Early in my fellowship year, a very frustrated medicine resident approached me about a consult with Ms. M. by a resident who "Just didn't get it" referring to her poor prognosis. Ms. M. was a 59-year-old female who had a history of uterine cancer that had been treated. During an outpatient procedure, it was found that Ms. M.'s cancer had returned, spread beyond the ability to cure it, and caused a uretero-enteric fistula. After several weeks of a complicated hospital course including a short stay in the intensive care unit (ICU), she was now stable enough for discharge, but the team had difficulty making a discharge plan with her, because whenever they asked about how she wanted to proceed, she just stared blankly into space.
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