Questions

Gypsy, a Caucasian woman, had hemoptysis as she sat at the bedside of her dying husband.  His decline had been gradual, first peripheral vascular disease leading to multiple surgeries and finally resulting in chronic renal failure treated by dialysis. She learned the test results from her pulmonologist; she had poorly differentiated nonsmall cell lung cancer metastatic to the other lung, both kidneys, and possibly the cervical spine.  Surgery, chemotherapy, or radiation therapy couldn�t cure her cancer. The medical oncologist told her there were therapies that could be used to control her cancer but that none of them could cure her cancer.  He talked about the advantages and disadvantages of each therapy and of not doing anything to treat her cancer but doing everything possible to keep her comfortable.  Then he asked her which option she preferred. Gypsy didn�t hesitate, she told him that, as a 73-year-old woman, she didn't want to go through chemotherapy; she didn�t want to lose her hair.  She wanted to try radiation because it was likely to help the hemoptysis, which by now was very disturbing to her.  She didn�t want to cough and bleed to death.

Gypsy started radiation therapy to her lung. A few months later, Gypsy�s condition deteriorated. She developed severe pedal edema with skin lesions and urinary urgency.  Oral Lasix did not relieve Gypsy�s edema and she was admitted to the hospital for IV Lasix. Given Gypsy�s urinary urgency and in preparation for IV Lasix, Gypsy was given the option of a Foley catheter.  She readily agreed and was amazed at the amount of comfort it provided her.  She had not realized how much distress the urinary urgency had caused her until the Foley relieved it. After three days of IV Lasix, Gypsy�s edema was not improved and progressed to stasis ulcers on both legs in just three days.  Since she had told her physician of her wish for no home hospice, he offered her admission to an inpatient hospice unit where her skin breakdown could be treated and her comfort maintained.   She agreed to inpatient hospice care; she died two weeks later.