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He is a tall, well-built, older (but not old) man. I remember him as the Stanford grad, because I can never remember his name. He is taking a drug called Tarceva (erlotinib), which has been shown to be especially beneficial for patients with a mutation called the EGFR mutation. Amongst the drug's symptoms are dryness--of the skin, mouth, eyes, and just about every other body part. This man has a most painful looking rash all over his face and upper body, like red burning scales. Just looking at it makes my teenage acne seem like a joke. The rash is like a summer brush fire on his skin. It is so painful that he cannot put anything on it except a wet towel--not even lotion of any kind--and he sleeps with a fan on his body at night. Every time I see him, I fail to imagine how uncomfortable he is. A simple bug bite drives me crazy--and there are anti-itch creams for that. This is one example of the endurance that cancer patients have. Where they get it from I do not know, but I wonder how I would hold up if I were in their shoes.
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What I remember most about this elderly patient is her family, specifically her daughter and son-in-law. The first time I met them, I listened to the nurse practitioner try to give what we call a "hospice talk." As a side note, hospice is usually associated with death.It is suggested as an option for patients who will be needing extra care at home as their condition deteriorates. They may become too weak to come in for regular checkups in clinic, in which case hospice nurses and doctors will provide them with care at home--specifically with symptom control so that the patient can maintain his or her quality of life as much as possible. The goal is to make sure the last days are not wasted. Given the subject's negative connotations, it is no surprise that when the NP or doctor suggests a patient consider hospice care, sometimes the response is not pleasant. In this case, the patient's family became subtly defensive, explaining that they came to City of Hope for an ounce of hope. Understandably so. But what they said next is what I'll never forget (I'm paraphrasing). "Give her anything, even if it's not chemo, even if it's just water. Just give her something." For some patients, hope means treatment, shoving something into the patient's veins even if it will do them no good--or worse, it may actually do them harm. I've been told time and again that the first rule is to do no harm. So as soon as symptoms from treatment begin to ruin a patient's quality of life in attempt to enlarge the quantity, this line has been crossed, and it's time to weigh the scales.