One of my long-time patients with metastatic prostate cancer, Mr. L, was admitted this week with DIC, disseminated intravascular coagulation- essentially a case of blood not clotting properly. He had had a tooth pulled, and it would not stop bleeding. Imagine something as simple as seeing a dentist turning into a nightmare. His cancer was the cause of his abnormal bleeding, which finally had stopped with aggressive measures such as transfusions. Ultimately, treating the cancer was the only way to keep this problem from recurring. Unfortunately, he did not have any good treatment options for the cancer left. Thus, we had the 'hospice talk.' Generally during this discussion, I tell patients that we have reached a point where we cannot make the cancer go away, so we want to try and make the symptoms go away with supportive measures (pain meds, anti-nausea meds, etc). I also remind them that my role in their care will remain "unchanged"; I will just have help from the hospice nurses, who are my "eyes, ears, and hands" in their home, and the patients will not be "troubled" with clinic or hospital visits anymore.
He was a tough old bird, and as we clasped hands, he said he understood, but he just wanted to be around as long as he could as he gestured to a picture of his new grand daughter. As a new parent, I understand that desire. I also understand, on a daily basis, how lucky I am to be in my shoes rather than Mr. L's.
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