This OSP Journal of Case Reports section is a vignette almanac whose purpose is to provide a record of the emotional climates of the general practitioner, expressed as metaphors of landscapes, geographical features, atmospheric data, lunar phases, sunrises and sunsets, beginning and end of the seasons of the year, winds, tides , etc., when dealing with different clinical cases, with the aim of achieving a greater understanding of what we are and what we do as doctors, and then achieving greater empathy. Here, a vignette of a case of pancreatic cancer is presented where the patient seems to make a last wish from the general practitioner. This situation creates an emotional climate in the doctor that suggests the loneliness of a long, narrow piece of land that extends into the immense sea, wanting to embrace the bay… without managing to stop the force of the sea…, which invades it with immense waves…
Emotions; Terminal Care; Pancreatic Neoplasms; Metaphor; General practitioner
[“A long, narrow piece of land that extends into the sea, a river, etc.”]
Vignette
Henry, 71 years old, had worked as a street vendor all his life until the shortness of breath due to his COPD prevented him from doing so. He had stopped smoking, was taking bronchodilators and was taking a hypotensive medication for the high blood pressure that had been diagnosed a few years ago, but remained acceptably controlled.
A few months ago, persistent symptoms of anorexia, nausea, occasional vomiting and weight loss led to the diagnosis of surgically unresectable pancreatic cancer [1-3] and he went from oncology, which rejected his treatment, and was sent to palliative care at home. After a period of persistent digestive symptoms, a few weeks followed where he felt better, eating five small meals without vomiting, stopping the weight loss, and being able to walk with help for a few minutes each day… The family, of Gypsy ethnicity, decided from the moment of diagnosis not to tell him about the situation… and he did not ask [4, 5].
In that situation, Henry said that “he was better…” And the family spoke to the general practitioner (GP): “As he is recovering… and he cannot see well…, we took him to the optician and he told us that he would not gain anything with new glasses… that it must be cataracts… and so we asked you to refer him preferentially to the ophthalmologist for cataract treatment.”
GP was surprised… Had he heard correctly? They asked him to go to the ophthalmologist to put him on the cataract surgery waiting list… being a terminal patient with a life expectancy of a few months, at most!? It was like the last wish of the condemned man on death row, he thought [6].
Henry and his family were a dark, narrow and long strip of land that juts out into the immense sea, wanting to embrace the bay… without managing to stop the force of the sea…, which invades it with immense waves… Al GP Henry suggests a portion of land surrounded by water, and which is only connected and communicated by a relatively narrow part with another land of greater extension… to which he is heading [7].
GP gave the family the referral to the ophthalmologist.
- Puckett Y., Garfield K (2022) Pancreatic Cancer. StatPearls. [Crossref]
- Neoptolemos JP., Springfeld C, Hackert T (2021) A Review of Pancreatic Cancer. JAMA. 326: 2436. [Crossref]
- Mizrahi JD., Surana R., Valle JW., Shroff RT (2020) Pancreatic cancer. Lancet; 395: 2008-2020. [Crossref]
- Asociación Española Contra el Cáncer (2021).
- McCabe MS., Wood WA., Goldberg RM (2010) When the family requests withholding the diagnosis: who owns the truth? J Oncol Pract 6: 94-96. [Crossref]
- Grace E (2024) Granting Last Wishes of the Terminally Ill. TerminalIllness.
- The Coastal Wiki (2024) Definitions of coastal terms.
