Thanks for listening

When we walked into the room, you could sense the anger and frustration on the patient’s face, as well as two other relatives in the room.  We knew that the patient had had lung cancer for several months and had failed radiation and chemotherapy.  He had labored breathing and looked miserable. I went to his bed and asked if I could sit down on his bed.  I took his wrist and began checking his pulse.  Then I asked him to tell his story. The 50-something patient had many pack years of cigarettes.  He understood his diagnosis and wanted to pursue further treatment options.  His breathing had worsened, partly due to metastases in his upper chest. He greatly disliked his oncologist and the radiation oncologist.  He felt that they had not explained everything to him, and that they did not provide radiation to the upper chest mass. He had clear metastases on CXR. When we examined him, he was tachypneic and he was visibly uncomfortable breathing, yet his oxygen saturation was in the 90s.  His lung sounds were clear.  His heart was regular and without murmurs or rubs. We told him that we we might be able to eliminate the cancer, but that we would do everything possible to make him feel better.  We told him that we would work to get a different oncologist. After we left the room, the team huddled.  His number one problem was a sense of breathlessness.  Our excellent palliative care physicians had taught me that low dose morphine worked wonders for breathlessness.  We...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs