Critical Conversations

Abstract

Vignette Background: Sharon is a 56-year-old woman who has been complaining of bloating and discomfort for years. While descending steps from her hillside home, she recently fell and fractured her pelvis. A CT of the pelvis revealed a large ovarian mass with smaller masses in the peritoneum, and studies of the chest and upper abdomen revealed masses in the liver and lung. A recent biopsy confirmed poorly differentiated cells. She was diagnosed with metastatic ovarian carcinoma and managed conservatively for the pelvic fracture. Until last month Sharon ran a preschool, but she has been homebound for weeks. Presentation: Now, a month after the fracture, Sharon has developed increasing shortness of breath and has been admitted to the hospital with fever and pulmonary infiltrates bilaterally. She appears weak and delirious and has a raspy cough and signs on examination of extensive lung consolidation. She has lost a substantial amount of weight since last month. She is receiving high-flow oxygen 100% in the ICU, as well as antibiotics and vasopressors. At Sharon’s bedside is her 24-year-old daughter, who lives with her and works at the preschool. Her 30-year-old son, who has been working in South America, has not seen his mother in years. He arrives from the airport tonight. Sharon’s spouse Frank cannot be with her as he had been hospitalized only days earlier due to complications of Parkinson’s. Sharon has no written advance directive documented. The primary physician on the case, her oncologist, has requested the assistance of a pulmonologist and an orthopedist. The charge nurse asks the attending-of-record to consider involving the palliative care service, but the physician responds that “this is not the time.” A night shift nurse places a call to Clinical Ethics.