Let's Think About it Again
Refractory Existential Distress
Clifton Ryder (fictitious name) is a 63-year-old man with past medical history of non-small cell lung cancer diagnosed 3 years ago. He has never been a smoker. He is a nutritionist and exercise physiologist with an interest in wellness, and throughout his cancer treatment he has maintained an active practice as a personal wellness coach. He is married, has two grown children, and lives happily in rural New England, where he enjoys hiking and kayaking. He was initially treated with curative intent and underwent a wedge resection of his primary tumor, followed by chemotherapy. He had a 2-year period of disease remission without evidence of recurrence. Unfortunately, in recent months, he developed worsening back pain and abdominal pain. He was busy attending to his business and preparing for one of his children’s upcoming wedding, and unfortunately he was delayed in presenting for medical care. Ultimately, he developed worsening weakness and clumsy gait and eventually sought care in a local ED. There, he was diagnosed with metastatic disease to several lumbar vertebral bodies, with developed cord compression, leaving him as a wheelchair user indefinitely.