C) None of the above.
I do not think this patient is actively dying. I do not think there is an iatrogenic treatment dilemma here either. I think this patient has a straight-forward, reversible problem, that if treated, the treatment burden likely will be far outweighed by a rapidly and significantly improved overall QOL, for the time being.
For a moment, I will put on my Emergency Medicine hat. The diagnostic gestalt that I pick up is:
- Stones (renal or biliary)
- Bones (bone pain)
- Groans (abdominal pain, nausea and vomiting)
- Thrones (sit on throne - [polyuria])
- Psychiatric overtones (depression, anxiety, cognitive dysfunction, AMS, delirium, coma)
STAT labs including Ca2+/(some like Ionized Ca2+), peripheral IV access, aggressive NS rehydration followed by furosemide, diuresis, calcitonin, and bisphosphonates.
I also think that in fact patterns like these, with metoclopramide and morphine on the med list, one does have to consider cumulative anti-cholinergic burden/side-effects. Steroid psychosis is a possibility but, "Look at the [groans]..." I think this is a pretty straight-forward case of hypercalcemia of malignancy.
Cheers!