She's 65 with no other comorbidities. I fully expect this to be a challenging case, not to mention emotional. In the ICU setting, I would manage this with propophol, IV dex, cooling blankets, dilantin, ICP monitors, basal temp probes, etc. Without all the bells and whistles and only PO decadron, a seizure pack and a comfort pack and some knowledge packed away about increased ICP, I feel kind of naked.
She already has focal involvement with left sided hemiparesis and her level of consciousness is obtunded to lethargic to obtunded. She was diagnosed 2 months ago with grade IV primary glio. If any of you have any experience in the hospice setting with this nasty brain cancer, please share. The family needs everything I can muster with this one.
It will be two years in June that my husband passed from an aggressive, left temporal GBM (inoperable). I agree with LPN, this CA is ravaging. My husband chose to starve himself rather than to eat and allow the tumor to kill him. In his teenage son's eyes, he died a hero--he kept his promise to his sons that he wouldn't let the GBM kill him--he chose starvation instead. It was one of the most trying times I have ever had as a hospice nurse--whether to start chemo and radiation--whether to try to fight the battle and maybe lose precious quality time. He decided to fight and I decided that I would support his decision--after 6 weeks of radiation and chemo--the tumor had grown!--EOL symptom control was horrific the last few hours--he was young and his heart wasn't ready to give up even though every other system was shutting down.
Yes---there are definitely things worse than death. Aggressive symptom control (or anticipation of such) is a key element of this CA process--be prepared for anything--seizures, temps, aggression, wide mood swings depending on where the tumor is pressing for the moment, etc. This CA is more prevalent in males of the 45-60 range so the psychosocial issues are usually intense--get your team on board early!
Although I would not ever wish this type of experience on anybody, I definitely got a look at "the other side" of the coin--what families have to go through with paperwork and disability and coordination of MD appointments and trying to work and having co-pays alone eat you alive for expensive nausea drugs---the guilt my husband went through for feeling like he was depleating our resources-the worry of "keeping it together" for my children. Supporting my husband's wishes although they necessarily wouldn't have been mine. The act of being the caregiver alone is exhausting. Again, althoug I miss him terribly, he gave me a wonderful gift that I will be able to pass to my patients and their families---the gift of empathy. He will ever be our hero.
Last edit by rnboysmom on Apr 2, '08
: Reason: spelling