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A Piece of My Mind
February 2, 2011


JAMA. 2011;305(5):447-448. doi:10.1001/jama.2011.31

I had to trek about a mile, mostly through heavily wooded terrain, to get to their home. All I knew about my patient was that she was in her late 80s and had advanced pancreatic cancer. She lived with her son, who was her primary caregiver, and her younger sister had moved in, having come from somewhere else in Haiti to be with her at this last stage of her life. Their home was cramped, cluttered, and dark even at midday. Upon entering I could hear the local church bell ringing in the distance and was greeted by the oppressive, dank smell of bodies, urine, and cancer. Her son's clothes were dirty and disheveled, and a pronounced stutter made his naturally timid personality seem like outright anxiety. In fact he was calm and pleasant, his English was excellent, and I was genuinely surprised at how medically well versed he was about his mother, whose English was as limited as my Creole. He had been employed and supporting the family up until a few months ago, when his mother's illness had by necessity become his primary concern. His aunt, who was tiny and hovered protectively at her sister's bedside, spoke only Creole and merely smiled in my direction during most of the visit.

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