She had been admitted overnight: a previously healthy 62-year-old woman who had been blindsided by acute onset of abdominal bloating and pain 6 months prior. A flurry of tests showed she had pancreatic cancer, and that it was advanced. She had started chemotherapy, but the regimen was so toxic; she suffered from unrelenting nausea and fatigue to the point that in the last six weeks she had gone from playing tennis every weekend to becoming unable to rise from bed. In the last 24 hours her family witnessed a significant decline. She was awake only sometimes, and when she was, she was incoherent. This prompted her admission.
I was on service then, and even though much time has passed, I still can see her face. With IV fluids and the correction of some lab abnormalities, she had “woken up” — able to speak to her family and clearly aware that she was in the hospital. I saw her the next morning and asked how she was doing.
“Well, I could be better!” she stated. She told me about how the pain had gotten worse recently, that chemotherapy was making her feel worse than before, instead of better. “I had no idea it would be this hard.” We had also done a CT scan, which showed the worst: The cancer was now in her liver, where multiple sites of metastases had grown despite chemotherapy.
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