Cancer patient and professional relationship

[Susan Lawson]

I have been working in oncology nursing for approximately 15 years and I have never run across this situation before.  Hoping I can get advice on how to communicate effectively and suppprortively with a terminal cancer patient who is coming to the end of his treatment and he does not want to leave the oncology nurses. He said "if the price of getting cancer is knowing my infusion nurses then I want to keep my cancer and keep coming here (infusion center)". He has little to no support outside of the infusion center. He has asked to volunteer but only wants to come to the infusion center and doesn't want to go through the hospital vetting process for volunteers. He said he just wants to come in and talk or read with others getting treatment.  This past valentines he brought a very large bouquet of roses and stuffed teddy bears for the staff. Im concerned he has taken this beyond the professional relationship. I understand the lack of support but feel this relationship should end. Any input? Ideas?

Sue

 

[Been there,done that, ASN, RN]

This is a TERMINAL cancer patient. If he wants to come and read and support others during infusion... why not. The hospital should let him forgo the "vetting" process and welcome him. Who CARES if this is beyond the "professional" relationship. Many patients give the nurses gifts, terminal or not.

[kim47]

Does he have a case manager? Maybe they would have some ideas. 

[kbrn2002, ADN, RN]

Been there,done that said:

This is a TERMINAL cancer patient. If he wants to come and read and support others during infusion... why not. The hospital should let him forgo the "vetting" process and welcome him. Who CARES if this is beyond the "professional" relationship. Many patients give the nurses gifts, terminal or not.

I second this and have an idea how to get around the hospital's volunteer vetting process. This will only work though if the entire infusion center staff is on board.  Does the infusion center allow visitors? Most settings have allowed visitors to resume. If so, well he can come in as often as he wants to "visit" whichever patients would like his company during their treatment. 

[JKL33]

Susan Lawson said:

He has little to no support outside of the infusion center.

That is a genuinely sad situation that sounds like it calls for possibly some outside the box thinking; maybe a reasonable exception to usual practice. I personally wouldn't feel too compromised over boundary-type traditional concerns in this particular kind of instance. He is going to die and he has no one.

 

Susan Lawson said:

He has asked to volunteer but only wants to come to the infusion center and doesn't want to go through the hospital vetting process for volunteers. He said he just wants to come in and talk or read with others getting treatment. 

Unfortunately this sort of exception can quickly become inappropriate as it specifically involves other patients. There can't be an expectation that other patients struggling with their own battle will wish to participate in this man's situation. Certainly they could sign up for visit from volunteer--if he wanted to go through the vetting process.

I think it also goes without saying that it's unreasonable to ask any legitimate organization to okay a non-vetted volunteer in 2023; especially involving patient contact.

This is an opportunity for the infusion center to consider adding resources or putting together outside resources for situations like this.

[Nurse Beth, MSN]

I agree with @JKL33 that some process is needed.

From a risk/manager point of view, sadly, it would open a can of worms. Sorry!

Is he eligible for hospice?

 

[JKL33]

Can he drop off the daily newspaper on days when he would've normally been coming in for treatment?

Just something simple that helps him not feel completely alone?

Or maybe the manager (or care manager/navigator/social worker) arrange to give him a check-in call a couple of times a week as he transitions out of in-person visits?

[Nurse Beth, MSN]

JKL33 said:

Can he drop off the daily newspaper on days when he would've normally been coming in for treatment?

Just something simple that helps him not feel completely alone?

Or maybe the manager (or care manager/navigator/social worker) arrange to give him a check-in call a couple of times a week as he transitions out of in-person visits?

I love those ideas!

[Susan Lawson]

Thank you all for such helpful comments. I've seen transference in mental health similarly this patient has established an attachment bond with one of my coworkers and she has requested not to be assigned to his care. He was upset she wasnt there last week, I told him she was off to celebrate her anniversary with her husband and that seemed to bother him.  Also we typically, have pts ring the bell on their last treatment day, but he refused, stating he is talking to his doctor about starting a maintenence chemo with just 5fu pump so he can continue to come in.  It really is a sad situation and I do appreciate your comments and suggestions. Thank you again

[JKL33]

Susan Lawson said:

Also we typically, have pts ring the bell on their last treatment day, but he refused, stating he is talking to his doctor about starting a maintenence chemo with just 5fu pump so he can continue to come in. 

The attachments to those at the center are part of his much heavier struggle, which is facing his own mortality head-on. It isn't just that he has to say good-bye to everyone.

He refused to ring the bell because (if he is terminal?) then being done with treatments isn't exactly a moment to commemorate--going off to die with no hope left?

It might be easy to confuse his issues. Yeah, he is attached to people and "refuses" to literally and figuratively say good-bye to you all....because doing so is, in his case, part of saying good bye to everything. The End.