Lather, Rinse, Repeat

One of my assigned patients is dying of metastatic liver cancer. I was told in report, "he's full of mets". The day before I took care of him, Hospice was consulted. He had a significant amount of pain, but if we kept up with his Oxy (he also has a Duragesic patch) he was comfortable.

So my usual morning routine goes like this: print my report sheet, and start putting in my little boxes for med times, assessments, etc (yes, I'm the OCD nurse), while I wait for the night nurses to be ready for report. Get face-to-face report from the off-going nurse(s). Then we do walking rounds, so we can meet the patients....and make sure they're still breathing (true story: not long ago in walking rounds we discovered a palliative patient had just died...imagine if we had skipped rounds and I hadn't gone to assess her first?). As soon as I've met my patients and made sure there's nothing that needs my immediate response--patient crashing, in pain, etc--then I go back to my computer. At this point I take a good 20 minutes to look at the last set of vital signs, any a.m. labs that are back, and the last nursing note. By this time I feel "ready" to decide who I need to see first, and start passing my meds. And it's probably 8am by now.

Generally I find it helpful to have looked at vitals and labs before pulling meds, so that I know if the patient's BP is low enough to hold meds, for example. Or I know what their K+ is before I pull out a big dose of Lasix. So anyway, I pull my first patient's meds, and do my first assessment when I go to give them.

Lather, rinse, repeat. I usually pass all my morning meds and cover fingersticks before sitting down to document any assessments. Of course, by this time docs are rounding and writing new orders, too....

So. Back to my patient. After hearing in report that he's full of cancer, we go to see him first and he needs pain meds. So right away I pulled his Oxy and gave it. He said to me, "you girls are soooooooooooo nice".

About a half hour later, after seeing my next patient, I went to re-assess his pain, and he was much more comfortable. I asked him if he needed anything, and he said, "oh just a few ice chips if that's ok". I said of course, and then suggested some ice cream. His whole face lit up, and he asked, "I can have ice cream?"

Oh lordy, you can have anything you want.

As far as I'm concerned, when you're dying of cancer, ice cream for breakfast is not only ok, it's medicinal.

So I went to see all my other patients, gave meds, sent folks for xrays, talked with some docs. Then I went to see him again. With an ice cream in hand.

He beamed from ear to ear.

All day he kept thanking me for being so nice. Honestly, he was an easy guy to like, grateful for the most trivial of things. One of the things I like most about palliative patients is that the focus really is on the small things--fluffing pillows, backrubs, clean sheets, cool cloths. Pain meds. Ice cream. Lather, rinse, repeat.