A 70-year-old woman has received weekly blood transfusions due to myelodysplastic syndrome. She declined chemotherapy and opted for alternative therapies even though some times her physician had told her the risk of sudden death without chemotherapy.
She has been hospitalized in neurosurgery for the past month since she developed acute subdural hematoma by falling down and striking her head while attempting to feed her cat. Upon admission, she presented with mild impaired consciousness and aphasia. After receiving platelet transfusions, she managed to get through the acute phase without surgery. She is now undergoing rehabilitation while preparing for discharge home.
Recently, after rounds, she tells me, “Thank you, always.” I like her word, “always.” I don’t remember when she started saying “always.” When does “always” begin, and when does it end? I suggest she may say it because she knows when it will end.
WILLPOWER MELTDOWN SOMETIMES 