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INTRODUCTION

Dr. Ann-Yi is a licensed psychologist and marriage and family therapist in the Department of Palliative Medicine at MD Anderson Cancer Center with a background in family therapy and pediatrics. She spends most of her time as a consultant for hospitalized patients and works primarily with adults diagnosed with cancer with young children.

My pager almost never goes off, since colleagues in psychiatry handle psychiatric emergencies, such as suicidal or acutely agitated patients. So, when I received four pages in quick succession recently, I first thought they were wayward pages intended for psychiatry. When I dialed the first of the four numbers, someone on the oncology unit answered on the first ring: “Please come now … patient died … young daughter … no family … Spanish speaking.” She was so distressed that she barely paused for breath, much like each of the other three callers, all of whom worked on the same unit. All four pages were clearly intended for me. Rather than try to piece together fragments of the story over the phone, I immediately went to the unit to assess the situation firsthand, climbing five flights of stairs to avoid waiting for an elevator. As I emerged from the stairwell, the scene in the hallway looked like a code blue. Clinicians in scrubs of various colors frenetically shuttled in and out of a room by the nurses’ station as a chaplain huddled in the hallway with a few other clinicians, clerks, and administrators. A woman wearing black scrubs and a white coat, signifying her role as nurse manager, looked up from the mayhem, spotted me, and asked, “Dr. Ann-Yi?” Before I could answer, she directed me to a relatively quiet spot a few paces down the hallway to debrief me.

The patient was a young woman with progressive malignancy who was admitted through the emergency center for seizures related to newly discovered brain metastases. She had fought her illness bravely over several months, but her condition had declined so precipitously in recent days that she was no longer a candidate for more cancer treatment. It became clear to her oncologists and to everyone else caring for her that she was rapidly approaching death. She was initially alone in the hospital due to visitor restrictions related to the pandemic, but her care team allowed a compassionate exception for her four-year-old daughter and two family friends who had taken care of her during the hospitalization to come to the hospital for a visit. Shortly after her daughter arrived, the patient had a grand mal seizure and was postictal for a few minutes. She then awakened just long enough to tell her daughter, “I love you”; closed her eyes; and took her last breath.

Everyone knew the woman was gravely ill, but nobody thought she would die that suddenly. Of course, the little girl had no idea what had just happened because at ...

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