Terminal family member, please help me help her

[MollyJo]

I am a Med-Surg RNC. I have been off work for a year now taking care of a family member who is stage-4 colo-rectal cancer that has metastized to the bone, lung, and now brain. She's physically been doing quite well until the last few weeks, so I've been mostly been driving miss Daisy. I am not the primary care-giver. Yet. The primary care-giver has been my sister-in-law, which is her younger sister.

Anyway, I'm just a Med-Surg girl. I know a bit about Hospice and a bit about 1013s, but as far as I can see, this family member doesn't fall into either category quite yet. The primary is her younger sister by 10 years and absolutely financially and in every other way supporting her from next door, where the younger set her up. The patient's condition is deteriorating and she fell a few days ago and had to go to the emergency room for an injury to her head at 04:00 when she called her 13-year-old son from the bed that he was sleeping in with her. Complete with much blood, urine, missing ostomy pouch, and a walker that she thought she had with her but was in the living room. But when her primary/younger sister was with her in the ED, she was as always a bad historian yet by then cognizant enough to back her sister and obviously the nurses off because of privacy rules.

She has palliative chemo every 3 weeks at an outpatient chemo center. I will take her tomorrow. We are there at least 8 hours every time. Not a time management thing with the nurses, that's just how long it really takes.

She is what we in Med/Surg would call "noncompliant", "needy", "bad historian". I don't anticipate that getting better as her disease progresses. She very certainly has no money, so please don't let that be an issue in your response. This is a family member with kid who frankly just wants to get the hell out of there.

What do you cancer nurses do with this? Far as I can see, you just give meds and hope for the best.

For real. Sumpin? Help?

[jadelpn, LPN, EMT-B]

I would get hospice care into the house. She needs someone with her 24 hours awake, as to help her when she is agitated and pulling at things, and attempting to get up to use the restroom.

Get a cot and put it right beside the bed for the son. And get him some therapy, and hospice can help with that. I am sure he wants to be close to his mother--especially if it has always been just them. It is a scary process to lose the only constant in one's life. Does HE know what is going to happen when his mother passes? Where he will be, the plan?

And that is the bottom line, there needs to be a better more consistent plan. And to call and have hospice come in to do what needs to be done would be a good thing. And an overnight sitter. And someone for her son to talk to about all of this.

And no, there is no giving meds and hoping for the best stuff. The goal is peaceful and comfortable. If there is a medication that will calm anxiety, great. But that the patient still goes to chemo and can ambulate and such tells me that she is not quite there yet. And do speak with hospice about the brain mets. Someone needs to help explain to the son what can happen as far as mental status changes.

[Been there,done that, ASN, RN]

Deep breaths, step back and regroup.

Take control.. have a conference with her physician. Get a hospice consultation and let them handle it. It is past time for hospice to manage her end of life issues.

Best of luck, let us know how it's going.