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A Piece of My Mind
July 13, 2011

The Gift of Perspective

Author Affiliations

Author Affiliation: Division of General Medicine and Primary Care, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (wstead@bidmc.harvard.edu).

JAMA. 2011;306(2):136. doi:10.1001/jama.2011.914

Sometimes I wonder why so many bad things happen to me.
And then I thank God for the strength to handle it
.—My Patient

She is 41 and, after many cycles of unsuccessful in vitro fertilization, finally 18 weeks pregnant, when we get the worrisome news. She is sent to a gastroenterologist by her obstetrician to be evaluated for some rectal bleeding. Sigmoidoscopy shows a 4-cm mass with biopsy confirming adenocarcinoma, stage III at the time of diagnosis. She sees three different oncology teams for opinions, and everyone says the same thing: chemotherapy, radiation, surgery ASAP . . . not wise to carry pregnancy as the cancer may progress to untreatable disease . . . advised to abort. She is not interested in abortion despite the repeated urging of the consultants. She doesn't want to “let myself down.” This is the child they have worked so hard to have. I am humbled just to watch her digest all of this. She is so small, but so strong. I deeply respect her decision. At the same time I think about her and her family, and I want to start infusing the chemotherapy.

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