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The drover’s wife

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Finding the strength to say it like it is

One day she sat down “to have a good cry,” as she said — and the old cat rubbed against her dress and “cried too.” Then she had to laugh.1

The registrar called about her first consultation as a trainee oncologist. The “case” was a 69-year-old previously well woman (let’s call her Tracey) from a semirural setting, who had gone to bed, one week ago, as normal, and had then woken up to find she was having difficulty holding her coffee mug. Within 24 hours she was intubated, ventilated and transferred to a metropolitan centre. A week later she had been diagnosed with a severe demyelinating polyneuropathy and metastatic squamous cell cancer of the lung.

We reviewed all the data, spoke to other members of the team and agreed on a plan of supportive care and withdrawal of ventilatory support. The next difficult task was communicating this to the patient. Our only method of communication was that she could answer yes or no by blinking her eyelids: one blink for “no”, two blinks for “yes”. We went through why her condition precluded effective treatment of her cancer, and that we were recommending “keeping her comfortable”. We asked if this made sense…