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Clinical Crossroads
May 26, 1999

A 44-Year-Old Woman With Severe Pain at the End of Life

Author Affiliations

Author Affiliation: Dr Foley is Professor of Neurology, and Member, Memorial Sloan-Kettering Cancer Center, New York, NY.

 

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

JAMA. 1999;281(20):1937-1945. doi:10.1001/jama.281.20.1937

DR PARKER: Mrs L is a 44-year-old woman admitted to a Boston, Mass, teaching hospital with terminal cancer complicated by severe pain. She lives in the greater Boston area with her husband and has managed care insurance.

Mrs L experienced a flaccid left arm for 5 days prior to admission—the first manifestation of metastatic lung cancer. She also noted some mild weakness in the left leg accompanied by slurred speech and some drooling. There was no associated headache, change in vision, fever, or weight loss. She complained of mild shortness of breath and back pain. Her medical history is complex and notable for a seizure disorder since age 16 years, polycythemia vera, hemiplegic migraine, carcinoid, colitis, pseudotumor cerebri, and distal pancreatectomy for islet cell tumor.

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