CHN Health Matters

End of life care


I recently read a book titled “Mortality” that was written by a surgeon and addresses the problems and challenges we face with end of life care. It dealt with some examples of patients he had cared for and his personal experience with the care of his father.

As I read the book, I was reminded of a patient I recently saw in the emergency department who had a cancer in her abdomen. I had not seen her before. The cancer was not curable and she had already been through surgeries and chemotherapy yet the cancer was still present and growing. She came to the emergency room because she had developed acute severe abdominal pain during the night. Testing quickly showed that she had a perforation of her bowel, which was the cause of her pain. This meant that without surgery she would surely die.

We tend to assume that people will want all the treatment that modern medicine can provide to prolong life. She could have surgery to find the perforation, try to repair it, and drain the bowel to the skin. She would have had a difficult hospital course with no guarantees that she would survive the painful procedures done during the course of her treatment. She would have been separated from her family with tubes coming from all parts of her body. The surgery could have repaired the hole in her bowel but would not have solved her underlying problem. The cancer would have still been there.