days.

We never know how much time we have in this world, and in the last 8 days (including 5 twenty-four hour shifts) I have repeatedly run into the fallout of people with terminal diagnoses deciding to tell or not to tell their families.  I advise the patients that if their loved ones would spend more time with them, knowing that the end was near, that they should by all means spread the knowledge. 

Most listen.

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Life, death, Facebook, drama, and irony

July 12, 2012

Time becomes wisdoms fount,

We’re given an unknown amount

But for family and friend,

When we’re close to the end,

We try to make each minute count.

 

I won’t say when and where these events happened.

On a Monday I attended a hospital patient with a very bad malignancy.  A gratuitous cancer with a notoriously bad reputation had flung metastases to the bone, liver, lung, and brain.  Yet doctor after doctor hadn’t penetrated a wall of denial.  My job description has never included taking away a patient’s hope.  After my usual questions, exam and update, I sat and listened and didn’t contradict.

In the subsequent week, a drama played out over Facebook.  A young couple (not my patients) had found out at the 18 week ultrasound their baby had a problem incompatible with life and decided to carry to term.  The child survived a few hours.  (Not the first time nor only time such irony has appeared on Facebook, I hope that such regrettable circumstances bring learning and insight to the readers.)

The next time I talked with my hospital patient, acceptance had swallowed denial, and Hospice arrangements occupied most of the visit.

At visit’s end, the patient revealed the importance to her of a close family relationship to two teenaged grandchildren.  They had not yet received news of the poor prognosis, and the patient didn’t know whether to tell them or not.

I related the story of the people on Facebook.

In the final analysis, I said, none of us know how much time we have with our loved ones.  Though we tend to squander precious hours, when we know the time has a definite limit, we make the minutes a priority.  If those who cherish you know that the end is approaching inexorably, they will prioritize spending time with you, and they’ll treasure the moments.  Thus they need to know.

And without telling the patient, I remembered the last three days I spent with my mother after she had decided to die.