The First Time I … Gave a Family Bad News

Dr. Gary Frenette
Oncologist, Carolinas Hematology and Oncology Associates

Dr. Gary Frenette

Chris Edwards

I was a resident at Duke on a floor dedicated to patients on clinical trials. There was a fiftysomething woman with Stage IV metastatic colon cancer, meaning the cancer had left her colon and gone into her liver. She was part of a Phase I dose-finding study, where they gradually increase the amount of a trial medicine a patient receives until side effects occur. Hers was a drug in the earliest stages of clinical trials.

She had two daughters in their twenties who were completely devoted to her care. Her doctor was primarily a researcher, and he'd come around in the morning, proposing new directions with treatment, and trying to sound promising, but I knew he was giving them inappropriate hope. He'd never talk about the 800-pound elephant in the room: her disease was getting worse, and the treatment was clearly failing. She was becoming acutely weak, short of breath, and hypotensive [having abnormally low blood pressure].

I remember my increasing frustration with the doctor as I sat with her daughters in their mother's room. It was my first year out of medical school, and I didn't feel it was my place to question the attending physician, but as she got weaker and weaker, the daughters became more and more distraught. The mother became frustrated with herself, too, asking, "Why am I not feeling stronger? Is there something I'm doing wrong?" At that point, I took it upon myself to sit the daughters down and tell them what I honestly felt I was seeing: that by all accounts this was a terminal case, and that the treatment appeared to be failing.

I remember seeing their relief. They knew they could shed this burden and reset their priorities for their mother. For terminal cases like that, the best treatment is often to focus on maximizing the quality of life the patient has remaining. — As told to Annie Monjar

Cancer Mortality Rates For Mecklenburg County (per 100,000 population)

  • Lung cancer 49.8 (statewide rate: 58.4)
  • Prostate cancer 27.8 (statewide rate: 26.6)
  • Breast cancer 24.5 (statewide rate: 24.3)
  • Colon cancer 16.0 (statewide rate: 16.8)

SOURCE: From NC Central Cancer Registry, 2004-2008

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