Hospice, TPN, Ovarian Cancer

[AJ28]

Tell me if this makes sense:

Pt diagnosed with stage 3 ovarian 4 years ago. Cancer has metastized to line the GI tract and causing ascites. Basically has a non functioning GI tract. Can't eat or really drink anything. If she does it absorption will be impaired to say the least. Dr says that if she can't absorb anything she may last a month, if she can tolerate some then it may be 3+ months. So basically she is going to starve or dehydrate. She requested TPN. Have any of you heard of TPN being used in a case like this? I was under the impression TPN was not done in a hospice or home care setting. Is it justified and could it help (theoretically)?

[CampbellSoupCan]

Alright...let me try to respond here without crying...when my entir world was in her final days with OVCA, terrible ascites...I (a home health nurse at the time) begged for her to have TPN because she could not eat. I was not in nurse mode. I was in daughter mode.They let me give her TPN, even after telling me why it's not recommended.

It was Dec 1st. I HAD to do everything I believed was needed to make her live longer, at least until Christmas. I remember hugging the hospice nurse when she agreed to start TPN. I remember how 2 weeks later I realized mom's tummy was getting bigger.The Hospice Nurse repeated exactly what she had told me 2 weeks ago, only this time I actually was able to accept the information.

Mom's nurse was such an angel, that she realized I was grieving too hard to accept the rational for withholding fluid.

Well now of course I understand why we do not like to give TPN, but only because I am now Hospice Nurse.

If I was not a nurse, I probably would have gone the rest of my life questioning the decision to omit the TPN.

I never would have had complete peace about it.

So my point is...we are treating not only the patient, but also the devasted loved ones left on earth to wonder if they did "everything they could do". Sometimes people are just grieving too hard, and are too afraid to accept the logic. We have to give them peace and let them at least try.

Mom died days after Christmas. I have never had such sincere admiration for anyone in my life, as I did for my mom's hospice nurse. Her patience with me, and her kindness in letting me try to help my mom, when she knew it wouldn't help, still to this day...brings me to tears. I became a Hospice Nurse because of my admiration for mom's nurse Suzanne Peebles RN.