Quiet caring.

D URING A WALK ABOUT THE ONCOLOGY unit where I was receiving antibiotics for pneumonia, I encountered an elderly woman, her arm splinted and wrapped by a sling and burdened by intravenous and oxygen tubing. She was slowly and painfully making her way to the family lounge with her nurse and daughter. I helped them into the room, and then we all sat down. I asked her about her arm. She told me that she had broken her wrist in a fall and how upset she was to hear that she needed surgery for the fracture because all she really wanted was to go home and experience a little peace and comfort. She was leaving the hospital that day, and the surgery was planned for the following week. We conspiratorially spoke of our diseases: she had ovar-ian cancer with metastases to her liver; I told her I had undergone a second stem cell transplant—this one from my brother—for recurrent non-Hodgkin lymphoma and was now prone to infections, particularly pneumonia. She had persevered through debulking surgery twice and both standard and intraperitoneal chemotherapy, and she understood that she had little time left. The planned wrist surgery upset me; I knew that, although such fractures are quite routinely surgically repaired , no evidence exists to show that such surgery improves outcomes in elderly patients. Furthermore, when the procedure, after years of use in older patients, was finally evaluated, a prospective study of displaced wrist fractures had shown no benefit from surgery compared with nonoperative management in any elderly patients , 1 let alone those who are terminally ill. I informed her that there were always many opinions about how to best treat broken bones. I had already told her that I was an orthopedic surgeon, myself, but we did not discuss her care any further. We talked about the difficulty of being sick and the hope for better days, and then I left the lounge and wandered back to my room. A few days later I was back at work, seeing patients in the office. My pneumonia had not been severe, but I was still receiving antibiotics through a peripherally inserted central catheter. I went into an examination room to see the last patient of the day, and I was greeted by my fellow hospital inmate and her daughter. They had come for another opinion regarding the planned surgery for her fracture. …