Tuesday, September 22, 2009

No. Just no.

Fucking pancreatic cancer.  It is a goddamn awful diagnosis and an exceedingly difficult one to make until it's too late.

Perhaps that is why newFNP's patient received her diagnosis when the tumor was already unresectable and had metastasized to her liver, intestine and lymph nodes.  

NewFNP took one look at her today and knew that something wasn't right.  She had lost way too much weight for that amount of time, and not in a healthy-appearing way.  NewFNP had seen her six weeks ago and noted scleral jaundice.  At that time, she drew STAT labs.  Her acute hepatitis panel was normal, her bilirubin, alk phos, AST and ALT were sky high.  NewFNP's colleague sent her to the emergency room where, during the course of her three-week inpatient stay, she received her terminal diagnosis.

She was born the year after newFNP -- she in in her 30's.  She has four kids under the age of eighteen.  

She has three to six months to live.  If that.  Her oncology appointment is in four weeks -- too long a wait when every week is one of the last she has to spend with her family.

NewFNP is absolutely fucking heartsick about this.  This is a woman who was abused by her former intimate partner, who suffers with symptomatic myasthenia gravis and who has diabetes.  NewFNP cannot believe that after all this woman has gone through, she is going to die.

NewFNP couldn't bring herself to say this to her.  She is, after all, not an oncology NP and she didn't have a quantified prognosis in the very well-organized three-ring binder of information from the hospital.  She told her patient that this is a very serious diagnosis, that the physicians in the hospital had determined that the tumor was inoperable, that there is no cure.  She referred her to the medical-legal partnership to seek out health insurance coverage and, horribly, to draft a will when she is ready.  (As though someone could possibly be ready for this activity given the non-theoretical impetus for doing so.)  She referred her and her children to counseling.  She counted on the personal connections of a colleague to attempt to facilitate a more prompt oncology appointment.  She found a clinical trial that accepts Spanish-speaking patients.

Who is going to take care of her children?  How is she going to have hospice care without insurance?  How will she afford her pain medications?  Who will take care of her children?  NewFNP cannot imagine what would have become of her if her aunt had not raised her after her own mother died when newFNP was fourteen.  It wasn't the right time to bring this up with her patient today.

NewFNP doesn't know what else to do.  She cannot do much of anything.  She hates that.


Anonymous said...

Sigh. Big sigh. Actually, big exhalation. Life is too short for some, too long for others. The rest of us end up somewhere in the middle. Sorry for your patient. Glad you had your aunt.

Anonymous said...

Life isn't fair. Sometimes I wish I could wave a magical wand and fix problems, such as this one, that are totally out of my control. But, what can we do?! Just hope her children are well taken care of...wish I could adopt them! Keep your compassionate heart....that's something else they don't teach you at school... My prayers go up to your patient and children.

lesbonurse said...

Oh, that really REALLY sucks. Just remember that terminally ill patients need someone that they trust and have rapport with to bring up the end-of-life issues. What is worse than bringing it up would be if she died before anyone got a chance to discuss her wishes with her.

I think this is one of those situations where it's ok to cry with a patient.

NurseJoc said...

Aw, that is very sad. Life isn't fair as others have said, but you gave her a very important gift by making that diagnosis. Now she can prepare for what's ahead of her. Had she gone undiagnosed, she would have spent the rest of her life not treating each day as her last, not spending as much time as possible with her family, planning out her will, and so forth. It's a morbid way to think, but your job was very important to her.

Anonymous said...

Very sad. Sounds like you have done a lot more than you think though!