I know the situation is grim, the prognosis not good at all-

There is yet another procedure, which gives a chance, albeit small

For improvement in your condition, I cannot but offer it to you

There is no guarantee it would work, could be harmful too

It could give you some longevity, but simultaneously compromise

The quality of your life- I believe that comes as no surprise

I know  everything we have done so far has kept you

Alive, but bouncing from hospital to  rehabilitation and home too…

You agree to the procedure because you have a will

To survive, which trumps quality of life still

**

I am the one who suggested this “n”th procedure

Whether this is the best thing to offer, I am not sure

I must admit I have serious doubts it would work for you

In the long-term- I’m afraid my fears would come true

Then, the other part of my brain chides me on my doubt

Because my duty is to offer every possible way out

Of this illness, how can a treatment option I not present

If it exists for this condition, these options are meant

To help you make a fully informed decision

But I know you rely on my judgment as your physician..

**

There is the part of me that wants to present outright

Options to do nothing more to fight

A losing battle against your disease process

Hanging on to the meager odds of success

Focus on palliation, and find ways to measure

Quality not quantity, help you do things to treasure

The remaining moments of your life with your family

Spend resources on keeping you comfortable, pain-free…

If I do that, however, a part of me believes I have failed

What is the point of the collective heights we have scaled

In treating illnesses that even two decades ago

Left us with no options except to let a patient go

It is hard to pull back when an option does exist

The possibility of improved survival is hard to resist..

**

Then I try the ultimate decision-making tool

What if I were the patient- I know I cannot fool

Myself- In my heart I know I would choose

To forego this procedure, I would rather lose

Months of my life than spend them in pain

With this clarity, I go back to my patient again

To talk to them about the less invasive option

I present to them the idea of palliation…