Profound depression and Cancer

[Curious1alwys, BSN, RN]

Hi all,

I so much need advice. My father has fallen into a very profound depression. He won't eat unless you put food in front of hime and say "EAT" and even then it is only a couple of bites. He just goes from the recliner in the living room to his bed (mostly bed) with the drapes closed all day. He hasn't showered since last Wed!!! (over a week ago!!!!! ) My sister and I were over there yesterday and suggested it because the weather was warm so he would not get cold and he blew us off. You try to talk with him and he gives one word answers or stares off into space or snaps cuz he is irritable. Not so much irritability now. There was a lot a couple of weeks ago but now it just seems like profound sadness and despair. It is so sad to watch yet I just don't know how to change it or what to say. He doesn't want to go anywhere, do anything. The odds of him seeking out a therapist or AD is very slim. He already has unmedicated bi polar disorder. He couldn't care less plus he denies there is anything wrong with him (psychologically). Add onto that his addict personality and his current use of legal AND illegal drugs to help with his CA (supposedly). Very, very frustrating to say the least.

In my Dad's defense, he has been battling lung ca and cancer tx for a while. HOWEVER, it hasn't been that long and he certainly is not doing as bad as he could be!! The doctor told him only 6mo to 1 yrs to live. It has almost been 6mo!! I think he really thought the chemo was going to really kill everything. I think he thought HE would be the miracle. I think he failed to research what was wrong with him. No, I KNOW. Well, anyway he isn't the miracle. He is likely a statistic. With metastatic lung cancer the prognosis is months, even with treatment. He has four brain lesions, one lung tumor, and a mass on his pancreas initially. Well, after the first round chemo, a NEW TUMOR grew in his other lung. Dissapointed with that the onc started second line tx, Hycamtin (topotecan). Made Dad very sick for a while; he even needed a blood transfusion. Well, since a couple rounds of that his stomach started to hurt where he felt he could not eat. He also had a growing pressure in his chest. Well.....last Friday he apparantly felt somewhat better, the pressure was relieved and he could eat!!! My sister said his spirits were better a bit. I think he thought he has won. Fast forward to 5pm. Doc calls. "It's back and there is more" "other organs are involved". I think he was crushed.

Now, he is more than ever acting how I previously described. To make it worse, he is MOVING!!! My brother is trying to move him (and himself) into this new house that already had furniture in it. So..we are making trips to the old house to get the furniture there to bring to the new, yard sale.....it's a mess to say the least, but necessary.

So........here is my question. How do I approach this ever so sensitively?? I want to say that I care for him, that we hate to see him like this. I REALLY REALLY want to say "you knew the statistics, what did you choose to live for". I want to cry and flail and beat on him. I mean, what did he think?? And now, because it did not go his way, he is going to waste the last month (possible) of his life. We go to see him and he does this. It is like "HELLO!!! Aren't WE what you chose to extend your time on this earth for??":madface: He honestly would be better off right now with a big ol' hefty shot of morphine to stop his respirations. He is that miserable. I am just saying that so you can get a feel for the severity here. How can I help him realize that he is not dead yet and in fact, he likely feels physically better now than he ever will again on this earth? I realize he has been thru a lot, but what can be done from here? It's like they said in Shawshank Redemption:

"Get busy livin' or get busy dyin'"

Which do you choose???

Thanks for any help.

Janice

[Curious1alwys, BSN, RN]

Just wanted to let you all know that my Dad was told there is nothing more the docs can do for him. They gave him weeks to one month. Hospice has been called in. He has been having some pains in his chest (around his heart) and the doc confirmed that the tumor is pressing on his heart. So...hopefully it won't take long and won't be as painful. Anyway, I am trying to clear the schedule and be there. Thank you all for your support.

God has his reasons I guess.

[sirI, MSN, APRN, NP]

thrashej,

I don't know what to say here. I am so sorry. But, I understand more than you could know. Please know that I care and am thinking of you. And, I am praying for your strength and to be at peace through all of this and for your father as well.

Please, please keep us informed.

[leslie :-D]

i echo siri's sentiments.

and i question the timing in your dad moving; can it be delayed. he just needs to stay put and concentrate on getting comfortable. this is where hospice is needed for dad, for you and any remaining family. right now, please focus on getting rid of any physical pain per the hospice nurse's recommendations. once he is settled and comfortable, spending 1:1 time would be incredibly helpful. i wouldn't focus on getting him out of his depression....it's very normal. just holding his hand even in silence, can be very comforting.

i'm so very sorry; be good to yourself. allow yourself to feel whatever you are feeling; it's all part of the grieving process. with such little time left, it's crucial that emphasis is put on dad's physical comfort and once he is stabilized, then maybe the hospice nurse can comfort him in other ways. perhaps a priest, rabbi paying a visit? close friends?

and don't hesitate to pm me if you need to talk.

wishing you all eternal peace.

leslie

[PhoenixGirl]

Janice,

I'm so sorry to hear about your father. I knew you said he was sick (from the AZ board) and I sometimes read this board...I was very sorry to see your post. This has got to be so hard for you.

How is school going? How are *you* ??? I know you are very concerned about your father, but I also hope you are taking care of yourself. I know you are finishing up block 2 with the thought of taking the PN state boards. I just finished up block two myself and am waiting to take boards. Let me know if there is anything I can do to help you. I even have a practice HESI book and CD if you want to borrow I'd be glad to help.

(((HUGS)))

Rebecca

[Curious1alwys, BSN, RN]

Hey Rebecca,

Thanks for thinking of me! I am doing OK. I am lucky in that I don't have to work FT at this time. That is really good because my new job in the ER really stresses me out most of the time, probably cuz of out of control anxiety right now. So.........I cut my hours significantly right now and am pushing on with school, keeping my head above the water.

My Dad is doing a bit better. They switched his meds to Oxycontin IR and SR which is really helping to control the pain in his chest. He goes from sleeping all day to staying up all night. His only real problem right now is transient nausea and fatigue...he can still get up and move about slowly. So...we have not hit the horrible part yet. I am bracing myself for that. Next week is the last week of the academic portion of Block 2, then we go soley to clinicals!!! So.....once I pass the classes (which I did), even if I end up leaving the program due to either stress or family necessity, I won't have to repeat that..only finish clinical. But, I don't plan to do that. I want to keep on, stay with my friends. I also have applied for an extern position so I am waiting to hear about that. Really, things are going as well as they could be right now!

R U plugging along? Have you taken the boards yet? RU gonna go for RN?? I don't plan to take the boards, I am going for RN. I was going to before I got my current job, but my job now has more flexibility and pays more than an LPN job would..so...

[Nesher, BSN, RN]

I am curious - you wrote that you haven't gotten to the horrible part yet. What will you consider the horrible part? What exactly are you envisioning? Might be able to help with that....

[Curious1alwys, BSN, RN]

I guess I am just imagining his organs shutting down. The part I consider the "horrible" part would be the part in which the cancer really takes it's full toll on the body and my dad stops eating and drinking, etc.

Can you give me a picture of what to expect? Small Cell Lung CA. The doctors say that the tumor that will likely kill him will be the one growing fast and pressing in on his heart. As of right now that same tumor causes some crushing/stabbing/pressure type pains in his chest, pretty much all the time...

Thanks!

[Nesher, BSN, RN]

Death is not a horrible thing. It can be very peacful. When and if the organs start shuting down can be a blessing. Slipping into a coma is a quiet event. Folks lose interest in food and drink and in conversation - or they might stare intently around the room. I have had people who are dying tell me there are people in the room - people they knew. It is comforting for them as if these spirits have come as escorts. ( I know this sounds weird, but death isn't something out of a text book)

I hope your Dad is getting what he needs for pain control. Hospice nurses are experts at this so if he is having pain - please have them adjust - there is NO NEED for pain when one is dying. If the tumor is pressing on his heart he might go suddenly with a heart attack... it is hard to tell.

While I haven't watched my own parents die I have seen and been with many who have - I always feel priviledged to be a part of something so profound and misunderstood. There is no road map for this - your Dad is going to go pretty much when he is ready to. Does this help?

[renerian, BSN, RN]

My dad did the same thing, then progressed to being angry and that was as far as he got in grieving cycle.

I am sorry your walking the road I did. It is VERY hard.

renerian