Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How do you tell a 24 year old that she is dying?

Jennifer Caputo-Seidler, MD
Physician
December 14, 2017
Share
Tweet
Share

Physicians are no strangers to death. We are baptized into medicine with cadavers as first-year medical students. We learn to break bad news. We lose patients, some that are expected and some we never see coming. Through it all, we maintain a distance, an emotional reserve that enables us to shoulder these losses but still see the next patient with the full attention they deserve. But every now and then we lose a patient, and that loss stays with us. One thing that we don’t learn in medical school is how to grieve these losses.

For me the grief came in my dreams, three consecutive nights dreaming that she was still alive, that the phone call notifying me of her death had been a mistake. She still had time. I would see her on rounds tomorrow.

How do you tell a 24 year old that she is dying? Just seven months ago this conversation was unthinkable. Seven months ago she went to a local Emergency Room for chest pain and had a CT angiogram that diagnosed a pulmonary embolism. The CT also found a lung mass. Next came the biopsy which confirmed everyone’s worst fear: cancer. Non-small cell lung cancer. She was referred to my hospital’s cancer center where she underwent two rounds of chemotherapy before starting immunotherapy. For a time her disease was stable. Then came excruciating back pain and the MRI which showed a pathologic fracture of the lumbar spine. She underwent radiation, and her pain medications were increased.

This was a setback, but she remained hopeful. Then came the shortness of breath and hypoxia and the home oxygen. After just a few weeks, the oxygen wasn’t enough to allow her to get the bathroom without becoming winded. She returned to the hospital, and another CT showed new lung nodules. She was started on antibiotics, and everyone hoped this was just a pneumonia while fearing the real culprit was the progression of her cancer. Oncology was consulted and planned to resume chemotherapy if there was no improvement with antibiotics.

This was the point when I took over her care. During the seven days I was her doctor, she didn’t get better with antibiotics; rather, as everyone had feared, she steadily got worse. Unfortunately, during this same weeks’ time, she became increasingly thrombocytopenic, sparking concern the cancer was now in her bone marrow. This was the line in the sand. With the severe thrombocytopenia, she was no longer a candidate for chemotherapy. Her oxygen needs increased by the day. There was no treatment left to offer other than palliation. She asked me if dying would be painful if she would be conscious and gasping for air. I promised her she wouldn’t suffer. All the while, her husband sat on her hospital bed, crying, unable to look at me.

Two days before she died she was sitting up in bed putting on make-up when I made my rounds, asking how my day was going. Within 24 hours her dyspnea became so severe that she could no longer get out of bed. Another 24 hours and she was gone, just two hours after signing a DNR. I knew her for only seven days, but her death and my unexpected grief for the life she never got to live have stayed with me far longer.

Jennifer Caputo-Seidler is an internal medicine physician.

Image credit: Shutterstock.com

Prev

Both markets and the government are needed to fix health care

December 14, 2017 Kevin 22
…
Next

Going skin deep: Is a tattoo ethically binding?

December 14, 2017 Kevin 1
…

Tagged as: Oncology/Hematology, Palliative Care

Post navigation

< Previous Post
Both markets and the government are needed to fix health care
Next Post >
Going skin deep: Is a tattoo ethically binding?

ADVERTISEMENT

More by Jennifer Caputo-Seidler, MD

  • Street medicine: a lifeline for Florida’s homeless amidst new public sleeping ban

    Jennifer Caputo-Seidler, MD
  • When pregnancy becomes a health risk

    Jennifer Caputo-Seidler, MD

Related Posts

  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • Hormone replacement therapy is still linked to cancer

    Martha Rosenberg
  • A silent moment with a dying patient

    Ramses Perez
  • Dying is a selfish business

    Nancie Wiseman Attwater
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Cancer care costs everyone too much. What can we do about it?

    Andrew Hertler, MD

More in Physician

  • The shocking risk every smart student faces when applying to medical school

    Curtis G. Graham, MD
  • The physician who turned burnout into a mission for change

    Jessie Mahoney, MD
  • Time theft: the unseen harm of abusive oversight

    Kayvan Haddadan, MD
  • Why more doctors are leaving clinical practice and how it helps health care

    Arlen Meyers, MD, MBA
  • Harassment and overreach are driving physicians to quit

    Olumuyiwa Bamgbade, MD
  • Why starting with why can transform your medical practice

    Neil Baum, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
  • Recent Posts

    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Clinical ghosts and why they haunt our exam rooms

      Kara Wada, MD | Conditions
    • High blood pressure’s hidden impact on kidney health in older adults

      Edmond Kubi Appiah, MPH | Conditions
    • Deep transcranial magnetic stimulation for depression [PODCAST]

      The Podcast by KevinMD | Podcast
    • How declining MMR vaccination rates put future generations at risk

      Ambika Sharma, Onyi Oligbo, and Katrina Green, MD | Conditions
    • The physician who turned burnout into a mission for change

      Jessie Mahoney, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How do you tell a 24 year old that she is dying?
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...