How could you not know she has cancer?

I imagine this happens everywhere: a patient with no PMH gets admitted, is diagnosed with metastatic disease, and dies within days.

What's even more interesting is the fact that most of those patients look like they are damn near dead to begin with.

I can think of three pt's within the past few weeks alone. One with bone ca, one with lung ca, and one with breast ca. All walked into the ER for some nonspecific pain (shoulder, etc) and ride out in a hearse shortly thereafter.

A few weeks ago I cared for a patient who looked like she belonged in a coffin more than a hospital bed. She was pale, cachectic, and minimally mobile. She just lied in the bed, sleeping away the shifts. I would often watch her breathing for a long time because her visual appearance alone was not enough to reassure me she was alive.

Giving report in the morning the nurse receiving her said, "You know when she gets the diagnosis she will die within days."

I agreed, commenting that she would maybe last a week at best.

I was wrong. She lasted two hours. She got the news, then we coded her because of course she had no PMH therefor never had a need for advanced directives. The code was unsuccessful obviously and the family was called.

They came in for the first time since she was hospitalized nearly a week ago, shocked and outraged. There has never been a think wrong with aunt Sally, how could she just die so suddenly?

I stood there in shock myself.

How could anyone not know she had cancer?

Most of her family died from cancers. She was essentially a bag of bones wrapped loosely in wrinkly skin. The minute she walked in the door she was diagnosed with everything under the sun. And that even excludes cytology diagnoses.

I couldn't think of anything to say in that moment. Another nurse stepped in to help them.

I rendered myself useless and walked away.

I still don't get it. How can one have a family member decline so much and present so many s/s of everything, yet think nothing is wrong. Never tell her to get checked out. Never have the smallest idea that she might have some pathology in her. I just don't understand.

But in the end she passed quickly. No chemo. No radiation. No surgeries or prolonged intubations. She lived her whole life without daily medications or medical interventions.

And as angry as it makes me to see how simple tests could go a long way, I realize that what is really making me angry is that I have a close family member who is aunt Sally a few years prior to her death.