Views 1,929
Citations 0
Teachable Moment
Less Is More
January 2016

Surgical Intervention in Terminal Illness—Doing EverythingA Teachable Moment

Author Affiliations
  • 1Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2016;176(1):18-19. doi:10.1001/jamainternmed.2015.6335

There comes a time for all of us when we must shift our efforts from focusing on more time to focusing on everything else.1

Atul Gawande

A man in his late 70s with dementia, oriented but unable to make complex medical decisions, presented with confusion, focal right-sided weakness, and hypoxemia. He was taking lifelong anticoagulation medication for recurrent deep venous thrombosis but was receiving subtherapeutic doses on presentation. A stroke alert was called, and imaging revealed a discrete mass measuring 3.4 × 5.1 × 6.0 cm in the left parietal lobe and another measuring 1.7 × 1.7 × 2.1 cm in the superior cerebellum, concerning for brain metastases. Computed tomographic angiography of the chest revealed a subsegmental pulmonary embolism, and a heparin drip was started. Subsequent evaluation revealed widely metastatic lung cancer. Biopsy confirmed adenocarcinoma with a molecular genetic profile not favorable to chemotherapy. Radiation oncologists recommended against radiation therapy because the brain masses were too large. Neurosurgeons offered palliative resection of the brain masses.

First Page Preview View Large
First page PDF preview
First page PDF preview