[QUOTE=weezieRN]Not to change the subject but I'm just udderly surprised at the amt of medication she is receiving and has not actually passed away from respiratory depression etc. I don't know her condition and won't pretend to but how can someone want to live out the rest of her short life sedated? Sure I will go for pain free and I know there are ways of doing it instead of sedation. Does she not want to spend "quality time" with her husband and children/family. If that was my mother I would want her comfortable and but I would also like to talk with her and let her express her feeling to her family and have some good meaningful talks with them. It would be good for her as well as her family and it will lead to some closure for them and not making things so rough especially for the children. Just my opinion. What about a pca, fentanyl patches, they seem to work ok, implanted pump etc. Lots of options out there. Don't really know how to help with inservice other than to do what family and pt wishes and keep her pain free.[/QUOTE
Thanks Aimee and Weezie, I've been doing some searches but hadn't found either of these sites yet. Weezie, I think your questions are exactly what some of the staff are asking - and yesterday, when they started Phenobarb, replacing the versed/ativan which was not working any longer, everybody expected her to stop breathing. But she has an amazing tolerance for medication. I've only known this woman for 4 weeks, but apparently she has suffered severe pain for many months. Whether she was undermedicated or the medications just didn't control the pain, I'm not sure. (It does happen sometimes) Some of the most intractable pain I've seen is in young women with end stage ovarian cancer. This lady presents similarly with metastatic cervical cancer - which I've not seen, maybe because cervical cancer is more likely cured, which justs adds to the tragedy of this situation. She has a wonderful husband, sister, mother and young children who are at her bedside 24/7. She is awake and perfectly lucid though lethargic several times a day. She cannot move a muscle without going from 0 to a zillion on the pain scale. About every 3 days her pain increases and the meds are bumped up - one day from 350 mg to 500 mg/hr. Her respirations never wavered - always 12 -14 min. She asks nearly daily for it to be over - I've been at her bedside when the doctor (an anethesiologist, btw, the ony doc who dug his feet in, fought all the inital staff reactions and did what needed to be done to make her comfortable and sedate her) asks her what she wants and she always says "put me out". This woman fought bravely for 2 years, she took all conventional treatment and then went to the bahamas for 4 months for more treatment (don't ge me started on that one....) I do not question her wishes - I've not been in her shoes. I want her suffering to end because that's what she wants. I don't know how soon she will die. It may be weeks. Unfortunately, she is getting a significant amount of fluid with all these IV drugs. I believe it is prolonging her life. I want to talk with the doc and pharmacist today about options. Maybe switching to IV Fentanyl. Can't do patches - she'd be covered with them.
Aimee - I'm thinking maybe the best way I can support staff in 20 minutes is to just make it a question/answer session. Let them do most of the talking. I would love to start a support group for them, but the time factor is always there - I don't want to create more stress for them. I've thought about putting a large card/poster on the wall, where they can write something to her and the family which could be given to the family when this is over. Maybe in the staff lounge where it's usually quiet.