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Cancer isn't the only malignant disease

BMJ 2002; 324 doi: (Published 02 February 2002) Cite this as: BMJ 2002;324:307
  1. Elizabeth Moulder, basic surgical trainee (
  1. City Hospital, Birmingham, rotation

    Tom was an inpatient for most of my six months on the vascular firm. Sometimes he'd be under the cardiologists, occasionally at home. His peripheral vascular disease meant horribly ulcerated legs and renal failure; his many heart attacks had left him with virtually no left ventricular function. Phlebotomy was impossible because of his gross oedema and he had reached the stage where he couldn't breathe sitting upright, let alone lying down with pillows. The nurses constantly battled to get him into bed and elevate his legs.

    Tom was in more distress than any cancer patient I have seen

    Tom was in more distress—so causing me more stress—than any cancer patient I have ever seen. I argued with senior staff about the need to keep checking his climbing Us and Es and received little clear direction or management. As he refused amputation and had visible swelling, it seemed obvious to me that a terminal cardiac event or sepsis would take over sooner or later. …

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