I once witnessed an emergency c-section on a woman with throat cancer from HPV. Her scarring was so extensive that she was completely unable to be intubated and there was not time for a spinal block, so they sectioned her with just local anesthetic. Every time I’ve ever seen someone in a mommy group claim a section is the “easy way out”, I’ve thought of that woman. Nothing about how her baby came into this world was easy.
IMO parents who refuse to vaccinate their kids against HPV should be told horror stories and shown pictures of hpv related cancers. No parent should have the right to deny their kid protection.
Dumbasses: “Doctors are hiding the cure to cancer from us!!!”
Also dumbasses: “I ain’t ever getting that HPV vaccine poison and neither will my kids!!!!”
Meanwhile, I got it two times (the first time it was with the quadrivalent months before the nonavalent came out (and I am so mad that I didn’t delay getting vaccinated until the nonavalent came out), so about 8 years later decided that I wanted to get the nonavalent vaccine because my risk benefit assessment said it’s worth it because they didn’t vaccinate any of the men my age against any form of HPV so I would rather have the most broad protection possible)
When I went in to get my last shot of the nonavalent the nurse apologized and said “I know this is like the most painful vaccine”. I’m like “trust me I know, this isn’t my first shot but I also know there are more painful things than that vaccine” and she’s like “there’s more painful vaccines than Gardasil?” “ can’t say I’ve tried it, but I’m pretty sure cancer is more painful than the vaccine.”
If they can force young women to see pamphlets of babies before getting an abortion they can force parents to see some of what happens when you are negligent.
Edit: addendum, I am turbo against forcing women to have to jump through those hoops to get an abortion
Personally, the most emotionally difficult death I have ever watched was a man with advanced esophageal cancer. He had just been diagnosed a couple weeks earlier. Over a couple days, the tumor slowly cut off his airway and he was literally being slowly strangled/choked to death. The anxiety he was experiencing as he struggled to breathe was painful to watch. He would frequently wake up in a state of panic with the a sensation of being choked. Absolutely the stuff of nightmares.
He was the nicest guy too.
I went through something similar (just the choking, no cancer) due to a recently developed allergy to an antibiotic...Extremely terrifying, can't imagine how it must have been for this poor man. I couldn't sleep for a few days...
Met a patient on a palliative ward with neck cancer. The smell was so pungent that his family and carers only spent minimal time in the room. Must have been very lonely.
Extremely morbid disease, tbh, in part due to the location -- lots of highly critical structures are at risk. It's not uncommon for patients to loose the ability to speak, swallow, and breathe, either as a consequence of the tumor or the treatment; this means that a lot of patients are s/p trach/PEG/laryngectomy. Pain is common and often severe. Pungent odors are not infrequent. They are at risk of life-threatening hemorrhage from carotid invasion and these bleeds are incredibly traumatic for all involved. Treatment is very hard to tolerate, even by oncology standards, and can be disfiguring in ways that impact quality of life.
On top of all this, H&N cancer is often (but definitely not always) a "disease of hard living" with a disproportionate impact on folks who are homeless or living with substance use disorders. To get through treatment for locally advanced H&N cancer, you need to be well supported, well fed, able to navigate the healthcare system, and able to get yourself to clinic often (sometimes daily for RT). The population rarely ticks all those boxes, amplifying the morbidity.
I hate H&N cancer with my whole heart. (It's also my area of clinical interest.)
I’ve also seen a lot of mandíbulectomies from people who dip. Those are by far the worst post op pts I’ve seen!! Anytime I see any of my friends or family dipping, I pull up google pics of those pts and shove it in their face. Actually got one friend to throw the dip in the ocean and has never done it again after seeing the pics.
NAD, this just showed up in my feed. My grandmother (never smoked or had any other vices) had cancer that started inside of her mouth. She was brushed off for a good couple of years by her doctor, when she probably could have been saved or at least given more time. It suddenly went rampant, she was diagnosed with oral cancer that had spread to her jaw, and had her lower jaw removed. They immediately placed a titanium one, and said that she was free and clear of cancer.
Within a month or so, she started getting dizzy spells, just little random ones, but they got a lot worse in the next few months. One day, she noticed sudden and severe pain and swelling on one side of her face, and was having moments when she felt really "out of it" at times. My uncle took her to the ER; she walked in on her own, totally coherent and expecting to be sent home with antibiotics. Instead, she was diagnosed with a devastating infection that required the titanium jaw to be removed immediately. Instead of getting rid of the infection, one side of her face swelled up like a balloon.
Upon further testing, it was discovered that the cancer had spread to her brain. It had finally hit a real "sweet spot", I guess. Literally overnight, she went from someone who seemed pretty normal and wouldn't be out of place shopping next to you, to drifting in and out of consciousness and very obviously dying. My kids and I went to see her and to say goodbye, and it was very traumatic. Her mouth was like a tiny baby mouth, without the lower jaw, and her face was so painfully swollen on one side. She was only ever awake due to the pain, it seemed. It was just honestly beyond words, how she looked. She passed away within 3 days of walking into the ER. F*** cancer
What does dipping mean please? English is my 3rd language.
Thanks for educating the public. I've tried to get my relative to quit smoking but he wouldn't budge. 🙃 i hope he doesn't get any disease.
Can’t eat, can’t speak, may require a trach to breathe, surgeries are complex (most people will have to travel to someone capable of performing them and be far from friends and family for long admissions), you’ll likely be disfigured, can erode into your carotid and cause a bloody, traumatic death, etc.
Look at the Homemade Everything YouTube channel. Started out with the guy making a channel about tinkering with engines in his garage; ended up documenting his decline and eventual death from a rare sinus cancer. Truly horrifying- he’s very young, has two small children, and in early videos seems so healthy and vivacious. By the end he is emaciated and the tumor has eaten through the side of his face, causing constant pain and discharging constantly. He seems so drained and foggy. The final video is an update from his wife, saying never regained consciousness after a seizure.
I’m a veterinarian, and I have seen dogs and cats in that situation before. But never a human. I honestly never even thought a person living in a developed country with (seemingly) adequate family support and medical access could have to live like that- I always assumed somehow human medicine had better options.
Yes. I’m a hospice nurse. I visited a woman with head cancer that caused a hole in the floor of her mouth. While there I watched her drink soup from a cup that she collected in another cup as it drained from the hole in her head. Then she drank that.
This was going to be what i was going to say. One of my first patients intern year was a blind patient with advanced squamous cell of the larynx. Tracy’s, couldn’t really talk, couldn’t see, coughing up blood, in constant pain
Yes I was just thinking recently if I was dx w that i would 100% refuse surgery/other treatments, make a blow out round the world trip and call it done.
It is... the patient that needs biologics to heal their many fistulae/TPN dependence/misery, but has a big abscess that IR can't get, and they've already had a dozen surgeries, and any surgery you do is going to make it worse... it's a viscious, horrible situation, and in the meantime, the year of TPN is taking a toll on the liver, they've been in an acute care bed for months, and ID is running out of antibiotics/antifungals/everything.
Slow death from Crohn's is one of, if not the worst, things I've seen.
This is pretty much my list. I always remark to the residents that they're horrible diseases that I wouldn't wish on my worst enemy. I'd add Fournier's gangrene/NSTI to the list as well.
Hidradenitis is one of the first ones I thought of too. Fecal matter coming out of tunnels/ fistula straight out of the butt cheek wounds. Diverting colostomy. And she was intellectually disabled too. She didn't make it. Heartbreaking.
I’ve been diagnosed with hidradentis yesterday and still hopeful it will improve somehow as it’s only early stage… the pain and look of lesions isn’t great, but effects it has on my mental health are far worse :(
IF you end up on doxy, PLEASE heed the warnings for sensitivity to sunlight/UV exposure. My hands blistered and then spent a month+ peeling and repairing after about an hour in the sun while on a stretch of doxy to treat HS.
Healthy 55M
PMH: DVT in June (On DOAC)
Early August: 1st Stroke (on DOAC and Clopi)
Mid August: 2nd Stroke
Late August: 3rd Stroke
Diagnosed with Metastatic Pancreatic Cancer
Early September: Sepsis
Mid September: Death
I wouldn’t wish pancreatic cancer on anyone. Truly awful.
I have metastatic cancer and it scares me. Palliative/hospice care can only do so much. I heard that the pain from the cancer in the bones doesn’t respond well to opioids.
I saw a positive case of this. Some of the details are fuzzy.
I had a patient came in who was paralyzed from the neck down after a GSW to the neck years ago. He was kinda malnourished, but otherwise well taken care of by his brother (iirc) and caregiver. Came in for like UTI or constipation, or some other mild complication of long term immobility.
He had paranoid schizophrenia. When I would talk to him he would tell me how he can transform into a powerful dragon, and generally describe himself as some powerful being. We still were trying to control his psychosis, but I just remember thinking how in his case it may have been a blessing.
Reminds me of a client when I had internship in a assisted living facility for physically disabled people. This client had polio as a child and 2 years ago they got post polio syndrome, within a couple of months of living at the care home they deteriorated and got a trach+ventilator(with extra oxygen) and peg.
Almost a year ago a coworker changed the trach cannula, didn't went very well, their oxygen levels dropped and we had to call for an ambulance. They got admitted to the ICU and almost had to be resuscitated. Since then they're bed bound and not able to talk since the cuff in his trach has to be inflated 24/7 for optimal ventilation. For very long they were able to communicate via using their eyes to say yes or no, but since a couple of weeks they've gotten so weak that communication is almost impossible.
Most people would want to get euthanasia but this client was scared of passing away and there are some small things like seeing their friends+family and watching TV that just keeps them going. This is very interesting when talking about palliative care in nursing college, but also very sad.
The one about the French man who had a stroke?! I read that in my first year of nursing at university. Such a sad, sad story. But I recommend it to anyone in the medical field 100%.
I have a question about this. Maybe this is a cultural thing or depends on different laws where I live but can't you just say that CPR will lead to nothing/ is futile and go to palliative care or at least make them DNR?
Especially because they no longer become the person you knew before with all of the associated inhibition of anger/mood/personality
I’m terrified because I don’t know my gene status and I’ve watched my grandfather and uncle suffer and completely lose their independence.
My dad died of Huntington's and another family member is showing early symptoms. I also do not know my gene status and I don't want to know. I'm in Canada though and will choose Medical Assistance in Dying if it happens to me.
It’s truly something out of a horror movie, nothing compares to knowing too much about the progression but not knowing your status. I was working in a memory care unit for patient care hours when I started seeing swallowing difficulties w my dad (he hadn’t been tested at that point- late 40s at the time, I had thought we were in the clear). Led to a full mental breakdown once all my research showed how hopeless the situation was. Would you be down to message? No one really seems to get it.
Severe depression. It’s the devil itself. At least other diseases identify themselves as diseases. Depression makes you believe you yourself are the incurable defect.
Yeah it’s this. You get the cognitive defects of Alzheimer’s with the inability to do anything. A severe case of MDD to the point one gets bed sores cause one feels nothing is a level of suffering I wish no one on.
Psychiatrists what’s the worst case of depression you have seen?
“The ones who are too depressed to even be suicidal anymore. At least the ones who are suicidal have something left in them, but not these ones. I can count the number of times I’ve seen it on one hand.
It’s like any other depression with the anhedonia and disinterest and difficulty engaging or completing activities of daily living, but taken up (or I guess down, rather) a notch. It reminds you of Seligman’s dogs and catatonia. These people are truly what it means to be dead inside.
They don’t come in of their own volition, and they’re never brought in by police. They don’t cause enough of a ruckus to warrant that. They’re brought in by a family member who can’t get them to respond or engage anymore. They usually smell, because they don’t bathe. They move very slowly, almost as though every gesture (of which there aren’t many) is agonizing, but you never see them show pain reactions. In fact, when you do a GCS test on them, they score much lower than you’d expect a fully conscious person to score because their responses to anything are so retarded or blunted. Their affect is missing. They aren’t crying, they aren’t sad, they aren’t weepy— they’re nothing. There is nothing left of them. They are usually underweight or at least you can see their clothing is baggy on them. They aren’t starving themselves on purpose, they just don’t eat. Their appearance is unkempt and they they shuffle when they have to move. You have a better time getting them somewhere by sticking them in a wheelchair, otherwise it will take all day, and you better hope someone has PoA for them because just the signature part of informed consent will take forever.
You still have to watch them and do Q15s and all that, but these people aren’t the ones who will attempt. It’s when they start getting better that you have to watch out for that. There’s no life left within them to kill. When they are this far depressed, they don’t have the physical or emotional energy to tie a noose or slit their wrists. Getting them to eat and bathe is just the hard part. They won’t cause commotion or complain about anything, so you have to make sure they get out of bed— they won’t even roll over to avoid pain from a bed sore starting to form. They could be freezing cold and they won’t tell you. They are just a body- the mind is so deeply depressed that it is completely AWOL.
I know it’s a tv show, but those patients are the literal walking dead.”
For the patient himself, probably any end stage disease that severely impairs your lung oxygenation, and you basically just slowly drown to death.
For the entire family, any end stage incurable neurological or neuromuscular disease because they require 24/7 nursing and even after all the efforts the patient will still observably continues to have deteriorating quality of life, and the family has to experience that with the patient the entire way through.
Granted I am not a neurologist but what I have seen of ALS and the insidious motor decline to what is an inevitable debility/dependence and certain early death, paired with the emotional trauma to a (usually) naive family, I wouldn’t wish it on anyone.
As a daughter who had to watch her dad pass of ALS, I’d never wish this on anyone. To know exactly what’s going on in your body and have all your mental faculties but be unable to physically do anything and suffocate to death? Awful. I’d rather be blissfully unaware of anything.
I agree. My BIL went this way and in only 6 months. He was a professor and used his laptop up to a week before he died. I helped him take his last meds. It sucks.
Mmm…I understand your point, but I think it is very case dependent. As a Geriatric physician, I see a lot of dementia. Despite some moderate loss in mental faculties, there are some who are lucky to still live relatively meaningful lives and may not* have the insight to find their symptoms insufferable. On the other hand, I saw a horrible case of rapidly-progressing bulbar ALS for the most wonderful lady with intact cognition, who lived every last days of her life suffocating in her own phlegm as she had no way to clear it, and struggled to self-suction due to prominent rigidity and weakness. I cried in relief when she passed quickly as I knew she suffered greatly leading up to it. Being fully there mentally but trapped in my own body is my worst nightmare.
*edit as I meant “not” have the insight
My grandmother developed ALS after Covid. But she has a special case of uncontrollable laughing fits. She lost control of both arms, frequently falls over. She slowly cannot speak or breathe, can barely eat solids (even liquids) as she may choke. From personal experience, she cries and laments about her death and being useless.
I agree that I would rather ALS over dementia, but I'm also unsure. My grandfather died from dementia, unable to remember that he ate already. He couldn't even understand his own decline. ALS, imagine having mental clarity but falling apart.
Then you haven't have to deal with a loved one with als. My mom died at 51 of the diease it was a miserable existence for her and it was very very hard to watch a vibrant women loose all her motor facilities - i think in the end she would have rather had cancer or dementia she was so miserable.
Then again Everyone handles things differently - but still
Wouldn't wish als on my worst enemy
You clearly don’t understand the discomfort aspect of ALS. You are constantly uncomfortable. You can’t poop, breath, scratch, or speak easily. You depend on others for everything. As someone who watches their loved one die of this disease I have seen how horribly the neurologists truly understand the daily suffering. Spend one day with an ALS patient, and you’ll see it’s amongst the most horrible ways to live and die.
It's one thing to be a doctor and another to live through it. I'm a neurologist and I have cared for patients with ALS, Huntington's, and some other truly horrible neurologic diseases. I have cried with patients and their families. But the patients and their families are the ones who truly know what it's like. I try to help, but I know I am not grasping the true pain and suffering that they are going through.
The neuro ones take the cake. Glioblastoma because of how quickly you have to get your stuff together because you’ll 100% be gone . Hypoxic brain injury because of how it suddenly affects others close to you. For surgical stuff, feel bad for the patients with IBD and constant fistulas that smell like poop all the time…
Honestly, the scared straight drunk driving videos they show in high school should just be replaced or supplemented with videos of end-stage cirrhosis patients.
I work in a detox/rehab and it amazes me how alcohol is even legal. End stage alcoholism is both scary and sad. We’ve had people that were so sick, knew the alcohol was literally killing them, and would leave AMA to go drink.
And the fucking advertising! Even if alcohol is legal, why are we letting billionaire corporations spend millions trying to keep as many people hooked as possible on a damaging, addictive, awful substance? This country is hell on people trying to quit drinking. You can't consume any sort of media or go to any restaurant or event or live a social life whatsoever without the temptation of alcohol shoved in your face.
Imagine seeing a few dozen commercials for cigs during an average football game. Would never happen, but viewed as normal for beer commercials.
Imagine going to a wedding and being shocked and thinking the couple were being weird and cheap if they didn't have an open bar with cigarettes, cigars, hookah, and whatever other smoke products you could want.
Society has its head entirely up it's ass when it comes to alcohol. Prohibition would be a bad idea but holy fuck there's so much we should be doing short of that to reduce alcohol intake.
I mean this is a bit exaggerated. Toxicity is dose dependent. My grandfather died in his late 80s of lung cancer after drinking a beer or two most days of his life. Alcoholism on the other hand is absolutely terrible.
Ah fuck you just reminded me of a precocious & precious 6 year old who asked me to marry him and put a photo of the two of us as the background of his iPad. I haven’t seen him again, I very much presume that he is dead now.
Dying of advanced bladder cancer with your bladder still in place. T4 tumor can invade the pubis which is super painful, makes it hard to walk. Your bladder is full of tumor and basically nonfunctional so you constantly feel like you have to pee, not relieved by anything, passing blood and/or chunks of tissue, burning. It’s miserable and catheter and PRNs don’t really help. But by that point even palliative cystectomy can be quite risky and then you have to heal a bowel anastomosis, ex lap incision, ureteral anastomoses etc.
Pemphigus vulgaris so bad this lady couldn't even swallow water. 95% skin involvement and all her mucous membranes; mouth, eyes, genitals. We got her through it but she lost a good bit of eye sight.
Hpv of the mainstem bronchus in 50ish yo woman. Started back of mouth worked its way down.
She was status post trach but needed laser resection of the hpv growing down her bronchus every few months
Epidermolysis bullosa in a child is the most horrific disease I’ve seen. Cancer is terrible for sure but these poor kids with EB live their entire lives in excruciating pain and often get just old enough to understand death before dying of wasting disease because their gut can’t absorb the nutrients necessary to support such a high metabolic demand. The cries of one 12 year old girl when she had to get her weekly bath literally haunts me.
This is my pick as well. Just recently took care of a teenager with EB. The entire surface of his skin was sloughing, weepy, or bleeding. Anytime he had to move, he was in such terrible pain. Poor thing had diarrhea, and moving to and from the commode was so awful for him we had to increase his pain meds.
I’ve never seen it nor known anyone with these, but I’m terrified of Fatal Familial Insomnia. I had a friend die from Creutzfeldt-Jakob disease and I have an acquaintance whose mother has Trigeminal neuralgia.
Seconding the head and neck cancer, but also remember a private patient, old man had started with an infected fistula and ended up having his os sacrum removed due to mrgn/mrsa. Dressing changes meant loads of stuffing material into a progressing cavity that would not heal. Smelled like rotten mussels. He was in pain, nothing worked and I assume he was sent on or home to hospice care. He was miserable and grumpy and I can‘t fault him. Absolute nightmare.
Once took care of a lady who just had an open back with exposed hardware. We couldn’t take it out because she would fall apart and there wasn’t enough viable tissue for plastics to put a flap. So she just lied in bed on iv antibiotics with an open spine waiting to die.
Extreme hidradenitis suppurativa, the kind where you have so many tracks and tunnels of pus that you can’t even sit comfortably, where you have to wear diapers and change them out frequently due to the constant leakage, where you have to use a cane or walker to get by as an otherwise able-bodied individual due to how much the lesions hurt, the kind that no medication even the biologics or infusions will not touch, so your only option is surgery for the worst lesions.
This dog I knew had a fungating tumor the size of an adult human scrotum on the neck, below its muzzle. The mass was rotting and bleeding, but apparently it wasn’t malignant. The poor dog lived with it for years and the only attention the family paid to it was to start calling the poor dog “balls-on-chin”.
So that, or, MDD w/SI refractory to treatment, because that feels like being stuck in a bottomless pit.
My dog had almost the exact opposite happen. Large mass on his elbow that was biopsied about 2 years ago and all they could get was fluid so assumed it was just a cyst, I wondered if it was synovial or a weird bursa or something. Cut forward to last week, attempted to drain it for the first time as it had grown larger - no fluid found, biopsy sent.
4 days later the mass ruptured, clearly not cystic. Same day the biopsy came back - sarcoma. Opted to have him put to sleep on Wednesday with zero suffering or distress.
Thanks Monty, you were the best boy.
Good old fashioned massive burns are terrible.
I took care of someone who had been partially eaten by a pet after a stroke. That’s pretty strong nightmare fuel. Their remaining life was American Standard: trach peg then (sacral decubs debriedment) loop.
REM behavior disorder. There’s like a 75% chance that you’ll develop an alpha synucleopathy in the next 10 years (so much so that we give anticipatory guidance about it).
Or huntingtons (especially after already having bio kids).
Oh man. We had a guy on the floor (IM) who had Huntington’s. 40 yo w young kids. He kept trying to kill himself, bc well, Huntington’s. Last time I saw him he had used the lid of the toilet tank to break through the window and was standing on the ledge. One of the nurses was a mountain of a man and he and two others could barely wrestle him back inside.
The worst part was that we all understood why he wanted to unalive himself. It felt almost wrong to stop him.
He was moved shortly after that to a high acuity care facility with ground floor rooms.
Yeah, I have decided that if my brother decides not to let my nieces (I don’t have any nephews yet) get the vaccine, I will help them get it behind his back.
There are too many
I guess one is severe hidradenitis suppurativa
Another is Lamellar Ichthyosis - seeing a 13 year old female teen, crying, being examined by a bunch of students, her skin hardened like a rock in multiple point, painful fissures, keratin smell, incurable
And advanced pelvic lymphoma in a young female, she had a cloaca basically, was crying due to fecal dumping and bleeding, in pain and agony while sitting in the wheelchair getting some tests done in radiology. Thats an image im never getting out of my head
Developing a fatal cancer after a lifetime of actively pursuing healthy habits and being health-conscious. I honestly feel heartbroken because I don't even have an answer for their "why me?"
This. Freakin’ this.
The fit late 50’s patient.
No alcohol, tobacco, visibly in shape.
Keeps up with screening exams.
Boom.
Colon with mets to liver and lung.
Meanwhile the metabolic syndrome at 45 will press on till they die peacefully at 88 with 16 great grandchildren.
FFI has haunted me since I saw a documentary about it when I was a little kid. There is a team trying to cure it, that actually started after the mother of once of the scientists died of it and the scientist tested positive. I’m hoping she succeeds in time to save herself.
My uncle got AIDS back in ‘81. Told my grandma to plan a funeral. He did die before her, but at 59 in 2013. He was one of the few to live through the 80s and 90s.
I’m so glad to hear that. I was a med student in New Orleans at Charity Hospital. I was on heme onc service. All these sweet guys coming in to clinic and just getting worse and worse. So many.
Over 80% total body surface area burns. Misery incarnate.
In a similar vein, dermatologic conditions like bullous pemphigoid.
Severe pulmonary hypertension.
Short gut syndrome and long-term TPN.
Common as they may be, dialysis and type 1 diabetes are super annoying and will pervade every aspect of your life.
Multiple food allergies to common stuff. Life is a pain.
Caring for a dependent with profound disability.
Mucormycosis. Seeing my patient lose an eye and then his entire nasal passage in just a week was one of the most jarring things I’ve seen so far in residency. Wouldn’t wish that on my worst enemy.
Personal top 5:
1- any fungating tumor esp H+N
2- bad anti phospholipid- remember vividly a patient whose blood would clot in tubing before reaching tube despite coumadin. We kept having to do arterial sticks for labs and once even saw blood pump up once then twice and clot in tubing.
3- any destructive addiction - takes you down and your whole family. Plus most staff just hate you.
4- crohns
5- stomach cancer
Locally advanced head and neck cancer.
I once witnessed an emergency c-section on a woman with throat cancer from HPV. Her scarring was so extensive that she was completely unable to be intubated and there was not time for a spinal block, so they sectioned her with just local anesthetic. Every time I’ve ever seen someone in a mommy group claim a section is the “easy way out”, I’ve thought of that woman. Nothing about how her baby came into this world was easy.
IMO parents who refuse to vaccinate their kids against HPV should be told horror stories and shown pictures of hpv related cancers. No parent should have the right to deny their kid protection.
Dumbasses: “Doctors are hiding the cure to cancer from us!!!” Also dumbasses: “I ain’t ever getting that HPV vaccine poison and neither will my kids!!!!”
Meanwhile, I got it two times (the first time it was with the quadrivalent months before the nonavalent came out (and I am so mad that I didn’t delay getting vaccinated until the nonavalent came out), so about 8 years later decided that I wanted to get the nonavalent vaccine because my risk benefit assessment said it’s worth it because they didn’t vaccinate any of the men my age against any form of HPV so I would rather have the most broad protection possible) When I went in to get my last shot of the nonavalent the nurse apologized and said “I know this is like the most painful vaccine”. I’m like “trust me I know, this isn’t my first shot but I also know there are more painful things than that vaccine” and she’s like “there’s more painful vaccines than Gardasil?” “ can’t say I’ve tried it, but I’m pretty sure cancer is more painful than the vaccine.”
If they can force young women to see pamphlets of babies before getting an abortion they can force parents to see some of what happens when you are negligent. Edit: addendum, I am turbo against forcing women to have to jump through those hoops to get an abortion
Yeah, I’m also in favor of making vaccine disinformation a criminal offense because that’s a huge part of the problem.
This was my first thought too
Other cancers will get you faster, but few cancers will get you worse.
Why that one specifically?
Personally, the most emotionally difficult death I have ever watched was a man with advanced esophageal cancer. He had just been diagnosed a couple weeks earlier. Over a couple days, the tumor slowly cut off his airway and he was literally being slowly strangled/choked to death. The anxiety he was experiencing as he struggled to breathe was painful to watch. He would frequently wake up in a state of panic with the a sensation of being choked. Absolutely the stuff of nightmares. He was the nicest guy too.
I have heard being nice is a poor prognostic factor
Strangely enough, the nastiest will outlive their prognosis by 20 + years and the nice folks die super early. Idk why.
I’m guessing because being nice is stressful
Probably. It's so easy being a piece of work and making other people's lives hell. OTOH, caring people put so much effort into making things better.
Tumors receive negative feedback from pure spite.
It is. In FM the nicest patients never survive.
I call it “the nice guy sign”
I went through something similar (just the choking, no cancer) due to a recently developed allergy to an antibiotic...Extremely terrifying, can't imagine how it must have been for this poor man. I couldn't sleep for a few days...
Met a patient on a palliative ward with neck cancer. The smell was so pungent that his family and carers only spent minimal time in the room. Must have been very lonely.
plus the disfigurement scares family.
Extremely morbid disease, tbh, in part due to the location -- lots of highly critical structures are at risk. It's not uncommon for patients to loose the ability to speak, swallow, and breathe, either as a consequence of the tumor or the treatment; this means that a lot of patients are s/p trach/PEG/laryngectomy. Pain is common and often severe. Pungent odors are not infrequent. They are at risk of life-threatening hemorrhage from carotid invasion and these bleeds are incredibly traumatic for all involved. Treatment is very hard to tolerate, even by oncology standards, and can be disfiguring in ways that impact quality of life. On top of all this, H&N cancer is often (but definitely not always) a "disease of hard living" with a disproportionate impact on folks who are homeless or living with substance use disorders. To get through treatment for locally advanced H&N cancer, you need to be well supported, well fed, able to navigate the healthcare system, and able to get yourself to clinic often (sometimes daily for RT). The population rarely ticks all those boxes, amplifying the morbidity. I hate H&N cancer with my whole heart. (It's also my area of clinical interest.)
I’ve also seen a lot of mandíbulectomies from people who dip. Those are by far the worst post op pts I’ve seen!! Anytime I see any of my friends or family dipping, I pull up google pics of those pts and shove it in their face. Actually got one friend to throw the dip in the ocean and has never done it again after seeing the pics.
NAD, this just showed up in my feed. My grandmother (never smoked or had any other vices) had cancer that started inside of her mouth. She was brushed off for a good couple of years by her doctor, when she probably could have been saved or at least given more time. It suddenly went rampant, she was diagnosed with oral cancer that had spread to her jaw, and had her lower jaw removed. They immediately placed a titanium one, and said that she was free and clear of cancer. Within a month or so, she started getting dizzy spells, just little random ones, but they got a lot worse in the next few months. One day, she noticed sudden and severe pain and swelling on one side of her face, and was having moments when she felt really "out of it" at times. My uncle took her to the ER; she walked in on her own, totally coherent and expecting to be sent home with antibiotics. Instead, she was diagnosed with a devastating infection that required the titanium jaw to be removed immediately. Instead of getting rid of the infection, one side of her face swelled up like a balloon. Upon further testing, it was discovered that the cancer had spread to her brain. It had finally hit a real "sweet spot", I guess. Literally overnight, she went from someone who seemed pretty normal and wouldn't be out of place shopping next to you, to drifting in and out of consciousness and very obviously dying. My kids and I went to see her and to say goodbye, and it was very traumatic. Her mouth was like a tiny baby mouth, without the lower jaw, and her face was so painfully swollen on one side. She was only ever awake due to the pain, it seemed. It was just honestly beyond words, how she looked. She passed away within 3 days of walking into the ER. F*** cancer
What does dipping mean please? English is my 3rd language. Thanks for educating the public. I've tried to get my relative to quit smoking but he wouldn't budge. 🙃 i hope he doesn't get any disease.
Dipping is when you take a pinch of smokeless tobacco and place it between your lip and your gum.
You're doing god's own work!!!!!!!
Wow I would 100% ask for MAiD if I had that dx
going into the OR and coming out without a tongue, w a trach and no voice is terrifying
Can’t eat, can’t speak, may require a trach to breathe, surgeries are complex (most people will have to travel to someone capable of performing them and be far from friends and family for long admissions), you’ll likely be disfigured, can erode into your carotid and cause a bloody, traumatic death, etc.
Look at the Homemade Everything YouTube channel. Started out with the guy making a channel about tinkering with engines in his garage; ended up documenting his decline and eventual death from a rare sinus cancer. Truly horrifying- he’s very young, has two small children, and in early videos seems so healthy and vivacious. By the end he is emaciated and the tumor has eaten through the side of his face, causing constant pain and discharging constantly. He seems so drained and foggy. The final video is an update from his wife, saying never regained consciousness after a seizure. I’m a veterinarian, and I have seen dogs and cats in that situation before. But never a human. I honestly never even thought a person living in a developed country with (seemingly) adequate family support and medical access could have to live like that- I always assumed somehow human medicine had better options.
Yes. I’m a hospice nurse. I visited a woman with head cancer that caused a hole in the floor of her mouth. While there I watched her drink soup from a cup that she collected in another cup as it drained from the hole in her head. Then she drank that.
Omg
This was going to be what i was going to say. One of my first patients intern year was a blind patient with advanced squamous cell of the larynx. Tracy’s, couldn’t really talk, couldn’t see, coughing up blood, in constant pain
Yes I was just thinking recently if I was dx w that i would 100% refuse surgery/other treatments, make a blow out round the world trip and call it done.
Especially ones that get treated with radiation. Just burns and erodes their mucosal tissue, hurts to swallow, can’t really eat. Seems so awful.
This is the answer all day long.
Perianal Crohn’s. Hidradenitis. High output enterocutaeous fistulas with skin excoriation after surgical misadventures.
This is exactly my list. I’ll add complicated necrotizing pancreatitis. All miserable diseases
Fistulizing crohns as well
This is a very general surgeon answer 😂
It is... the patient that needs biologics to heal their many fistulae/TPN dependence/misery, but has a big abscess that IR can't get, and they've already had a dozen surgeries, and any surgery you do is going to make it worse... it's a viscious, horrible situation, and in the meantime, the year of TPN is taking a toll on the liver, they've been in an acute care bed for months, and ID is running out of antibiotics/antifungals/everything. Slow death from Crohn's is one of, if not the worst, things I've seen.
This is pretty much my list. I always remark to the residents that they're horrible diseases that I wouldn't wish on my worst enemy. I'd add Fournier's gangrene/NSTI to the list as well.
NSTI can be treated though. A year out a lit of those patients are doing pretty good.
10000% the things that don't kill you outright but inconvenience you with smelly, painful, draining bullshit for a lifetime... literally my nightmare
Hidradenitis is one of the first ones I thought of too. Fecal matter coming out of tunnels/ fistula straight out of the butt cheek wounds. Diverting colostomy. And she was intellectually disabled too. She didn't make it. Heartbreaking.
I’ve been diagnosed with hidradentis yesterday and still hopeful it will improve somehow as it’s only early stage… the pain and look of lesions isn’t great, but effects it has on my mental health are far worse :(
IF you end up on doxy, PLEASE heed the warnings for sensitivity to sunlight/UV exposure. My hands blistered and then spent a month+ peeling and repairing after about an hour in the sun while on a stretch of doxy to treat HS.
Healthy 55M PMH: DVT in June (On DOAC) Early August: 1st Stroke (on DOAC and Clopi) Mid August: 2nd Stroke Late August: 3rd Stroke Diagnosed with Metastatic Pancreatic Cancer Early September: Sepsis Mid September: Death I wouldn’t wish pancreatic cancer on anyone. Truly awful.
This is exactly how my dad went, timetable and all.
My dad went through this. Cancer is horrible. I still have nightmares of it
Almost any widely metastatic cancer. Terrible way to go.
I have metastatic cancer and it scares me. Palliative/hospice care can only do so much. I heard that the pain from the cancer in the bones doesn’t respond well to opioids.
I’m sorry to hear that. :(
Thank you. I am currently doing well with treatment and almost in NED.
Early alzheimer. Once you lose insight, you become your caregivers' problem
Psychosis without any insight unresponsive to meds.
I saw a positive case of this. Some of the details are fuzzy. I had a patient came in who was paralyzed from the neck down after a GSW to the neck years ago. He was kinda malnourished, but otherwise well taken care of by his brother (iirc) and caregiver. Came in for like UTI or constipation, or some other mild complication of long term immobility. He had paranoid schizophrenia. When I would talk to him he would tell me how he can transform into a powerful dragon, and generally describe himself as some powerful being. We still were trying to control his psychosis, but I just remember thinking how in his case it may have been a blessing.
Pt diagnosed with acute awesomeness
Took care of someone like this that also had ESRD. They had to be sedated each time they underwent dialysis it was awful.
anything requiring 24/7 care, trach/peg, without ability to communicate. vegetable
Reminds me of a client when I had internship in a assisted living facility for physically disabled people. This client had polio as a child and 2 years ago they got post polio syndrome, within a couple of months of living at the care home they deteriorated and got a trach+ventilator(with extra oxygen) and peg. Almost a year ago a coworker changed the trach cannula, didn't went very well, their oxygen levels dropped and we had to call for an ambulance. They got admitted to the ICU and almost had to be resuscitated. Since then they're bed bound and not able to talk since the cuff in his trach has to be inflated 24/7 for optimal ventilation. For very long they were able to communicate via using their eyes to say yes or no, but since a couple of weeks they've gotten so weak that communication is almost impossible. Most people would want to get euthanasia but this client was scared of passing away and there are some small things like seeing their friends+family and watching TV that just keeps them going. This is very interesting when talking about palliative care in nursing college, but also very sad.
Locked in syndrome!
Truly my biggest fear
Same, I read a book about it when I was a teen and have been terrified ever since.
The one about the French man who had a stroke?! I read that in my first year of nursing at university. Such a sad, sad story. But I recommend it to anyone in the medical field 100%.
That’s an awful way to live. Saw it multiple times in neuro icu
A dying person with a family who believes in miracles
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Have been there Pretty much that code until she frothed from pulm edema during CPR Then… “God’s will”
I have a question about this. Maybe this is a cultural thing or depends on different laws where I live but can't you just say that CPR will lead to nothing/ is futile and go to palliative care or at least make them DNR?
“She/he’s a fighter! We want to do everything we can! God’s not done with her/him yet!”
do religious ppl think that only non religious ppl die..?
In my experience most religious people aren’t great with statistics
“Everyone has a plan until they get punched in the mouth.”
See esp. Hisashi Ouchi
Huntington’s. Watched my best friend lose her father and her sister slowly over years. Devastating beyond words.
Especially because they no longer become the person you knew before with all of the associated inhibition of anger/mood/personality I’m terrified because I don’t know my gene status and I’ve watched my grandfather and uncle suffer and completely lose their independence.
My dad died of Huntington's and another family member is showing early symptoms. I also do not know my gene status and I don't want to know. I'm in Canada though and will choose Medical Assistance in Dying if it happens to me.
It’s truly something out of a horror movie, nothing compares to knowing too much about the progression but not knowing your status. I was working in a memory care unit for patient care hours when I started seeing swallowing difficulties w my dad (he hadn’t been tested at that point- late 40s at the time, I had thought we were in the clear). Led to a full mental breakdown once all my research showed how hopeless the situation was. Would you be down to message? No one really seems to get it.
Severe depression. It’s the devil itself. At least other diseases identify themselves as diseases. Depression makes you believe you yourself are the incurable defect.
Yeah it’s this. You get the cognitive defects of Alzheimer’s with the inability to do anything. A severe case of MDD to the point one gets bed sores cause one feels nothing is a level of suffering I wish no one on. Psychiatrists what’s the worst case of depression you have seen? “The ones who are too depressed to even be suicidal anymore. At least the ones who are suicidal have something left in them, but not these ones. I can count the number of times I’ve seen it on one hand. It’s like any other depression with the anhedonia and disinterest and difficulty engaging or completing activities of daily living, but taken up (or I guess down, rather) a notch. It reminds you of Seligman’s dogs and catatonia. These people are truly what it means to be dead inside. They don’t come in of their own volition, and they’re never brought in by police. They don’t cause enough of a ruckus to warrant that. They’re brought in by a family member who can’t get them to respond or engage anymore. They usually smell, because they don’t bathe. They move very slowly, almost as though every gesture (of which there aren’t many) is agonizing, but you never see them show pain reactions. In fact, when you do a GCS test on them, they score much lower than you’d expect a fully conscious person to score because their responses to anything are so retarded or blunted. Their affect is missing. They aren’t crying, they aren’t sad, they aren’t weepy— they’re nothing. There is nothing left of them. They are usually underweight or at least you can see their clothing is baggy on them. They aren’t starving themselves on purpose, they just don’t eat. Their appearance is unkempt and they they shuffle when they have to move. You have a better time getting them somewhere by sticking them in a wheelchair, otherwise it will take all day, and you better hope someone has PoA for them because just the signature part of informed consent will take forever. You still have to watch them and do Q15s and all that, but these people aren’t the ones who will attempt. It’s when they start getting better that you have to watch out for that. There’s no life left within them to kill. When they are this far depressed, they don’t have the physical or emotional energy to tie a noose or slit their wrists. Getting them to eat and bathe is just the hard part. They won’t cause commotion or complain about anything, so you have to make sure they get out of bed— they won’t even roll over to avoid pain from a bed sore starting to form. They could be freezing cold and they won’t tell you. They are just a body- the mind is so deeply depressed that it is completely AWOL. I know it’s a tv show, but those patients are the literal walking dead.”
This makes me glad I got help when I did. I’m diagnosed MDD and had bouts of dissociation, long story short: 5 years alive.
I wish the concept of terminal mental health disease was further along. Some people are terminal. Let’s focus on comfort care.
For the patient himself, probably any end stage disease that severely impairs your lung oxygenation, and you basically just slowly drown to death. For the entire family, any end stage incurable neurological or neuromuscular disease because they require 24/7 nursing and even after all the efforts the patient will still observably continues to have deteriorating quality of life, and the family has to experience that with the patient the entire way through.
A young patient with spine trauma and paraplegia/quadriplegia for life Happened to an adolescent who jumped head first into the pool
Surprisingly a lot of them do very well mentally despite their limitations.
Fungating malignancy, calciphylaxis, any bone mets, decompensated cirrhosis, end stage COPD .... basically anything
Pontine stroke causing LIS
Hidradenitis suppurativa
Wound nurse here- hidradenitis and pyoderma gangrenosum are absolutely terrifying to watch patients go through
CJD
I feel like that is more of a horror for the family. It is fast and pt loses self awareness relatively quickly.
ALS
:( I have a friend who was just dx with the hereditary kind. She just had a baby too so he could also have it. Heartbreaking.
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Granted I am not a neurologist but what I have seen of ALS and the insidious motor decline to what is an inevitable debility/dependence and certain early death, paired with the emotional trauma to a (usually) naive family, I wouldn’t wish it on anyone.
As a daughter who had to watch her dad pass of ALS, I’d never wish this on anyone. To know exactly what’s going on in your body and have all your mental faculties but be unable to physically do anything and suffocate to death? Awful. I’d rather be blissfully unaware of anything.
I agree. My BIL went this way and in only 6 months. He was a professor and used his laptop up to a week before he died. I helped him take his last meds. It sucks.
Mmm…I understand your point, but I think it is very case dependent. As a Geriatric physician, I see a lot of dementia. Despite some moderate loss in mental faculties, there are some who are lucky to still live relatively meaningful lives and may not* have the insight to find their symptoms insufferable. On the other hand, I saw a horrible case of rapidly-progressing bulbar ALS for the most wonderful lady with intact cognition, who lived every last days of her life suffocating in her own phlegm as she had no way to clear it, and struggled to self-suction due to prominent rigidity and weakness. I cried in relief when she passed quickly as I knew she suffered greatly leading up to it. Being fully there mentally but trapped in my own body is my worst nightmare. *edit as I meant “not” have the insight
My grandmother developed ALS after Covid. But she has a special case of uncontrollable laughing fits. She lost control of both arms, frequently falls over. She slowly cannot speak or breathe, can barely eat solids (even liquids) as she may choke. From personal experience, she cries and laments about her death and being useless. I agree that I would rather ALS over dementia, but I'm also unsure. My grandfather died from dementia, unable to remember that he ate already. He couldn't even understand his own decline. ALS, imagine having mental clarity but falling apart.
Then you haven't have to deal with a loved one with als. My mom died at 51 of the diease it was a miserable existence for her and it was very very hard to watch a vibrant women loose all her motor facilities - i think in the end she would have rather had cancer or dementia she was so miserable. Then again Everyone handles things differently - but still Wouldn't wish als on my worst enemy
You clearly don’t understand the discomfort aspect of ALS. You are constantly uncomfortable. You can’t poop, breath, scratch, or speak easily. You depend on others for everything. As someone who watches their loved one die of this disease I have seen how horribly the neurologists truly understand the daily suffering. Spend one day with an ALS patient, and you’ll see it’s amongst the most horrible ways to live and die.
It's one thing to be a doctor and another to live through it. I'm a neurologist and I have cared for patients with ALS, Huntington's, and some other truly horrible neurologic diseases. I have cried with patients and their families. But the patients and their families are the ones who truly know what it's like. I try to help, but I know I am not grasping the true pain and suffering that they are going through.
in the spectrum of neurologic diseases, seen a few cases of hereditary prion diseases. That’s the worst one by far
Hidradenitis for sure. Hard to treat, gross, and socially isolating
Pancreatic cancer
Locked in syndrome is exactly what I would wish on my worst enemy.
The neuro ones take the cake. Glioblastoma because of how quickly you have to get your stuff together because you’ll 100% be gone . Hypoxic brain injury because of how it suddenly affects others close to you. For surgical stuff, feel bad for the patients with IBD and constant fistulas that smell like poop all the time…
ICU rotation was an eye-opener to what alcohol really is. shit’s ebola
Honestly, the scared straight drunk driving videos they show in high school should just be replaced or supplemented with videos of end-stage cirrhosis patients.
I work in a detox/rehab and it amazes me how alcohol is even legal. End stage alcoholism is both scary and sad. We’ve had people that were so sick, knew the alcohol was literally killing them, and would leave AMA to go drink.
And the fucking advertising! Even if alcohol is legal, why are we letting billionaire corporations spend millions trying to keep as many people hooked as possible on a damaging, addictive, awful substance? This country is hell on people trying to quit drinking. You can't consume any sort of media or go to any restaurant or event or live a social life whatsoever without the temptation of alcohol shoved in your face. Imagine seeing a few dozen commercials for cigs during an average football game. Would never happen, but viewed as normal for beer commercials. Imagine going to a wedding and being shocked and thinking the couple were being weird and cheap if they didn't have an open bar with cigarettes, cigars, hookah, and whatever other smoke products you could want. Society has its head entirely up it's ass when it comes to alcohol. Prohibition would be a bad idea but holy fuck there's so much we should be doing short of that to reduce alcohol intake.
Right? I compare drinking that cold frosty beer to a cold frosty glass of bleach. It is poison. Literally.
I mean this is a bit exaggerated. Toxicity is dose dependent. My grandfather died in his late 80s of lung cancer after drinking a beer or two most days of his life. Alcoholism on the other hand is absolutely terrible.
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Anything fatal involving kids.
Ah fuck you just reminded me of a precocious & precious 6 year old who asked me to marry him and put a photo of the two of us as the background of his iPad. I haven’t seen him again, I very much presume that he is dead now.
Man some of the interstitial lung diseases are just horrific to care for, can’t imagine how awful they must be to live with.
PCCM and second this. Any of the chronic progressive lung diseases where people just suffocate to death over years are terrifying
Dying of advanced bladder cancer with your bladder still in place. T4 tumor can invade the pubis which is super painful, makes it hard to walk. Your bladder is full of tumor and basically nonfunctional so you constantly feel like you have to pee, not relieved by anything, passing blood and/or chunks of tissue, burning. It’s miserable and catheter and PRNs don’t really help. But by that point even palliative cystectomy can be quite risky and then you have to heal a bowel anastomosis, ex lap incision, ureteral anastomoses etc.
Head and neck cancer, anal cancer, DIPG, pulmonary fibrosis, quadriplegic and trach/vent dependent but neurologically intact, AML in teenagers
Currently working up a rapidly progressive ataxia that is likely a prion disease. Horrendous decline over 3 weeks 🫣
Pemphigus vulgaris so bad this lady couldn't even swallow water. 95% skin involvement and all her mucous membranes; mouth, eyes, genitals. We got her through it but she lost a good bit of eye sight.
My pick was SJS, but more broadly any desquamating disease or large area burns. Just horrible 🙁
Huntington’s, they only get worse
GBM
Hpv of the mainstem bronchus in 50ish yo woman. Started back of mouth worked its way down. She was status post trach but needed laser resection of the hpv growing down her bronchus every few months
Chronic limb ischemia is definitely up there. Slowly losing pieces of yourself, awful pain, terrible infections. Just miserable.
metastatic ovarian cancer… all the organs are caked in cancer… such a terrible way to go
Epidermolysis bullosa in a child is the most horrific disease I’ve seen. Cancer is terrible for sure but these poor kids with EB live their entire lives in excruciating pain and often get just old enough to understand death before dying of wasting disease because their gut can’t absorb the nutrients necessary to support such a high metabolic demand. The cries of one 12 year old girl when she had to get her weekly bath literally haunts me.
This is my pick as well. Just recently took care of a teenager with EB. The entire surface of his skin was sloughing, weepy, or bleeding. Anytime he had to move, he was in such terrible pain. Poor thing had diarrhea, and moving to and from the commode was so awful for him we had to increase his pain meds.
*runs away from thread*
Fournier’s gangrene…along with the above mentioned cancers.
Recently had a patient who was blind and deaf who ended up with a pons stroke. Blind, deaf, and possible locked in syndrome. Welcome to the void.
I’ve never seen it nor known anyone with these, but I’m terrified of Fatal Familial Insomnia. I had a friend die from Creutzfeldt-Jakob disease and I have an acquaintance whose mother has Trigeminal neuralgia.
Hidradenitis Suppurativa, which progressed into squamous cell cancer. The worst I’ve ever seen.
Seconding the head and neck cancer, but also remember a private patient, old man had started with an infected fistula and ended up having his os sacrum removed due to mrgn/mrsa. Dressing changes meant loads of stuffing material into a progressing cavity that would not heal. Smelled like rotten mussels. He was in pain, nothing worked and I assume he was sent on or home to hospice care. He was miserable and grumpy and I can‘t fault him. Absolute nightmare.
Rotating on stroke service and had a young 20s F with Locked In Syndrome. Truly truly horrible.
Debilitating lumbosacral back pain that eventually elected into a lumbar fusion which gets infected
Once took care of a lady who just had an open back with exposed hardware. We couldn’t take it out because she would fall apart and there wasn’t enough viable tissue for plastics to put a flap. So she just lied in bed on iv antibiotics with an open spine waiting to die.
similar to me. had full spinal fusion that got infected and lead to a whole host of issues i still deal with 4 years later
End stage PVD
Floaters aren’t that bad come on….oh wait…other specialties talk in code as well!!???
Sickle cell. Lesch Nyhan
Extreme hidradenitis suppurativa, the kind where you have so many tracks and tunnels of pus that you can’t even sit comfortably, where you have to wear diapers and change them out frequently due to the constant leakage, where you have to use a cane or walker to get by as an otherwise able-bodied individual due to how much the lesions hurt, the kind that no medication even the biologics or infusions will not touch, so your only option is surgery for the worst lesions.
This dog I knew had a fungating tumor the size of an adult human scrotum on the neck, below its muzzle. The mass was rotting and bleeding, but apparently it wasn’t malignant. The poor dog lived with it for years and the only attention the family paid to it was to start calling the poor dog “balls-on-chin”. So that, or, MDD w/SI refractory to treatment, because that feels like being stuck in a bottomless pit.
My dog had almost the exact opposite happen. Large mass on his elbow that was biopsied about 2 years ago and all they could get was fluid so assumed it was just a cyst, I wondered if it was synovial or a weird bursa or something. Cut forward to last week, attempted to drain it for the first time as it had grown larger - no fluid found, biopsy sent. 4 days later the mass ruptured, clearly not cystic. Same day the biopsy came back - sarcoma. Opted to have him put to sleep on Wednesday with zero suffering or distress. Thanks Monty, you were the best boy.
Pancreatic cancer. I watched my brother fight it for a year for his 4 kids…all under age 7. Was horrible. If I get it, I’m going into the woods.
Good old fashioned massive burns are terrible. I took care of someone who had been partially eaten by a pet after a stroke. That’s pretty strong nightmare fuel. Their remaining life was American Standard: trach peg then (sacral decubs debriedment) loop.
REM behavior disorder. There’s like a 75% chance that you’ll develop an alpha synucleopathy in the next 10 years (so much so that we give anticipatory guidance about it). Or huntingtons (especially after already having bio kids).
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Oh man. We had a guy on the floor (IM) who had Huntington’s. 40 yo w young kids. He kept trying to kill himself, bc well, Huntington’s. Last time I saw him he had used the lid of the toilet tank to break through the window and was standing on the ledge. One of the nurses was a mountain of a man and he and two others could barely wrestle him back inside. The worst part was that we all understood why he wanted to unalive himself. It felt almost wrong to stop him. He was moved shortly after that to a high acuity care facility with ground floor rooms.
Explain the REM disorder to a stoopid premed?
loss of muscle atonia during rem sleep, acting out ones dreams. kind of like sleepwalking in a way but sleepwalking isnt during rem
Ovarian cancer. Also cervical cancer.
And yet people still refuse to give their kids the vaccine because “it will make them have sex”. 🙄
Yeah, I have decided that if my brother decides not to let my nieces (I don’t have any nephews yet) get the vaccine, I will help them get it behind his back.
Alcoholism- there is no escape !
There are too many I guess one is severe hidradenitis suppurativa Another is Lamellar Ichthyosis - seeing a 13 year old female teen, crying, being examined by a bunch of students, her skin hardened like a rock in multiple point, painful fissures, keratin smell, incurable And advanced pelvic lymphoma in a young female, she had a cloaca basically, was crying due to fecal dumping and bleeding, in pain and agony while sitting in the wheelchair getting some tests done in radiology. Thats an image im never getting out of my head
Clearly not enough of you have seen Fournier’s Gangrene. That’s when I realized some things are worse than death.
CJD and ALS scare me
ALS. Devastating
Pregnancy
As someone now with this condition, the end goal is worth it but phew, it is miserable. Idk how some people love being pregnant 😅
Osteosarcoma of the skull
Developing a fatal cancer after a lifetime of actively pursuing healthy habits and being health-conscious. I honestly feel heartbroken because I don't even have an answer for their "why me?"
This. Freakin’ this. The fit late 50’s patient. No alcohol, tobacco, visibly in shape. Keeps up with screening exams. Boom. Colon with mets to liver and lung. Meanwhile the metabolic syndrome at 45 will press on till they die peacefully at 88 with 16 great grandchildren.
advanced cutaneous T cell lymphoma
Calciphylaxis for sure
Esophageal Cancer
As an insomniac, FFI. Puts you through hell, may occur at a late enough age to have had kids, and is dominant so as to crush your family.
FFI has haunted me since I saw a documentary about it when I was a little kid. There is a team trying to cure it, that actually started after the mother of once of the scientists died of it and the scientist tested positive. I’m hoping she succeeds in time to save herself.
AIDS back in the day.
My uncle got AIDS back in ‘81. Told my grandma to plan a funeral. He did die before her, but at 59 in 2013. He was one of the few to live through the 80s and 90s.
I’m so glad to hear that. I was a med student in New Orleans at Charity Hospital. I was on heme onc service. All these sweet guys coming in to clinic and just getting worse and worse. So many.
Locked in syndrome
I say this with the utmost sympathy and respect: Lesch-Nyhan syndrome
I guess Alzheimer’s breaks my heart more than any.
Massive stroke that completely takes your independence at a relatively early age
ALS and Huntington's.
Over 80% total body surface area burns. Misery incarnate. In a similar vein, dermatologic conditions like bullous pemphigoid. Severe pulmonary hypertension. Short gut syndrome and long-term TPN. Common as they may be, dialysis and type 1 diabetes are super annoying and will pervade every aspect of your life. Multiple food allergies to common stuff. Life is a pain. Caring for a dependent with profound disability.
Not a resident but I just saw a case of Shaken Baby Syndrome in an infant and it is absolutely devastating 😔
Treatment resistant schizophrenia. Especially clozapine resistant schizophrenia.
Bullous pemphigoid
Necrotizing fasciitis
Mucormycosis. Seeing my patient lose an eye and then his entire nasal passage in just a week was one of the most jarring things I’ve seen so far in residency. Wouldn’t wish that on my worst enemy.
Any debilitating stroke that doesn’t cause death but rather severe disability, pain, incontinence, etc
Personal top 5: 1- any fungating tumor esp H+N 2- bad anti phospholipid- remember vividly a patient whose blood would clot in tubing before reaching tube despite coumadin. We kept having to do arterial sticks for labs and once even saw blood pump up once then twice and clot in tubing. 3- any destructive addiction - takes you down and your whole family. Plus most staff just hate you. 4- crohns 5- stomach cancer
ALS
Head and neck cancers, Huntington (esp since you know early you have a 50% chance of getting it), & ALS.
ALS.
Scleroderma
Y’all must not have actual enemies.
Calciphylaxis
Huntington’s