Gold or Platinum?Nancy Robertson, DNP May 3, 2022
She was a strikingly beautiful woman. She lived life fully, juggling her catering business with raising her kids, being a partner to her doting husband, and occasionally doing a favor for friends and serving as a model for their restaurant business. Life was good. Until the dentist found a lump. Cancer, a terrifying diagnosis for all, sent everyone into immediate, must be done now, surgical interventions. Removing the cancer was the focus as the medical team ran full steam ahead with saving her life. Complications prolonged her hospital course which lasted 6 weeks, 3 of them in the ICU.
By the time I met her in the outpatient palliative care clinic, she was no longer the woman she used to be. Her mouth was disfigured and without normal function. She was reliant on a feeding tube for all nutrition and hydration. While she could sip thickened fluids through a straw, the fluids more often than not dripped out the side of her mouth, down her chin, and onto her ever-stained shirt. She would never again be able to kiss her husband fully, mouth “I love you” to her kids, or smile her once photographic smile.
While the pain began in her mouth, it gradually took over her entire being. Pharmaceuticals for neuropathic pain only got us so far in minimizing this symptom. Visits were spent time and again sitting in the despair of it all. Even in a world that embraced masks, she would no longer go out. An extravert locked inside, connecting only with the number of family that can be counted on one hand.
My thoughts wondered back to those beginning medical discussions. Did we, her healthcare team, counsel her on treatments through the lens of the Golden Rule? And in doing so miss the whole essence of who she was? What if the Platinum Rule had been used as a guide instead? Would the outcome have been different?
Read Dr. Chochinov’s powerful editorial to understand the differences between these two approaches.
Chochinov, H. M. (2022). The Platinum Rule: A New Standard for Person-Centered Care. Journal of Palliative Medicine