You can tell I'm gearing up for haloween can't you.
Thing is, there have been a few patients recently who could be said to fit that category, including one charming gentleman this morning. They all have one thing in common. A terminal prognosis. That is to say that we have identified in them a condition that will, whatever we do, and unless some other catastrophe intervenes, claim their lives. They have crossed some invisible line between the curable and incurable.
It is very easy for patients and their relatives to hear one message at such a time. "I'm very sorry Mr Bloggs but there's nothing we can do".
Well that's just not true, there's plenty we can still do. For my patient this morning the introduction of steroids have transformed his appetite and his sense of wellbeing. They have also, coincidentally, done a great deal to help his arthritis (not his terminal condition, but a potent source of misery in its own right). In restoring his appetite they have also brought some pleasure back to mealtimes, both for himself, and for his wife who was beginning to doubt her culinary abilities quite unneccessarilly.
He has also been able to have a number of pulses of palliative chemotherapy which have helped at least slow his disease progression. And throughout it all, despite the fear that came with the original diagnosis, he has managed to keep his good humoured nature and positive outlook. We both know that he is already as good as dead given his diagnosis, but he is determined to keep on living, in the very best sense of the word, for as long as he can. And today he reached a landmark.
Back at diagnosis he asked how long the oncologist thought he might have left. She was pretty clear in her prognosis-- a month or two perhaps, probably not six months. That was six months ago, and today he feels fitter than he did back then and is "very happy to have proved her wrong".