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Richard A. Parker, MD; Erin E. Hartman, MS
From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 1999;282:2354.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

In September 1998, Kathleen Foley, MD, discussed the management of severe pain in a 44-year-old woman near the end of life.¹ Mrs L was admitted to the hospital with a flaccid left arm, her first manifestation of metastatic lung cancer. Her hospital course was marked by severe back pain secondary to metastases and exacerbation of her usual severe headaches. Her physicians tried several regimens to control her pain, eventually consulting with the hospital pain service.

Mrs L felt that her pain was never adequately controlled, but she acknowledged that she disliked the loss of mental acuity that occurred at higher drug doses. She spoke openly with her doctors, saying, "My biggest fear is dying alone." Mrs L died in her hospital room the day after the interview shortly after her sister stepped out of the room.

Dr Foley defined the goals of . . . [Full Text of this Article]

MRS J, THE PATIENT'S SISTER



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