[Skip to Content]
[Skip to Content Landing]
A Piece of My Mind
August 8, 2007


Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2007;298(6):604. doi:10.1001/jama.298.6.604

He was 64 years old, a lifelong bachelor with three sisters and a limited medical history—that is, until one month ago when he was diagnosed with stage IV adenocarcinoma metastatic to the liver.

“Hello, I’m Dr Rousseau. I’ll be your new doctor in the nursing home.” He nodded his head and then wiped his lips with a wet washcloth. There was pain on his face and concern in his eyes.

When I first meet patients, I ask them to tell me about their disease, their life, and their expectations, but Mr Jones' words were mumbled and unintelligible, precluding any semblance of a conversation. He swallowed with difficulty and leaned forward on the bedside table to spit into a basin. I knew that seven days ago he had received his first dose of chemotherapy, a concoction of irinotecan, leucovorin, and fluorouracil, and that his white blood cell count was a dismal 200/μL.