Robert A. Buckman, M.D., Ph.D.
Adjunct Professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center
Dr. Buckman:
Mrs. James.
Daughter:
Yes.
Dr. Buckman:
My name's Dr. Buckman. Sorry, I'm a new face. I've been covering for Dr. Adams this weekend.
Daughter:
Oh, right. Okay.
Dr. Buckman:
And I was called to see your
father, Mr. Young. Would you mind telling me what you know, and what
happened this morning from your point of view?
Daughter:
Well, he was feeling quite chipper and wanted to go for a walk...
Dr. Buckman:
Yeah.
Daughter:
So we went to the atrium at the end of the hall...
Dr. Buckman:
Yes.
Daughter:
He was fine. And then on the way back, he said he felt tired.
Dr. Buckman:
Yes.
Daughter:
And he looked kind of shaky, so I took him back to bed. And he said that he needed to have a bowel movement.
Dr. Buckman:
Yes.
Daughter:
So I didn't think he should make the
trip on his own, so I ran for the nurse. But he got out of bed, and
said he was okay to do it by himself...
Dr. Buckman:
Yes.
Daughter:
And collapsed.
Dr. Buckman:
He collapsed.
Daughter:
So.
Dr. Buckman:
That must have been a very great shock?
Daughter:
And then she showed up, and sent me out of the room.
Dr. Buckman:
Yeah.
Daughter:
And that's all I know.
Dr. Buckman:
Let me tell you what happened. I'll put a Kleenex there for you.
Daughter:
Okay.
Dr. Buckman:
I'm sorry to say that your dad had
what we call a pulmonary embolism. That's a clot of blood coming from a
clot in a vein, and flying into the lung, which very often produces
that...
Daughter:
Okay..
Dr. Buckman:
...feeling, I've got to have my bowels emptied.
Daughter:
Oh, okay.
Dr. Buckman:
Then it unfortunately stops the heart doing its normal thing...
Daughter:
Oh..
Dr. Buckman:
In making the blood go around.
Daughter:
All right.
Dr. Buckman:
And so the patient collapses.
Daughter:
Yeah.
Dr. Buckman:
And basically what happened after
that is that his heart stopped beating, just shortly after I got there,
he had what we basically call a cardiac arrest.
Daughter:
Right.
Dr. Buckman:
And we tried very hard to try and get his heart started again. Sometimes it's possible, not usually.
Daughter:
Okay.
Dr. Buckman:
And in your dad's case, I'm very
sorry to tell you that we were not able to get his heart started again.
We couldn't actually get him going again at all.
Daughter:
So what did you do? What?
Dr. Buckman:
I'm afraid that your dad unfortunately has died.
Daughter:
No.
Dr. Buckman:
He died of that clot in the lung.
Daughter:
What?
Dr. Buckman:
Sorry to tell you that.
Daughter:
What? He was doing so well. Oh, my God.
Dr. Buckman:
I know this is very hard for you.
Daughter:
Oh, no. How did this happen?
Dr. Buckman:
I'm really sorry.
Daughter:
Oh, my God.
Dr. Buckman:
When somebody has a cancer, particular if it's in, has spread to the liver...
Daughter:
Yeah.
Dr. Buckman:
It makes these kinds of clotting
things happen much more frequently. And as you heard from Dr. Adams, we
weren't expecting your father to die for at least two or three months,
maybe even longer...
Daughter:
Yeah.
Dr. Buckman:
Which makes it a great shock to you...
Daughter:
Yeah.
Dr. Buckman:
That he died so suddenly. That's the...
Daughter:
Oh, my God. I just can't believe it.
Dr. Buckman:
Very hard to believe, isn't it?
Daughter:
Oh, my God. He was doing so well.
Dr. Buckman:
Yeah.
Daughter:
He was about to go home the next day.
Dr. Buckman:
We were planning to send him home.
Actually, you're absolutely right, we had planned to send him home
tomorrow. The pain was under good control. As you know the cancer had
made metastases in the liver and wasn't under control, but it wasn't
growing particularly fast.
Daughter:
Yeah.
Dr. Buckman:
But this happened very suddenly.
Daughter:
Oh, my God. I have to call my sister and tell her. Oh, my God.
Dr. Buckman:
Who have you got at home, Mrs. James?
Daughter:
My husband.
Dr. Buckman:
Your husband, does he know about
your dad's general condition? Did he realize that your father had lung
cancer and liver metastases?
Daughter:
Yeah.
Dr. Buckman:
Yes, he did. But he obviously wouldn't be expecting it either?
Daughter:
No. I don't know, I think, we all thought we were going to have a little bit more time with him.
Dr. Buckman:
Yes, yes.
Daughter:
Are you sure you did everything?
Dr. Buckman:
That I am sure of. In this sense that resuscitation, CPR is something, obviously, people are very good at now a days...
Daughter:
Yeah.
Dr. Buckman:
Really good at. And in a few cases,
it's possible to propel the clot onwards, but in a vast majority,
particular in your dad's age group, it isn't, I'm so sorry.
Daughter:
Was he in a lot of pain, do you think?
Dr. Buckman:
Absolutely none. In fact, I can tell you that, because we know people who have survived this are able to tell us...
Daughter:
Yeah, yeah.
Dr. Buckman:
That they felt faint. They felt this urge to go to the toilet.
Daughter:
Yeah.
Dr. Buckman:
They feel faint, and they don't remember anything else.
Daughter:
Right.
Dr. Buckman:
And perhaps in a very strange sort
of way, it's, you know, it's a relief to you to know that your dad
would not have suffered in any way, anymore then you or I would suffer
when we're fainting, or if you we're fainting, then that's what we know.
Daughter:
Yeah.
Dr. Buckman:
So he didn't suffer.
Daughter:
Okay...
Dr. Buckman:
And perhaps in another way, he was sort of saved the last two months...
Daughter:
Yeah.
Dr. Buckman:
Or so, which might have been suffering for him.
Daughter:
Yeah. Oh, my poor dad. Oh.
Dr. Buckman:
Let me ask you a question. Would
you like, or would you not like to say goodbye to him? Do you want to
say goodbye to his, to see his body in the hospital ward?
Daughter:
I think I would.
Dr. Buckman:
You think you would? I'll come take you there in a moment.
Daughter:
Okay.
Dr. Buckman:
We'll do that. The other thing I'd
like to do is that, normally, the nursing staff would call somebody
you'd like, it could be your husband, or it could be your sister, and
they'll come here to the hospital to collect you. It's not really...
Daughter:
Yeah.
Dr. Buckman:
...easy for a relative to make her own way home. So we'd...
Daughter:
Yeah.
Dr. Buckman:
Have somebody collect you.
Daughter:
Yeah, we should call...
Dr. Buckman:
Okay.
Daughter:
My sister
Dr. Buckman:
Call your sister?
Daughter:
Yeah. I just, I can't believe this is happening.
Dr. Buckman:
Very, very difficult.
Daughter:
It just does not seem like it's real.
Dr. Buckman:
Yeah, especially since this morning you were, you and him talking, yeah.
Daughter:
And he was feeling so good. We were talking about getting a bridge group together again.
Dr. Buckman:
Yeah.
Daughter:
I just. I mean we started to try to prepare ourselves for it, but it's just.
Dr. Buckman:
You had started to prepare yourselves for the fact that he was going to die but...
Daughter:
Yeah.
Dr. Buckman:
A lot of my patients say there's no such thing as being prepared, you know, however prepared...
Daughter:
Yeah.
Dr. Buckman:
You are...
Daughter:
Yeah.
Dr. Buckman:
It is always a tremendous shock.
Daughter:
Yeah.
Dr. Buckman:
It always is. And that's why saying goodbye to his body may actually...
Daughter:
Yeah.
Dr. Buckman:
Be of help to you. And it may actually make things a little easier for you if you'd like to do that.
Daughter:
I think I would. I think I would.
Dr. Buckman:
Okay. I'll take you there, and then we can come back here...
Daughter:
Okay.
Dr. Buckman:
And you sit down, and we call your sister and bring her in.
Daughter:
Okay.
Dr. Buckman:
Okay.
Daughter:
All right.
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