Just When You Think You Are Having a Bad Day!

Just when you think you are having a bad day, you meet someone like Laura. Laura is a 28 year old, who was diagnosed with metastatic non small cell lung cancer in January. It all started as a bad cold that progressed to pneumonia. When the pneumonia did not clear up with antibiotics, her family doctor ordered a chest cat scan that revealed a large tumor in the right lung. She was taken immediately to surgery and found to have metastases to her lymphnodes, bone, and kidneys. She has never smoked, had rare second hand smoke exposure, no exposure to any known carcinogens, and no family history. It is a case you rarely see nor want to.

Laura started chemotherapy and radiation right away but the cancer was already advanced (stage IV) when diagnosed that it had little effect. Her oncologist had followed serial cat scans to evaluate progression of the disease and last week noticed some fluid around the heart. It was decided that she would come in this past wednesday for surgery to drain the fluid but on tuesday, she became acutely short of breath and was rushed to the emergency room and ultimately surgery one day early. Surgery was sucessful but her shortness of breath remained. I was consulted to see her for a possible pneumonia and what we found was that the cancer had narrowed her airway and nothing more could be done. A decision was made to discharge her to her childhood home with hospice.

This morning I recieved a page asking me to see Laura immediately. She had become increasingly short of breath overnight, was now on high levels of oxygen, recieving morphine with little relief of her distress, and was experiencing quite a bit of pain. We met with Laura, her family, and our palliative care nurse- a final decision was to provide morphine and allow the inevitable to happen at the hopsital with her family at the bedside. As I walked out of the room, she asked if she could see her cats. My heart broke because if I were in her position, I would want the same thing. We arranged for her husband to bring the cats to my office and then we brought them up the back way to her room. They simply curled up on her bed at her side. She died at 3:53 this afternoon with her family and cats by her side.

Please keep Laura and her family in your prayers. Her family, understandably so, is devastated.