I had a fairly young patient last night who has metastatic lung ca...mets to bones, liver, adrenals...multiple pathological fractures. I could not manage to get her nausea or pain under control, despite a Fentanyl patch, frequent morphine, zofran, and reglan. She was getting blood, and every freaking time she'd manage to drift off to sleep, I'd have to get vitals on her. She was so sweet, her family was wonderful, and you can tell that they just aren't coping well with her diagnosis. They're doing radiation oncology treatments, apparently palliatively, since the oncologist wrote in his note "consider d/c'ing treatments if unable to achieve significant pain relief from treatments".
The day nurse is supposed to push the docs for better pain and nausea management (we're thinking more Fentanyl and Ativan IV), and ask them about talking to the patient and family about code status. Currently she's a full code, but she's got so many mets in her ribs and spine that I hate to even THINK about doing CPR on her.
