saw a pt once with a strong fam hx breast CA (sisters and mom). When her own breast started falling off in chunks, she just put gauze over it and wrapped her entire chest with an Ace bandage. What did she see me for? An ingrown toenail.

She figured she was going to die from the breast CA and didn’t want to go through treatment for that (said her sisters and mom both died despite agonizing chemo/radiation/surgery), but she wanted to be able to walk pain-free until she was actively dying.

We had to involve ethics team on that one, because I really, really, really didn’t feel I could just say, “Oh, OK.” At this stage in my career, I would be more comfortable with a patien’ts autonomous decision being not the one I’d make.

-FD

PS: Thanks for your blog help by phone yesterday!