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Cancer Care Chronicles
August 2017

Processing Death

Author Affiliations
  • 1Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
JAMA Oncol. 2017;3(8):1025-1026. doi:10.1001/jamaoncol.2016.5105

She was dying. I knew she was dying. She knew she was dying. Her family knew she was dying. We all knew, in fact, that she would die in the hospital. After all, that was the plan. But I, selfishly, was not ready. Cancer was consuming her body. Even with the full understanding of an irreversible process where no additional interventions were possible—even armed with that knowledge, my preparation for her death seemed grossly insufficient.

For my pediatric oncology patients, I would spend most of my time on call actively managing hypertension, electrolyte derangements, anemia, thrombocytopenia, nausea, vomiting, and infections. But, a strange thing happens when a patient’s resuscitation status changes from full resuscitation to do not resuscitate and do not intubate. You not only do much less but it often seems that medical providers spend less time with the patients who you should arguably be spending more time with. On rounds, the team seems to discuss everything but death in front of the family. We tiptoe gently around the word as if out of reverence. Somehow everyone drifts away from the patient. It's ironic, is it not?

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