 Provided by Clinician 1
I previously posted a blog “Oh By The Way” and mentioned a case where one patient had discussed her neuritis of the leg...which led to my discovery of metastatic lung cancer to her brain and spine. This past week, 18 months after I discovered the metastasis, I saw J. and her husband for a hospital follow-up visit.
She has endured a lot of hardships in the past year-and-a-half...pulmonary emboli, lumbar fractures and kyphoplasty, gamma knife procedures, radiation treatments, and daily palliative chemotherapy…
And she remains a joy to see, a tribute to her faith and commitment to her family. My heart breaks when I see her, for she is a shadow of her former self. At her second-last hospitalization in July, she met with a covering physician, who discussed her wishes for care. Per his report, her goal was to get to the beach for a family vacation. After that, she would be open to hospice therapy.
I saw her this past week for a hospital follow-up visit. After seeing this note AND reading an oncology consult stating she would consider hospice after her third chemo session, I was prepared to discuss her hospice options. So...imagine my surprise when she told me she was having a new chemotherapy port placed.
I admit, I fumbled and stuttered for a second. Then I admitted, point-blank, to her and her husband, “I am completely confused.” I told them what the consultations had stated, and I asked her if the doctors had misunderstood her wishes.
Her response was, “I hope to continue treatments until I have too much pain, and my quality of life has diminished to the point where it is not worth it anymore.” Then she amended her statement, saying, “Well, my quality of life HAS decreased...certainly.” However, her pain was fairly well-controlled with Fentanyl patches...at 200 mcg/hour and Roxanol twice daily. Which was heartening to me, as she was in tremendous pain two weeks before...and I had suggested the Fentanyl patches for pain management, as the oxycontin was not working anymore. Her pain was now back to tolerable levels.
So, in the hour we spent together, I explored her wishes...she wanted to visit friends and play cards with her husband, “like old times.” She wanted to do “normal things” and not be reminded of the daily rigors of chemotherapy...while she still could enjoy the time she had.
She also mentioned that she felt like a “guinea pig” where her chemotherapy was concerned. She thought that the oncologist was “trying this, and trying that, to see how things worked...and how it affected my body...I don’t think he’ll give up.” I felt my anger and frustration welling up inside and worked hard to quash it.
I held her hands in mine and told her that when she feels that she has had enough, I wanted her to promise me that she will tell me and Dr. B...and if she can’t tell the oncologist, WE will do so and initiate hospice. I explained what hospice options she will have. I will make sure that she is comfortable.
We shared tears and smiles...and a big hug at the end. As with many of my patients, the interaction moved me greatly. I hope that if I have to endure the same diagnosis one day, I will have as much grace and dignity as J. has shown me. And that I have a provider who will help me honor my wishes.
 Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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