I would also put in a couple of drainage catheters-permanent spigots that could be opened to release the fluids from her blocked-up drainage ducts or intestines when necessary. Or I could give her an ileostomy, disconnecting the bowel above the blockage and bringing it through the skin to empty into a bag. I wouldn’t be able to remove the intestinal blockage, but I might be able to bypass it, I told her. A range of alternative chemotherapy regimens could be tried to shrink the tumor burden, and I had a few surgical options too. Her oncologist and I had a menu of options.

Here it was, 11 at night, she couldn’t hold down an ounce of water, and she still had her lipstick on, her silver hair was brushed straight, and she was insisting on making introductions. “This is my husband, Arthur, whom you know, and my son, Brett.” She got me grinning. She smiled brightly and pointed around the room. “I think I’m supposed to ask you that,” I said. “Well, look who’s here!” she said, as if I’d just arrived at a cocktail party. We really did have to have that hard discussion that was not about being allied around what he wanted to do.But walking into Douglass’ hospital room, I’d never have known she was so sick if I hadn’t seen the scan. It was like the conversation I described in the book about my dad doing surgery with a brain tumor where his hand was being paralyzed, and his operating staff were enabling him to operate with a hand that wasn't able to tie knots anymore. I don't know what to say about the driving discussion, because now it's not just about their risks, it's about the risks of others. She's now in the fourth year of no evidence of disease with stage IV ovarian, and it's sort of stunning that she did as well as she did, because it was on her own terms. She had to stop earlier than the end, but she kept her apartment. We'll take a risk with some anaphylaxis.' And my mother was very happy to take that risk.ĭid I feel good about it? I had to feel good about it and deal with that. The oncologist was able to fashion a pathway that said, 'Okay, we'll stop the chemotherapy when the neuropathy comes on, and we won't give you the standard steroid treatment.

Being Mortal by Atul Gawande