Paul Rousseau
“You told me you’re tired–tired of all the transfusions, and tired of being sick. Do you want to stop all the transfusions, Nancy?” I asked the woman lying in the hospital bed.
She was silent. Her husband of nineteen years, sitting nearby, was silent as well.
“What are you thinking, Nancy, can you tell me?” I asked.
Nancy, forty-eight, was suffering from chronic muscle inflammation, severe lung disease, pneumonia and–most severely–from terminal myelodysplastic syndrome (MDS), a blood and bone-marrow disease for which she had to receive transfusions of platelets and red blood cells every other day.
Fed up with the transfusions, she’d asked to speak with the hospital’s palliative-care doctor–me–for help in rummaging through her various treatment options. In fact, these were limited to two: to continue the transfusions, or to stop.
But without the transfusions, Nancy would likely die within a few days.
I was finding it extremely difficult to counsel her. For one thing, she looked so alert and vibrant–not nearly as sick as she really was. The only overt evidence of disease was the bruising on her arms and