Rant Against Cancer

RN always, BSN, RN · Jan 12, 2004

You sound like an awesome nurse! very gentle and sympathetic. It is so sad the stuff we see. I work in an oncology unit also and see stuff that rips my heart out.

She was lucky to have you for a nurse, thanks for sharing

bellehill, RN · Jan 12, 2004

Not being able to help your patients be more comfortable is a terribel feeling. Sounds like you are a caring nurse and the patient is lucky she had you taking care of her.

Agnus · Jan 12, 2004

leslie :-D · Jan 12, 2004

hi jane,

i really do feel your frustration and pain. but what i need clarification on is if you're feeling your patient's emotional/physical pain, or the frustration of not being able to get more effective pain mgmt. working with cancer pts. myself, i have seen cancers that do not respond to anything and when the pain gets horrifically unbearable, we choose to sedate and sometimes limit the patients' movements as little as possible. with the stage 4's and other cancer-infested wounds, i'll be damned if i'm going to irrigate to clean and remove all the drainage. the drainage is removed but the pressure of irrigation and the added length of the dsg. procedure is too much for many pts. is the md against further pain mgmt. thank God for your tenderness but it sounds like the md needs to actually see the suffering of this patient. am i wrong?

Jay-Jay, RN · Jan 13, 2004

I think you're right on the money, Earle, but I have to clarify two things: 1) this lady was dying at home, therefore there was no doctor just around the corner. I phoned him twice on the weekend. The first time he prescribed fentanyl drops over the phone for breakthrough pain to supplement the fentanyl patch she was wearing (just put on on Friday, therefore hadn't quite reached its peak effect.) The second time, when the fentanyl drops proved to be ineffective, he agreed to come in person.

2) Originally this lady was getting BID drsg. changes. The evening nurse (quite rightly!) REFUSED to do the second change. For my part, I did the change with the minimum amount of repositioning possible. Basically, I cleaned off the discharge with a syringe of warm NS, blotted dry, and applied some Flagyl cream. It was the minimum I could get away with to maintain hygeine, promote comfort, and prevent or delay further skin breakdown.

I left before the MD arrived. Hopefully by now, they've achieved better pain control. It's difficult, because she tends to hallucinate with morphine and dilaudid, and this gets the daughter upset, and she then witholds the meds. One of the disadvantages of dying at home.... The daughter is losing BOTH her parents, so you have understand where she's coming from too. She doesn't want her mom to suffer, but at the same time, she wants to be able to still talk to her. Her dad has a trach, and cannot speak.

leslie :-D · Jan 13, 2004

i definitely see the limitations of working home health. is this family in a hospice program? and if this patient is having 'pleasant' hallucinations, you might be able to tell her dtr. she's in a 'good' place. of course if the mso4 is causing agitation, then it's just an add'l aspect of suffering. i do find that an anti-anxiety (ativan) increases the efficacy of a narcotic....and of course, this poor dtr., who has the burden of caring for both her parents. als is a slow, horrible way to go, especially if the patient is cognitively aware of his disease, as well as the passing of his wife. this is really too sad. for their sakes, i hope you do return to their homes, as i am sure you will find some way to relieve their suffering, all family members included. please write me any time.

LPNtoBSNstudent, BSN, RN · Jan 13, 2004

I don't know how to respond. I have retyped it a couple times now (and deleted). You are a good person. Hang in there. This sounds very difficult for everyone involved. This post brings tears to my eyes.

Jay-Jay, RN · Jan 13, 2004

Thank you for your kind responses. The latest info is this patient has been admitted to hospital, is receiving appropriate pain control, and her LOC is declining rapidly.

nurseygrrl, LPN · Jan 13, 2004

Jane~

Sorry that you had to go through that. Witnessing human suffering is definitely one of the hardest parts of nursing. It sure takes an emotional toll. You are a good nurse. You were there for this woman when she needed you and you did all that you could. Do something nice just for you on your next day off...you deserve it...recharge!:kiss

Totone656 · Jan 16, 2004

{{{{{{{{{{{{Jane}}}}}}}}}}}}}}} I know how hard it is to watch patients suffer needlessly. I know from my limited experince in hospice the fentyl patches do not work on those patients with little or no adipose tissue.

I know the majority of nurses will tell me I am wrong, but our doctor who is the director of medicine of the hospice I work for is certified in Hospice and pain control of the Hospice patient. There are some great salespeople out there who have convinced nurses otherwise and I have to confess I was one of them. A great majority of the patients I take care of are on methadone ( which can be adjusted easily up or down as needed to control pain) with something for break through pain.

I just gained one patient with not one wound, but three cancerous wounds which are draining a prulent yellow! Whew! Instead of trying to change the dressings and compromise skin I opted for a wound drain bag. This way the patient can move without a bulky dressing and I can clean the wound through a small window located on the front of the bag. It can also be drained to keep the smell down and allow the patient to go out without the general public knowing he is coming 10 feet away. Bless you for all you are doing for this family.

Tweety, BSN, RN · Jan 16, 2004

Sounds like you need a hug. So hugs to you.

It gets to you sometimes doesn't.