When Bad Advice Is the Best Advice

[groovedaddy]

Eighteen years out of training, and I still find myself struggling to understand the moral imperatives of medical practice. Not long ago, as part of my hospital duties, I cared for a man who could no longer swallow. This dysphagia was his only medical complaint, one that had sneaked up on him over the course of a month. He simply couldn’t find the muscular strength to propel food and liquid down to his stomach.

After some investigation, the medical team discovered he had metastatic lung cancer. That explained the dysphagia: cancer had stimulated his immune system to attack his swallowing muscles.

While the cancer was incurable, we hoped we could slow its progression and give him a few extra months of life — small solace for a man in his mid-50s with a loving wife and several children ready to start new families, but the best we could offer.

On rounds the morning after he received a feeding tube, I stopped by to see how he was doing — checking his abdomen for signs of infection and, more important, assessing his fragile mood. I tried to keep things upbeat, making small talk while examining his belly. But something about his response, and the look he gave his wife, was troubling.

http://www.nytimes.com/2009/04/28/health/28case.html?th&emc=th

[Warpy]

1. I have cared for terminal cancer patients who still smoked

and when they got to the point they were unable to go out to the smoking area, I made sure they got the patch.

End of life care is comfort care. If that comfort includes cigarettes, alcohol, or any other vice, that's just the way it is.

By the time you've got metastatic cancer, smoking has already killed you. It's not going to do anything worse.

[uppityperson]

2. Very good article, thank you.

Having taken care of many terminal people, this is a really good article

[GoneOffShore]

3. Put me in mind of my aunt who had emphysema -

And was an alcoholic.

I went to see her a couple of weeks before she went into the hospital where she died. I asked if I could get her anything. "A nice bottle of Gallo port and a carton of Raleighs." I didn't question her, I just went and got them. I knew her "caregivers" wouldn't approve but she knew she was at the end. I knew that these things might hasten that end. I also knew they would also give her some pleasure.