The moments oncologists savor

When I first saw her in clinic, things did not look good. She was jaundiced, nearly bed bound and quite sick with metastatic cancer. She came in on a wheelchair. I told her frankly that I thought chemotherapy was equally as likely to harm her as to help her. After a long discussion between the patient and her family, we decided to try one treatment and reassess goals if things were continuing to progress. I even went so far as to admit her to the hospital for her first treatment, which I rarely do (the luxury of not treating hematology patients, I suppose). And thankfully things went really well — her jaundice resolved, her symptoms got better, and the next time I saw her in clinic, she walked in! I felt like a rock star, and there were high fives all around the work room. We took a big gamble and it worked out in the patient's favor.

These are the moments oncologists savor. She ended up making it to a big family event, and became "unjaundiced." Cancer is a cruel foe, however, and eventually she became jaundiced and sicker. Eventually she made the transition to palliative care and hospice. I just went to see her this week at hospice, and she is very close to dying now. And although I helped her feel better for a period of time and make it to that big family event, which was her primary goal when we first discussed life prolongation as a goal of therapy, I have a nagging feeling in the back of my head that says, "I wish I could have done more to help her." It's an interest swing of the pendulum, to feel so good about something you were able to do for a patient and then a few months later feel so bad that you couldn't do more.