Monday, March 9, 2009

Impending RIP

Today's patient was all SORTS of dying. 70something years old, long time smoker, the inevitable lung cancer with scary bone metastases. He came to us from some nursing home because of a fever, but the REAL problem was Hypercalcemia of Malignancy. Which is pretty much the definition of "make this guy comfort-measures only"...except the family only got there today to make the decision. Essentially, once you HAVE Hypercalcemia of malignancy, your chances of making it a MONTH are 50/50. That is, if you also dont die of massive fluid loss from electrolyte imbalance, or one of the other nasty side effects.
The guy was more or less out of it, rousable only by a bit of shaking, a loud voice, or me, trying to give him his shots. He was unimpressed. Also, he had a lot of trouble swallowing, the result of an old brain aneurysm that ruptured, so getting him his medications required creativity. The hospitalist dropped in, to say that a PEG tube would be torture, and to call him when the patient's family got in, so that he could convince them that there was nothing more modern medicine could do but make him comfy-ish.
Once they pull the calcitonin shots, he'll maybe have 3 days to live. RIP, cancerdood.

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