Blog | Tuesday, April 30, 2013

'They came and took my deathbed away'


Evelyn (not her real name) is 72. Three years ago she was diagnosed with multiple myeloma (MM).

MM is a rare type of blood cancer. Some famous folks who've died from multiple myeloma include Sam Walton, Geraldine Ferraro, Roy Scheider (the first Brody, Homeland fans ...), Roger Neilson, a former hockey coach (New York Rangers, among others) also died from MM. It occurs when there is a proliferation of a specific kind of white blood cell known as the plasma cell. Plasma cells have a special role in immunity. They make antibodies, which are specialized proteins that help fight infections.

When plasma cells turn cancerous, they start cranking out antibodies in huge quantities. Those large amounts of protein thicken the blood. They also clog up the kidneys, impairing their function (which is often how MM gets diagnosed). MM also causes lytic lesions of bones, clusters of plasma cells in the bone marrow set up shop, which weakens bones and leads to fractures. It's an interesting disease in that it has effects on so many parts of the body and gives many different signals enabling its discovery.

Those many signals also serve as targets for interrupting progress of the disease. We've made strides in treating MM over the years, so much so, that it's not surprising to see people with advanced MM live more than five years from the time of diagnosis.

Evelyn took a downward turn when she was diagnosed. She weakened from the disease itself, and then treatment wore her down even further. She lost weight. She was hospitalized. First with pneumonia. A second time for dehydration.

Her oncologist stopped treatment for anything beyond symptom control. The numbers measuring her "disease burden" had improved, but in the big picture, she was close to dying.

She was offered the opportunity to enter hospice. She declined, but still a hospital bed was ordered for her to use at home with the rationale that if she were eventually confined to bed, it ought to be adjustable so that she could attain maximal comfort.

Here's the thing: After her last hospitalization, she started feeling better. Might have been the antibiotics for her pneumonia. Could have been that the fluids "perked her up."

Whatever it was, her appetite improved. Her weight picked up. She was more mobile, and started attending church regularly again.

After about six months of this, the company that had provided her hospital bed came and collected it. Mind you, Evelyn still has a terminal diagnosis, even though she's doing remarkably better.

When I asked her how this came about, she merely stated, "They came and took my deathbed away. Said someone else needed it."

Made my week.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.