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On not giving what a patient what he "wants"

Posted by Dr. Lachlan Forrow  March 11, 2014 06:09 AM

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Since my last two postings were long, this one will be short.

I was reminded yesterday of a patient I had long ago, who I will call "Frank."  He had multiple complications of advanced AIDS, and in 1991 we didn't have the miracle drugs we have today.

One day I was sitting on a couch in my mother-in-law's den in Denver, on vacation with my family.  The phone rang, and it was Dr. Mary Fishman, my primary care colleague who was covering my patients.  It was the only time she ever called me when I was on vacation.  She said (roughly):

"Lachlan, I wouldn't call you except that Frank is back in the hospital, and he swears that you promised him that if he ever had to come back into the hospital because of the pain, you would give him all the IV dilaudid he wanted, to make the pain go away.  Is that true?"

I laughed.  It sounded just like Frank.  And of course it wasn't true.  So I explained that to Mary, and she laughed, too.  She said she would make sure Frank got the IV dilaudid that he needed, all that he needed, not what he said he wanted.  I think the Rolling Stones once wrote a song about that.  

I still remember right after Frank died, a few months later, his sister thanking me and the nurses -- I can almost see her in the hallway outside his room on the 11th floor of Beth Israel: "You guys did an amazing job.  The best thing about it was that you always let Frank just be Frank, right up to the end."

I think that's what Frank really wanted.  And needed.  And got.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »

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