RT Book, Section
A1 Moriates, Christopher
A1 Arora, Vineet
A1 Shah, Neel
SR Print(0)
ID 1106933991
T1 Ethics of Cost Conscious Care
T2 Understanding Value-Based Healthcare
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-181698-4
LK accessmedicine.mhmedical.com/content.aspx?aid=1106933991
RD 2024/04/24
AB Michael  is  12  years  old.  “Not  hungry?”  I  ask  when  I  enter  the  room,  eyeing  the  plate.  He  doesn’t  answer  my  question,  but  instead  remarks  with  a  lopsided  grin,  “You  look  funny.”  I  look  sideways  at  [my  reflection  in]  the  mirror  and  see  a  yellow-gowned  creature  fumbling  around.  Michael  is  right.  I  do  look  strange,  but  these  precautions  are  necessary  because  he  is  undergoing  chemotherapy  for  metastatic  Ewing’s  sarcoma.  He  was  diagnosed  3  months  after  he  first  saw  his  physician  for  leg  pain.  At  the  time,  his  pediatrician  told  him  that  he  was  having  growing  pains,  and  instructed  Michael  to  call  back  if  the  pain  worsened.  Surprisingly,  Michael’s  pain  went  away  after  the  visit.  However,  some  weeks  later,  his  pain  returned  with  a  new,  burning  intensity.  Concerned,  Michael’s  mother  made  another  appointment  with  their  pediatrician.  This  time,  the  pediatrician  attributed  Michael’s  pain  to  a  sports  injury  and  advised  him  to,  “Ice  the  leg,  take  some  Tylenol  and  call  back  if  the  pain  persists.”  While  Michael  felt  somewhat  better,  a  few  weeks  later  when  the  pain  began  awakening  him  from  sleep,  Michael’s  mother  took  him  to  the  emergency  room.  The  doctors  ordered  an  x-ray  of  his  leg,  which  showed  “onion-skinning”  lesions  on  his  bone,  a  classic  finding  in  Ewing’s  sarcoma.  A  subsequent  CT  scan  showed  that  the  tumor  had  metastasized  to  his  lungs.