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- W2160161081 abstract "Story From the Front Lines Aman inhis late70swithdementia, orientedbutunable tomakecomplexmedicaldecisions,presentedwithconfusion,focalright-sidedweakness,andhypoxemia.Hewas taking lifelong anticoagulation medication for recurrent deepvenousthrombosisbutwasreceivingsubtherapeutic doses on presentation. A stroke alert was called, and imaging revealed a discrete mass measuring 3.4 × 5.1 × 6.0 cm in the left parietal lobe and another measuring 1.7 × 1.7 × 2.1cminthesuperiorcerebellum,concerningfor brain metastases. Computed tomographic angiography of the chest revealed a subsegmental pulmonary embolism, andaheparindripwas started. Subsequent evaluation revealedwidelymetastatic lung cancer. Biopsy confirmedadenocarcinomawith amolecular genetic profile notfavorabletochemotherapy.Radiationoncologistsrecommended against radiation therapy because the brain masseswere too large.Neurosurgeonsofferedpalliative resection of the brainmasses. Patientconfusionandfocal right-sidedweakness improvedwith intravenouscorticosteroids initiated for cerebral edema. The patient had no living will or advance directive. He asked the primary team to “do everything.” Theprimary team’s discussionwith thepatient’s wife emphasizedhigh surgical riskdue to recentpulmonary embolism and poor functional status and a low probability of palliative surgery resulting inmeaningful cognitive recoverydue tounderlyingdementia. Thepatient’swifebelievedthatherhusbandwouldwanttopursue aggressive treatment and consented to surgical intervention despite personal reservations. Thepatientunderwentsurgical resectionofthebrain masses.Postoperativecognitionwasunchanged.Onpostoperativeday3,thepatientexperiencedintracranialhemorrhageafter restartinganticoagulationtherapyforanew pulmonaryembolism.Evacuationofthehemorrhagewas successful, though the patient remained minimally responsive. After several days without improvement, his wife transitioned him to comfort care. He was discharged to inpatient hospicewhere hedied 11 days later." @default.
- W2160161081 created "2016-06-24" @default.
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- W2160161081 date "2016-01-01" @default.
- W2160161081 modified "2023-09-23" @default.
- W2160161081 title "Surgical Intervention in Terminal Illness—Doing Everything" @default.
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- W2160161081 doi "https://doi.org/10.1001/jamainternmed.2015.6335" @default.
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