Case Sceanrio: REALITY CHECK: Compassion Comes in Different Forms Annie, a 27-year-old woman with two children, began experiencing severe pain in her abdomen while visiting her family in May 2002. After complaining of pain to Mark, her husband, in June 2002, he scheduled an appointment with Dr. Roberts, a gastroenterologist, who ordered a series of tests. While conducting a barium scan, a radiologist at Community Hospital noted a small bowel obstruction. Dr. Roberts recommended surgery, and Annie agreed to it. After the surgery, on July 7, Dr. Brown, the operating surgeon, paged Mark over the hospital intercom as he walked down a corridor on the ground floor. Mark, hearing the page, picked up a house phone and dialed zero for an operator. The operator inquired, "May I help you?" "Yes," Mark replied. "I was just paged." "Oh, yes. Dr. Brown would like to talk to you.

I will connect you with him. Hang on. Don't hang up." (Mark's heart began to pound.) Dr. Brown asked, "Is this you, Mark?" Mark replied, "Yes, it is." Dr. Brown replied, "Well, surgery is over. Your wife is recovering nicely in the recovery room." Mark was relieved but for a moment. "That's good." Dr. Brown continued, "I am sorry to say that she has carcinoma of the colon." Mark replied, "Did you get it all?" "I am sorry, but the cancer has spread to her lymph nodes and surrounding organs," the doctor said. Mark asked, "Can I see her?" Dr. Brown replied, "She is in the recovery room, but I am sure it will be okay to see her." Before hanging up, Mark told Dr. Brown, "Please do not tell Annie that she has cancer. I want her to always have hope." Dr. Brown agreed, "Don't worry, I won't tell her. You can tell her that she had a narrowing of the colon." Mark hung up the phone and proceeded to the recovery room. After entering the recovery room, he spotted his wife. His heart sank. Tubes seemed to be running out of every part of her body. He walked to her bedside. His immediate concern was to see her wake up and have the tubes pulled out so that he could take her home Later, in a hospital room, Annie asked Mark, "What did the doctor find?" Mark replied, "He found a narrowing of the colon." "Am I going to be okay?" "Yes, but it will take a while to recover." "Oh, that's good.

I was so worried," said Annie. "You go home and get some rest." Mark said, "I'll see you in the morning." Mark left the hospital and went to see his friends, Jerry and Helen, who had invited him for dinner. As Mark pulled up to Jerry and Helen's home, he got out of his car and just stood there looking up a long stairway leading to Jerry and Helen's home. They were standing there looking down at Mark. It was early evening. The sun was setting. A warm breeze was blowing, and Helen's eyes were watering. Those few moments seemed like a lifetime. Mark discovered a new emotion as he stood there speechless. He knew then that he was losing a part of himself. Things would never be the same. Annie had one more surgery two months later in a futile attempt to extend her life. In November 2002, Annie was admitted to the hospital for the last time. Annie was so ill that even during her last moments she was unaware that she was dying. Dr. Brown entered the room and asked Mark, "Can I see you for a few moments?" "Yes," Mark replied. He followed Dr. Brown into the hallway. "Mark, I can keep Annie alive for a few more days, or we can let her go." Mark, not responding, went back into the room. He was now alone with Annie. Shortly thereafter, a nurse walked into the room and gave Annie an injection. Mark asked, "What did you give her?" The nurse replied, "Something to make her more comfortable." Annie had been asleep; she awoke, looked at Mark, and said, "Could you please cancel my appointment at the university? I will have to reschedule my appointment. I don't think I will be well enough to go tomorrow." Mark replied, "Okay, try to get some rest." Annie closed her eyes, never to open them again.

1. Do you agree with Mark's decision not to tell Annie about the seriousness of her illness? Explain your answer.

2. Should the physician have spoken to Annie as to the seriousness of her illness? Explain your answer.

3. Describe the ethical dilemmas in this case (e.g., how Annie's rights were violated).

4. Place yourself in Annie's shoes, the physician's shoes, and Mark's shoes, and then discuss how the lives of each may have been different if the physician had informed Annie as to the seriousness of her illness.

5. In the final analysis, is it difficult to say who is right or wrong? Discuss your answer.