Fucking pancreatic cancer. It is a goddamn awful diagnosis and an exceedingly difficult one to make until it's too late.
Tuesday, September 22, 2009
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.