Palliative Care and Decision Making at the End of Life

  • Melissa F. Perkal


Mr. O is an 82-year-old man living independently with his wife of 57 years. He presented to the surgery clinic with 2–3 months of left lower quadrant pain radiating to his groin, a mild increase in abdominal girth, and a small nontender umbilical hernia. Computerized tomography revealed a 24  ×  17  ×  7 cm retroperitoneal mass consistent with a liposarcoma, a moderate left-sided pleural effusion and atelectasis of left lower lobe. He described his bowel movements as normal and his pain was well-controlled with Tylenol. He had some early satiety, mild shortness of breath but was ambulating comfortably for 1–2 blocks with a walker. After a long discussion regarding the risks and benefits of surgery, he wished to proceed. His wife was identified as the surrogate decision maker.


Palliative Care Advance Directive Hospice Care Palliative Care Team Palliative Care Patient 
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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of SurgeryYale University School of MedicineWest HavenUSA
  2. 2.Department of Veterans AffairsVA Connecticut Healthcare SystemWest HavenUSA

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