was another matter. Like my father’s doctors, the
oncologist and I had a menu ofoptions. Therewas a
wholerangeofnewchemotherapyregimensthatcouldbe
tried toshrink thetumorburden. I had a fewsurgical
options for dealing with her situation, as well. With
surgery, I told her, I wouldn’t be able to remove the
intestinalblockage,butImightbeabletobypassit.I’d
eitherconnectanobstructedlooptoanunobstructedone
orI’ddisconnectthebowelabovetheblockageandgive
heranileostomy,whichshe’dhavetolivewith.I’dalso
put in a couple drainage catheters—permanent spigots
that could be opened to release the fluids from her
blocked-updrainageductsorintestineswhennecessary.
Surgery risked serious complications—wound
breakdown, leakage of bowel into her abdomen,
infections—but it offeredher the only way she could
regainherabilitytoeat.Ialsotoldherthatwedidnot
havetodo eitherchemoor surgery.Wecouldprovide
medicationstocontrolherpainand nauseaandarrange
for hospice at home.
The options overwhelmed her. They all sounded
terrifying.Shedidn’tknowwhattodo.Irealized,with
shame,thatI’drevertedtobeingDr.Informative—here
arethefactsandfigures;whatdoyouwanttodo?SoI
steppedbackandaskedthequestionsI’daskedmyfather:
Whatwereher biggestfears andconcerns?Whatgoals
were most important to her? What tradeoffs was she
willing to make, and what ones was she not?
Noteveryoneisabletoanswersuchquestions,butshe
did.Shesaidshewantedtobewithoutpain,nausea,or
vomiting.Shewantedtoeat.Mostofall,shewantedto