Now that that procedure had failed, Helene's mother explained quite convincingly and in no uncertain terms that she didn't want invasive surgery. Helene had been able to eat about 50% of her lunch the previous day, though it took a lot of time and effort. I discussed her options, the best ones being A) continuing to try to feed Helene orally, and B) hospice. But again, I did not try to talk her into it. She thanked me for being the first one to sit and talk to her like a person.
"Recommend second surgical opinion. Patient is not eating well and is malnourished."Wait, wait, wait . . . what??
This may sound strange coming from a surgeon (though hopefully it doesn't), but not everyone needs surgery, even if it means they will die without it. Though it may seem on its surface hypocritical coming from a guy who readily admitted that he's talked someone into surgery who initially didn't want it, but hopefully you can see the great chasm of difference between the cases. Neither Mathilda nor Helene could have been reasonable helped by anything I could do. Only a miracle could have helped them.
And I am not a miracle worker.
Postscript: Mathilda refused all surgery and walked out of the hospital a few days later to spend whatever time she has left with her family. Helene's mother met with the palliative care doctor, and she ultimately decided to pursue hospice care.