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…
This has got to be hard. My doctors and I talk about this. The decision was made to go back on chemo…for another year. Yet it beats the alternative.
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I remember decisions like this regarding having breast cancer twice within 3 years. Your words your feelings are a mirror of mine.
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True reflection of your papa’s thoughts.
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