November 2011 (Part 1)
By Sean Cleymaet, OREXer ’11-12
Today’s OREX was outstanding and thought provoking on several levels. I saw Dr. Harken put in a pacemaker and Dr. Hoffman put in a titanium nail along the length of a patient’s broken femur. But it’s the third case that gave me pause.
The third patient was an elderly woman with stage 4 cancer. Stage 4 in broad strokes means that the cancer has metastasized from its origin into other areas of the body. In this patient’s case the cancer was so advanced that it was likely terminal. It was present in her liver, her lungs, and had even almost completely replaced one of her vertebrae. Why on earth was this woman in the operating room if there was essentially 100% chance that she would die from this disease?
I know many of us consider surgery something that one goes through in hopes of being better off afterwards, perhaps even regaining the quality of life we had before. There are risks in any medical treatment but rarely does someone elect to have surgery when they could be dead in a month. In this case, the surgeons operated not to eradicate the disease present throughout the woman’s body but to ease suffering in the last weeks or months of her life. It was palliative surgery; it’s primary goal was to provide some small measure of comfort. There was no hope of curing this woman.
This case gave me a chance to reflect on two paths, one where we search for a way to cure somebody of an ailment and the second where we maximize a patient’s quality of life. Oftentimes the two paths are aligned; normally when a patient no longer has a disease or condition, their quality of life improves as well. But at the end of life, our desire to pursue a cure fades and our focus shifts instead to being comfortable.
I deeply appreciate the opportunity I had this past Tuesday to reflect again on this issue. Thank you to the surgeons and staff that were present that day, and to all the rest who undoubtedly act with equal sensitivity in similar situations.