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A Piece of My Mind
August 19, 2009

More Things in Heaven and Earth

JAMA. 2009;302(7):723-724. doi:10.1001/jama.2009.1114

There are more things in Heaven and earth, Horatio, than are dreamt of in your philosophy.

The Tragedy of Hamlet, Prince of Denmark, Act I, Scene 5

I was not accustomed to my advice being taken so lightly, especially in a matter of life or death. Occasionally my elderly patients had wisely decided to forgo intensive cancer treatment. But in this case, a 20-year-old mother was refusing her chance to live. I dug in my heels. No matter how hard I tried, Emma could not be convinced to agree to chemotherapy, but that day we parted, as friends, and she had agreed to call me with problems, to have periodic blood cell counts, even to return to hematology clinic for follow-up in two weeks. As I reflect now on Emma's clinic visit that day 24 years ago, I had mistakenly assumed this young woman would be just another in a long succession of unfortunate patients who, when faced with a diagnosis of acute leukemia, would want the most up-to-date treatment available at the time.

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