Is it okay to slug an oncologist?

[JessicaInOr]

My Dad was dx'd w/Colon CA 12/03. He went through 6 months of 5FU and did quite well. A full year after his original dx he perf'ed his viscus, had emergency surgery and it was found that CA is everywhere. On his stomach, two tumors in his liver, throughout his colon, everywhere.

At the time of surgery the oncologist and GI surgeon explained the only thing they could do is more chemo but they were quite clear the best they could hope for was to shrink the tumors on a short term basis. There is no cure here.

Here is my problem, right after telling us the news the oncologist went in and told my Dad that with massive amounts of chemo on a pump in his home he has a 50%-80% chance of a FULL cure.

That's a load, there is no chance for a full cure. My Dad wants to try absolutely anything in an effort to survive this. He's just not ready to go.

I don't want him to destroy whatever quality time he has left with chemo. I've had patients before where the doc wasn't totally honest but never flat out lied like this bozo.

My Dad is calling me asking me for my opinion. I really don't know how to handle this. Some advice from my fellow brothers and sisters would be greatly appreciated.

[humglum, BSN, RN]

One point.

Were you present when the oncologist spoke to your Father?

Many parents will deny the severity of their disease to their children/SO/loved ones. They do not want to "hurt" them....despite the fact that we will be more hurt that we were not given the truth of the situation. It can also be a coping mechanism for him.

Another is that patients hear what they want to hear, not necessarily what is said. We tell them that they will be "treated" with X% of "response" by the disease, and they hear "treat" and "response" as cure, when it is not.

If you were present when the oncologist spoke to your father, then you should have confronted him as soon as he left the room. There is no excuse for such unethical behavior.

Excellent points, Carolina.

[JessicaInOr]

My Dad was finally told the truth this morning. He's back in the hospital, yellow as a banana, dehydrated, and very ill. I knew he had liver involvement so I knew the eventual outcome.

Today he was told that with chemo he has 4 months at best.

I haven't done oncology in 20 years. Any advice? Suggestions? His oncologist wants to buy more time. With chemo he gets up to four months. My personal opinion is to leave him alone and preserve any potential quality of life. The doc wants huge doses of 5FU on a pump, at home. I want my Dad to not suffer.

He called today to tell me what I already knew. He asked about chemo. My personal feeling is no chemo. Please help, was I correct?

I wish he would scream or cry or do something. Instead he's being so strong and stoic. I am so angry with myself. I thought I had prepared myself more than I had for this call today. When he told me what he knows. Instead I sat there like a blubbering idiot. I had to hang up the phone. Then I called him back and said... okay, let's talk this out. That is what he needed.

I could really use some thoughts on this.

Thanks!

[leslie :-D]

My Dad was finally told the truth this morning. He's back in the hospital, yellow as a banana, dehydrated, and very ill. I knew he had liver involvement so I knew the eventual outcome.

Today he was told that with chemo he has 4 months at best.

I haven't done oncology in 20 years. Any advice? Suggestions? His oncologist wants to buy more time. With chemo he gets up to four months. My personal opinion is to leave him alone and preserve any potential quality of life. The doc wants huge doses of 5FU on a pump, at home. I want my Dad to not suffer.

He called today to tell me what I already knew. He asked about chemo. My personal feeling is no chemo. Please help, was I correct?

I wish he would scream or cry or do something. Instead he's being so strong and stoic. I am so angry with myself. I thought I had prepared myself more than I had for this call today. When he told me what he knows. Instead I sat there like a blubbering idiot. I had to hang up the phone. Then I called him back and said... okay, let's talk this out. That is what he needed.

I could really use some thoughts on this.

Thanks!

(((michelle))),

have you asked your dad what he wants to do?

going through chemo isn't exactly the way i would want to live with that ltd. amt. of time secondary to all of its' adverse and dangerous se's.

when my mom was dx'd w/acute myeloid leukemia, the onc told her that with chemo, she had a good shot of survival, which was bunk. all the research i did showed very poor prognosis in the elderly population, basically averaging 2-5 mos w/chemo....and only weeks w/o it. because my mom was so fearful of dying, she opted for the chemo.

yet i'm glad the onc didn't give her a time span for she wouldn't be able to handle it.

so she went to the hospital as an inpt for 10 day chemo tx.

on her 5th day of chemo, her sm and lg bowel were totally infected, developed peritonitis and eventually became septic. her wbc was under 10. she ended up on a vent, vasopressors and 4 different abx....she was unconscious/semi-comatose the entire time (thank God).

i got a call at work one noc stating she took a turn for the worst.

i flew down the next a.m. and my stepdad, the poa, was too distraught to make any decisions and wanted me to make the decisions. so w/2 oncs, myself and my stepdad, we discussed options....both oncs wanted to wait and see. i asked why....just so she could wake up to die shortly thereafter?

one onc and me were butting heads as i wanted all txs stopped that day.

she had a 104 temp; her vasculature had basically all but collapsed so she had blown up like a balloon and i knew she wouldn't survive. yet they hadn't put her on any mso4 because they were afraid of her bp lowering (even though she was on a dopamine drip) and even when she was unconscious, i could tell she was uncomfortable.....i'm a hospice nurse and my expertise is in pain assessment.....when i gave her mouth care, her eyebrows would knit, her face was tight...

eventually the arguing stopped and so were her treatments.

the nurse then started a mso4 drip, extubated her, stopped all iv's and she died 55 minutes later.

i guess my point is that many oncologists just want to continue with treatment w/o looking at the big picture.

you really need to find out what your dad wants.

if he goes on chemo, his remaining time would not be comfortable.

yet if he uses hospice, he will be kept comfortable and he still might last the 4 months; but he also might not on chemo, because of what happened to my mom.

so open communication is needed.

i'm so, so sorry and will pray for peace for you and your father.

pm me anytime, should you want to vent.

leslie

[JessicaInOr]

(((michelle))),

have you asked your dad what he wants to do?

going through chemo isn't exactly the way i would want to live with that ltd. amt. of time secondary to all of its' adverse and dangerous se's.

when my mom was dx'd w/acute myeloid leukemia, the onc told her that with chemo, she had a good shot of survival, which was bunk. all the research i did showed very poor prognosis in the elderly population, basically averaging 2-5 mos w/chemo....and only weeks w/o it. because my mom was so fearful of dying, she opted for the chemo.

yet i'm glad the onc didn't give her a time span for she wouldn't be able to handle it.

so she went to the hospital as an inpt for 10 day chemo tx.

on her 5th day of chemo, her sm and lg bowel were totally infected, developed peritonitis and eventually became septic. her wbc was under 10. she ended up on a vent, vasopressors and 4 different abx....she was unconscious/semi-comatose the entire time (thank God).

i got a call at work one noc stating she took a turn for the worst.

i flew down the next a.m. and my stepdad, the poa, was too distraught to make any decisions and wanted me to make the decisions. so w/2 oncs, myself and my stepdad, we discussed options....both oncs wanted to wait and see. i asked why....just so she could wake up to die shortly thereafter?

one onc and me were butting heads as i wanted all txs stopped that day.

she had a 104 temp; her vasculature had basically all but collapsed so she had blown up like a balloon and i knew she wouldn't survive. yet they hadn't put her on any mso4 because they were afraid of her bp lowering (even though she was on a dopamine drip) and even when she was unconscious, i could tell she was uncomfortable.....i'm a hospice nurse and my expertise is in pain assessment.....when i gave her mouth care, her eyebrows would knit, her face was tight...

eventually the arguing stopped and so were her treatments.

the nurse then started a mso4 drip, extubated her, stopped all iv's and she died 55 minutes later.

i guess my point is that many oncologists just want to continue with treatment w/o looking at the big picture.

you really need to find out what your dad wants.

if he goes on chemo, his remaining time would not be comfortable.

yet if he uses hospice, he will be kept comfortable and he still might last the 4 months; but he also might not on chemo, because of what happened to my mom.

so open communication is needed.

i'm so, so sorry and will pray for peace for you and your father.

pm me anytime, should you want to vent.

leslie

Leslie...

Your post made me go into another crying fit, one I didn't know if I could stop. But I did. And you are right. And what you wrote is what I need to hear.

After I blew it on the phone with him and had to hang up and call him back, I asked him what I could do for him. What did he want to know.

He wants to know if his pain can be managed. I told him yes. It can be managed. I will personally see to it that his pain is managed one way or another.

I realize this isn't going to make sense but you said something weirdly comforting. You told me that you and your Mom were told total crap by the onc. I have been a nurse for 20+ years and have never seen an ocologist lie through this teeth the way this little butthead has. I was starting to question common sense and logic. While I fully admit not being in oncology for far too many years, I knew better than what he was saying.

>>eventually the arguing stopped and so were her treatments.

the nurse then started a mso4 drip, extubated her, stopped all iv's and she died 55 minutes later.

I asked my Dad to please please please do me one favor. Please, get a pain management specialist in there so he won't suffer. He won't do it. He insists his onc (the same little buttwad that gave him a 50% - 80% chance of a full cure) said he won't let him suffer. I tried to tell him that sometimes CA pain is different from other pain. He won't hear of it. I plan to fly home soon and I will reopen the topic. I do think he will allow me to be his pain advocate.

I would rather he die sooner vs. suffer.

But you know what? It's still my Dad. He's my all time favorite person. I'm a daddy's girl 100%. I love him and respect him. I won't permit him to suffer.

Thank you, Leslie. You wrote what I needed to read. (hugs)

[UnewmeB4]

Leslie...

Your post made me go into another crying fit, one I didn't know if I could stop. But I did. And you are right. And what you wrote is what I need to hear.

After I blew it on the phone with him and had to hang up and call him back, I asked him what I could do for him. What did he want to know.

He wants to know if his pain can be managed. I told him yes. It can be managed. I will personally see to it that his pain is managed one way or another.

I realize this isn't going to make sense but you said something weirdly comforting. You told me that you and your Mom were told total crap by the onc. I have been a nurse for 20+ years and have never seen an ocologist lie through this teeth the way this little butthead has. I was starting to question common sense and logic. While I fully admit not being in oncology for far too many years, I knew better than what he was saying.

>>eventually the arguing stopped and so were her treatments.

the nurse then started a mso4 drip, extubated her, stopped all iv's and she died 55 minutes later.

I asked my Dad to please please please do me one favor. Please, get a pain management specialist in there so he won't suffer. He won't do it. He insists his onc (the same little buttwad that gave him a 50% - 80% chance of a full cure) said he won't let him suffer. I tried to tell him that sometimes CA pain is different from other pain. He won't hear of it. I plan to fly home soon and I will reopen the topic. I do think he will allow me to be his pain advocate.

I would rather he die sooner vs. suffer.

But you know what? It's still my Dad. He's my all time favorite person. I'm a daddy's girl 100%. I love him and respect him. I won't permit him to suffer.

Thank you, Leslie. You wrote what I needed to read. (hugs)

Allow yourself to NOT be a nurse, as difficult as that may be, unless he asks your opinion as a nurse. Just be his "Daddy's Girl" and be there for him in the way he needs you. Take your cues from him. Let him know he calls the shots. He is still your Dad, and it is still HIS life and HIS choice. Perhaps(?) he wants to make sure you get home before he leaves this life?

[JessicaInOr]

Allow yourself to NOT be a nurse, as difficult as that may be, unless he asks your opinion as a nurse. Just be his "Daddy's Girl" and be there for him in the way he needs you. Take your cues from him. Let him know he calls the shots. He is still your Dad, and it is still HIS life and HIS choice. Perhaps(?) he wants to make sure you get home before he leaves this life?

You know... the forum I post on the most is a police forum. They relate to us nurses farrrrr more than we realize. Do you know policemen don't give nurses tickets if they know they are nurses? Okay, that aside.

I love the guys I post with. With all my heart and soul I love those guys. When I need to vent, scream, b*tch, or whine they are first in line to listen and understand. They really care about me. They care if I am losing my Dad. They do everything they can for me. (Policeone.com) Every nurse should go there. Anyway, one of the guys there gave me some advice. He said just because my Dad is dying doesn't mean I shouldn't let my Dad by my Dad to the very end. He said it is a guy thing. I need to let him be the strong one, I need to let him be my Dad regardless of reality. The reality is that I should be taking care of Dad, not Dad taking care of me. He was right. I know my Dad through and through and there is a role he plays and that is what he feels is right and proper.

Today when I blew it on the phone and busted out in tears... he was his usual self. Strong and stoic. I apologized and told him I had been waiting for this phone call and I had it planned much different from what I did. I was going to be the strong one. He said no, he really needed to play out the Dad role to the very end. It is what he does well. And you know what? He is right.

The nurse part of me says NO! He needs someone in his court being strong. But the daughter in me knows my Dad through and through. He needs to be strong and stoic. Not saying it is fair, it just is.

You are right in one aspect, I need to let him be my Dad but when he can't do that I need to be the nurse. The advocate. How many times do we advocate for our patients to stupid doctors? More than we likely realize.

As for his leaving this planet, *I* need to be there when he does. I can't have it any other way. Oh my God, I love my Dad to pieces. I'd do anything for him. But in this case, my efforts will be useless. He will die and I can't do a thing about it.

[UnewmeB4]

You know... the forum I post on the most is a police forum. They relate to us nurses farrrrr more than we realize. Do you know policemen don't give nurses tickets if they know they are nurses? Okay, that aside.

I love the guys I post with. With all my heart and soul I love those guys. When I need to vent, scream, b*tch, or whine they are first in line to listen and understand. They really care about me. They care if I am losing my Dad. They do everything they can for me. (Policeone.com) Every nurse should go there. Anyway, one of the guys there gave me some advice. He said just because my Dad is dying doesn't mean I shouldn't let my Dad by my Dad to the very end. He said it is a guy thing. I need to let him be the strong one, I need to let him be my Dad regardless of reality. The reality is that I should be taking care of Dad, not Dad taking care of me. He was right. I know my Dad through and through and there is a role he plays and that is what he feels is right and proper.

Today when I blew it on the phone and busted out in tears... he was his usual self. Strong and stoic. I apologized and told him I had been waiting for this phone call and I had it planned much different from what I did. I was going to be the strong one. He said no, he really needed to play out the Dad role to the very end. It is what he does well. And you know what? He is right.

The nurse part of me says NO! He needs someone in his court being strong. But the daughter in me knows my Dad through and through. He needs to be strong and stoic. Not saying it is fair, it just is.

You are right in one aspect, I need to let him be my Dad but when he can't do that I need to be the nurse. The advocate. How many times do we advocate for our patients to stupid doctors? More than we likely realize.

As for his leaving this planet, *I* need to be there when he does. I can't have it any other way. Oh my God, I love my Dad to pieces. I'd do anything for him. But in this case, my efforts will be useless. He will die and I can't do a thing about it.

ABsolutely!

[JessicaInOr]

ABsolutely!

Oh L... thank you! Your one word little post.. thank you!!!

I'm tellling you, I can't wait to meet you in real time. I just want to give you a big 'ol bear hug and thank you again!

Okay, so I'm weird. But I am a weird person that can't wait to meet you in real time and give you a big 'ol bear hug!

(thanks for the PMs, they make a mega difference!)

[mysticalwaters1]

Your title reminded me when I had to get the oncologist/blood doctor because I could not get this foley in a guy because his member was extremely small. The pt even said he had a urologist put it in with anesthetic so the doctor came down (it may seem he thought what's wrong with the nurse's technique but i think he realized maybe there was an issues and boy was there) and he tried to put it in with just some lidocain lubricant i put on and the pt didn't slug him but sure squeezed the heck out of his hand and i heard him yell or maybe not yell but sternly say don't ever do that agiain. Didn't get the foley in. Uh oh!

I'm allways surprised when a pt is going downhill is a dnr then the family will stop in and look perplexed! I think lots of times the doctors may say the prognosis is poor but does not outright say the pt is dying when i feel sometimes they really need to just get it out! This happened a couple times to me and i hate it because i feel the family feels i've neglected their loved one. Infact a DNR dying of resp failure was very lethargic had hard time breathing and read md note pt dying gave morphine and the family just after i did it came in and i told them i gave morphine to make him comfortable acted as if i just pused him to deaths door! It was enough that i didn't give anymore because i didn't know what they would do. I finally got the doctor on the phone by pure CHANCE on call on the weekend and he finally was straightforward about it but even if i say it they still need the doctor to say it because they were not straight forward to begin with and they are distrustful of the nurse. I'd be as a relative too so i just wish they'd be straightforward. However i have tried being straightforward with md plans i get in report and sometimes it opens can of worms. I'll say I need stool sample and they are like why and i tell them well if there is blood they are thinking of a colonoscopy then i get screamed at i don't want this md and oh my goodness so i guess everything is taken in perspective but end of life people need to tell people upfront what's going on!

[UnewmeB4]

Oh L... thank you! Your one word little post.. thank you!!!

I'm tellling you, I can't wait to meet you in real time. I just want to give you a big 'ol bear hug and thank you again!

Okay, so I'm weird. But I am a weird person that can't wait to meet you in real time and give you a big 'ol bear hug!

(thanks for the PMs, they make a mega difference!)

OK..OK! I'm weird too. I have been called that...and a whole lot more. However, I LOVE it, cause when they are talking about me, they aren't talking about someone else.