cancer is a four letter word

[gvrn13]

One of my patients the other day, a 60 year old man, s/p laryngectomy, pharyngectomy for some kind of throat cancer (what he exactly has escapes me right now), has a peg tube, NG tube, tracheostomy, and has a submandibular fistula. This man, arrives, smiling, giving me thumbs up, answers my questions using a writing board, for as bad as I think his situation his, I am immediately taken by how upbeat his attitude is (or at least how he portrays himself in my office). Halfway through his treatment, he starts "coughing", and it is obvious that he can't clear the secretions. His wife says this happens, it's not unusual for him, and he just needs to clear the inner cannula of his tracheostomy tube. I assisted him to the bathroom where he took out the inner cannula and started to rinse it out.... all this time he is turning from bright red to maroon, to an awful dark maroon, almost navy color. I had oxygen ready to give to him, but he did not want it. I stood there, waiting to catch this man, because I was sure that he was going down. In my head is racing thoughts of how I'm going to breathe for him, does the ambu bag we have an attachment to fit on the trach tube? Is he going to need CPR?? And this whole time, while I'm expecting the worst to happen, and he is almost navy blue, he is patiently washing the tube, nodding his head when I'm asking him if he's ok, I think he gave me a thumbs up. After he finished washing, and I was almost convinced that he wasn't going to drop and pass out, he's looking in the mirror while inserting the cannula, and I'm watching him watch himself.. and I'm thinking, did he ever think that he would be doing this to himself? Did he ever think that he would have cancer, and have half his throat removed? What does he think of the man cancer has turned him into? Does he think the cancer is going to win? And I'm thinking this is real bad, how in the world is he going to beat this?? And as bad as I was feeling for him, really thinking wow this sucks, because I think this is the absolute worst thing I've seen so far, he gave me the thumbs up after he was all done and smiled at me, and I think that's when my heart broke for him. Because as bad as it is, and it's real bad, it's not that bad that he has lost himself or his spirit to the cancer.

I'm in my first year of nursing with cancer patients, and all my patients have their own story, and they are all real sad in their own way, cancer sucks. But this man, turning blue and still being "ok", really touched me. I can't stop thinking about him since. And the rest of that day, I had that feeling of when you've held your breath for too long, and you think you might burst if you don't take a breath like right now... that's what I imagine he was feeling like that whole time...

Anybody else have an experience like this where they saw cancer, and realized it might win???

[OCNRN63, RN]

workingharder, thank you for your insight and answering hard questions!!! I know life is a circle, we're born, we live, and we pass on, theres no way around it. I guess I don't know which is worse though, knowing or not knowing how you will go. I give you a tremendous amount of credit for being on top of all your affairs, and making sure things are done the way you want them. I also hope that you enjoy the Xanax, and get to go home soon. Hospitals stink!!

My work, is a doctors office, with an outpatient infusion facility. My patients come in, get their chemo, and go home. For the most part they are "healthy", and in my 8 months there I have seen about 3 chemo reactions, and my 1 pt who was turning blue. They really for the most part do well, and there isn't a lot of problems. But I can't stop thinking what if, and I'm really hating that I'm in a position where I feel uncomfortable with what I'm doing, or lack of doing, even just by being someplace where I wouldn't have the tools that I needed if I ever did need them, which I may not. I honestly have no idea why there is not a minimum standard.

When I see this man again, I will definitely ask him if he knows how to use the suction he has at home… he really may not!! I will also ask the wife about bringing a extra kit with her so if this happens again, we can just change it, instead of him having to wash the cannula out. I will also ask what kind of services, if any is he receiving. Thank you for all your ideas, and input. I really enjoy talking to other nurses, who make me think, and question, and want to be better for myself and my patients. :)

I can't believe that your infusion facility doesn't have at the very least a rudimentary crash cart that would include a suction machine, CPR backboard, O2 supplies, etc. At the infusion center where I worked (located in a large outpatient pavilion), we had our own crash cart. We had several reactions that went south. Usually the taxanes were the culprits, but I also saw reactions to Gemzar and some others. We had to call codes a few times; there was a code team in place since they did some outpatient cardio procedures and day surgeries there.

Like workingharder, I have my will, advanced directives, POLST completed. I keep a copy of the advanced directives and POLST in a ziplock baggie in my purse. I also have medical, financial, and bank POA in place.

[gvrn13]

OCRN63, thank you for your insight as well!! I am sorry that you both have first hand knowledge of what cancer is really like.

And like you, I can't believe we don't have a crash cart. Not really sure if this is common practice for a doctors office/infusion center, but I can't understand why. It seems like my nurse manager is very well educated and versed in all things oncology, and I do like the doctors at the office, and they seem very smart and up on their specialty, but I'm not sure where this lack of basic equipment comes in… we have oxygen, and a SPO2. Not gonna cut it in a life or death situation. Needless to say, I am actively (and somewhat desperately) looking for a job in a hospital (think I have one lined up, I missed the HR lady when she called me on Friday). Thanks for replying and for you input, I appreciate it.

[OCNRN63, RN]

I remember one pt who had a really bad reaction to oxaliplatin. He'd been getting it for quite a while. One day during his infusion, he went from chatting and laughing with us to turning blue and unresponsive, just. like. that. Fortunately, he revived, but that was the last time he got oxali.

The thing with having a full blown crash cart is you have to have people who can use it. Are the staff there ACLS certified? Even if you are certified, if you're not involved in codes on a fairly regular basis, like ICU and ED, you forget all those drugs, dysrhythmias and algorithms. Do you just call 911 if you have an arrest? Is there a doc readily available when you're running chemo?

I wish ONS had a CEU on emergencies while administering chemo, e.g. which drugs can cause which type of emergencies.

[workingharder]

To OCNRN63 and gvrn13, nice avatars. Too many good songs, too many good times.

[gvrn13]

The crash cart… If they just required the ACLS, everybody would have to have it, and that would just be their requirement.. it just seems crazy being unprepared when you're in a situation where so many things can go wrong!!! There is always a doctor there, and what has been my experience when I have seen a reaction, is some more benadryl and steroids.. If there is an arrest, or somebody turns blue, it's 911. We're nurses, but our hands are tied by not having basic things. THere should be a emergency course, that's a really good idea.

I hope you are feeling better. :-)