Responding to unexpected events

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1049-a (Published 30 October 2003) Cite this as: BMJ 2003;327:1049

Patients have to be treated as individuals

  1. Halina M Iwanowska (halina{at}mbox301.swipnet.se), retired surgeon
  1. S-170 77 Solna, Sweden

    EDITOR—Saunders et al discussed responding to unexpected events in planning for a good death.1 I was recently in a very similar, difficult, and sad situation.

    My husband for 14 years had been treated for prostate cancer for three years, in an outpatient clinic, where he received chemotherapy, radiotherapy, and intravenous isotopes, focusing on bone metastases. He had no pain and was full of plans and ideas for the future. Iliac artery thrombosis developed; he was taken to hospital and was given heparin as an antithrombosis regimen. A few days after returning home he began to have intense bleeding from the bladder. His condition deteriorated, but he was full of hope, knowing that new treatments had prolonged his life on many occasions.

    A urology specialist from another hospital decided to try to detect the cause of the bleeds and, seeing his expectation, we transferred my husband by ambulance to a hospital 30 km away. The bleeding came from a ligated artery, but the mucosa of the bladder was swollen and brittle. He was very weak but still full of hope. Three days later he started to have massive bleeding from the bladder and stomach, and he died—very still, in the presence of family, almost to the end conscious.

    I think that with every patient we have to look at the individual person, taking into consideration the patient's physical, mental, and psychological state. We cannot deprive a patient of hope, even knowing that his or her chances are minimal.


    • Competing interests None declared.


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