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A Piece of My Mind
August 27, 2019

A Difficult Conversation

Author Affiliations
  • 1Division of Neurorehabilitation, Washington University School of Medicine in St Louis, St Louis, Missouri
JAMA. 2019;322(8):727-728. doi:10.1001/jama.2019.11757

In her late 50s, Cathy developed fatigue. Over the course of a few months, she began to take afternoon naps and fall asleep earlier than normal. Then, over a 2-week period, she gained 15 pounds. Overnight, her belly swelled full of fluid, and she appeared 7 months pregnant. The next day, Cathy's primary care physician sent her to the hospital emergency department for a CT scan of her abdomen and pelvis. As a physician myself seeing patients at another nearby hospital, I logged into the network computer and, with Cathy’s permission, reviewed her scan results with the emergency department physician over the phone. Cathy's imaging and subsequent peritoneal fluid were consistent with advanced ovarian cancer—to me, a death sentence. I had delivered poor prognoses many times during my career, so I took it upon myself to give Cathy the bad news and ensure that I would be with her during this difficult conversation. This was especially challenging because Cathy was no ordinary patient—she was my wife of 31 years.

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