Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [69]
In the early evening on the second day of Mary’s treatment, a hospitalist came to her room. Hospitalists are physicians who are trained in inpatient medicine, and over the past few years they have increasingly assumed the care of people who are admitted to the hospital. Deidre and her father were at the bedside when she entered, a young woman in her early thirties. “How are you feeling today, Mrs. Quinn?” she asked.
Mary responded, “Not so well today, Doctor.”
“I’m sorry to hear that. You know, we are trying to treat your infection, but we don’t seem to be making progress,” the doctor said. “We need to know how much more you want done.”
Deidre’s father looked away, and Deidre saw his eyes well with tears.
“Why can’t you treat my infection?” Mary asked.
The doctor explained that Mary had received multiple different antibiotics over the past several months, and the antibiotics weren’t working anymore. She continued that they weren’t sure whether the new ones they were now administering would succeed since the bacteria may have changed and become resistant to the drugs. Furthermore, the antibiotics might not be getting into the abscesses.
Mary listened quietly, then said, “Can you drain the abscess again? That helped before.”
“Yes, we could try that, but it may not work,” she responded. “From the scans, it also seems as if the cancer may be starting to grow again,” she added.
Mary’s face took on a tight and determined look; she fixed her gaze on the physician. “I want to be treated.”
“Okay, then,” she said. “We will keep going.”
“It seemed like Mom was going against everything that she had told us before.” The family was distraught and confused by this change, Deidre told us. “She had said no heroic measures, and that she wanted to die with dignity, not be in the hospital, to spend her last days at home. Now, she was agreeing to more procedures, more needles.”
The morning after Mary told the hospitalist that she wanted to keep going, her oncologist visited her. This specialist had treated her over the years and knew the family well. He and Mary were very fond of each other.
“How is that novel?” the oncologist asked, picking up a book from her nightstand. “It got great reviews.”
“I’m too exhausted to read,” Mary replied. “But I’m hoping to catch up once I go home.”
Deidre was sitting near the head of the bed. Mary turned toward her daughter. “Don’t forget that Sean’s birthday is next week,” Mary said. “Dee, pick up that book we talked about. He’s expecting it from Grandma.” Deidre said she would.
“Mary, I heard that you’re thinking about your wishes, what makes sense for you now,” the oncologist said. Like many oncologists, he was trained in what the end-of-life specialists term “the conversation.” He had acquired skills to gently but clearly focus his patients on understanding their circumstances and better delineating their preferences.
“Mary, I understand that you said you want to continue with antibiotics for now.”
Mary nodded. “Yes. I do.”
“I understand your wishes. But if circumstances changed, like you were to go into a coma, would you want us to sustain you?”
Mary didn’t answer right away. Her eyes turned toward Deidre and then focused back on the oncologist.
“No. I wouldn’t want that.”
“Would you want us to keep you on a ventilator if you couldn’t breathe on your own?”
Mary shook her head. “No.”
“At that point you’d want us to focus on comfort, to make sure that there was no pain, and that everything was, as you told me before, dignified.”
Mary’s eyes filled with tears. Deidre stood up, took a tissue from the bedside table, and wiped her mother’s eyes.
“I want to live,” Mary said. “I want you to keep trying to get rid of these infections.”
“I understand. We will do our best,” the oncologist assured her.
Deidre walked with him into the corridor, out of Mary’s earshot. “I can’t believe that she wants to keep going,” Deidre said. Mary’s medical team had proposed again attempting