Breaking Bad News: Case 2

You are a 25-year-old female medical student doing a rotation in an HIV clinic. Sara is a 30-year-old woman with advanced HIV who dropped out of college after she found that she contracted HIV from her husband, who has hemophilia. In talking to Sara, it turns out you share a number of things--you are from the same part of Montana originally, also have young children, and like to cook. Later in the visit, when you suggest that she will need some blood tests, she gets very angry and says, "What would you know about this?"

What happened?

Breaking Bad News: Case 1

Case 1: Jose is a 62-year-old man who just had a needle biopsy of the pancreas showing adenocarcinoma. You run into his brother in the hall, and he begs you not to tell Jose because the knowledge would kill him even faster. A family conference to discuss the prognosis is already scheduled for later that afternoon.

How should you handle this?

Advance Care Planning & Advance Care Directives: Case 1

An elderly woman with chronic kidney disease told her daughters that if she ever ended up with dementia she wouldn't want to live like that. Years later she developed senile dementia and moved into a nursing home. Although she did not recognize family or friends, she enjoyed the company of others and the nursing home's cat. When her kidneys stopped functioning, staff at the nursing home expressed ambivalence about the value of kidney dialysis, yet asked her daughters whether their mother should be started on dialysis.