Medical decisions are not just about the facts What a life-threatening virus can teach us about empathy, psychology, and the practice of neurology

A patient with glioblastoma multiforme was referred to me for management of his seizure disorder. After a subtotal resection, he had undergone and failed concurrent temozolomide and radiation therapy. Recent scans showed disease progression, so treatment with bevacizumab was planned. Seizures were controlled on levetiracetam. As we approached the end of the patient interview, his wife suddenly beseeched: “Dr. Sethi, what would you do if this was your brother or father?” Confidently I reassured them that everything had been done as per existing protocol. I was, however, acutely aware that this was not, in fact, what I would have advised my family member. Cognizant of the dismal prognosis and potential toxicity of largely experimental chemotherapy, I would have counseled to opt out of further treatment.