For the last several days or so, I've been assigned to a four bed patient room with four very diverse characters - 2 men , 2 women (I know, I know thats Government Hospitals for you) One of my fellows, a 59 yr old chap who is a bit rough around the edges, an ex alcoholic, lives in a rural setting, divorced, somewhat estranged from his adult kids - I'll call him Dave. Well, he had a little problem with a tooth, had a broken tooth in his jaw for several months and typical of some blokes, just let it go, and put up with the pain. Dentists are expensive and alot of older men don't like them as they have awful memories of childhood dental services , usually school dentists. He eventually got fed up with the pain (got infected) - and took himself to a dentist, had the remainder of the tooth removed and was put on antibiotics. But the pain got worse and the swelling in his cheek got bigger so he went back to the dentist. The dentist said to him, 'no way am I going to touch this' as he sensed something amiss and sent him to the emergency department at our hospital. He was admitted under query abcess or remainder of tooth insitu. I was there when he arrived on the ward. He also had cirrohis of the liver which had up till then caused him little bother after he gave up the drink.
He began to really swell up once he was in bed and had an acites tap, CT scan, Pandectomy and biopsy - something was up.
To cut a long story short, turns out he has Lymphoma, a mass in his jaw, Mets in his liver and actually Mets all over. His legs are so odemetis, he is swollen like a baby whale and so tired he can hardly get out of bed... the whole process has happened over two weeks and while its dragged on until diagnosis its a very sudden change in his life.
Last two days he has finally shown some emotion. Up until then he has been quiet, awaiting the verdict, impatient at times, and agitated. He had been complaining the last few days "why don't they tell me what is going on? I'm sicker than ever" etc Now he has some idea he has been in bed just crying and tossing and turning... it's such a busy room I have had to drag myself away from him at times and try and get the social worker to see him.. he won't tell his kids. He doesn't want his family to go.. he's not sure if he is going to die, but I know, tho I can't tell him , he is palliative and will be lucky to last a few months. One experienced nurse told me, 'oh no that guy won't see christmas', he's deteriorating too fast.'... I've had a very very sad time today at work just looking at him, the dark circles under his eyes. He keeps saying 'I only came in for a tooth abcess... I wish I never came in at all" I can't blame him . He want's to go home and walk his dog and watch the cricket on TV.. mow his lawns. I just hope he can do that again just once. He was transfered to a bigger Oncology unit this afternoon, and it was so hard to say goodbye without being too heavy and him seeing the pity in my eyes. I encouraged him to phone his son.
I hope they just don't start chemo and make his last weeks miserable and he's going to die anyway, I hope he can have some quality.
well, thats my week

I can only imagine how you must feel for this man. As a hospice nurse who deals with this regularly I can almost guarantee you that no one has given information to this man in an honest and compassionate way. If you really want to help and his prognosis is 6 months or less I would suggest mentioning a hospice consult to the discharge planner or physician for the patient. Just an FYI patients are still able to receive palliative chemo and radiation on hospice, but a good hospice will focus on quality of life and your patient's goals. They will work to talk with him and explain the disease process so he can make decisions about what he really wants to do with the time he has left. This can be the most important thing because often in the hospital setting we are trained to give patients hope for a cure but truly when a person is diagnosed with a terminal illness they need to hear the truth and have someone to listen to their concerns. It is a difficult thing to do because we want to make the person better, but when it comes down to it this may be the best way to help him. Please let me know if you need any help talking with him, I would be more than happy to talk to you.

I feel like part of our job as nurses is not only to provide medical support but also emotional and mental support to our patients and their families. This means we must be strong mental (know our skill), physically (be able to perform it well) and most of all emotionally (so that we can handle these situations.)

My prayers are with you.....It is so hard to hold in our emotions especially when you have a genuine heart.......good luck and remember you can only do so much.......and that is it......

Jenna, I can sense your concern for this patient, and whereas I admire you for doing that, I am somewhat scared for myself. I am just starting nursing school, but I have a tendency to try to pick up problems/burdens and just walk around with them, even though I know that won't help the individual. I am fully aware that this will quickly lead to burn-out, but I still have a hard time separating myself from people's problems, I simply make them my own. I really do care, but it will do me no good to cause harm to my body.

Thanks for sharing your experience.

JennaJay: It sounds like you may have found your calling! Isn't amazing how many terminal patients there are? I never realized it until I starting working in the Adult ICU. I was previously in the recovery room, and before that the Neonatal ICU. Neonates are often not terminal, and recovery room gives only small glimpses of MANY patients. Regardless, Hospice is more well known these days, but still greatly underutilized. Patients and families often don't know about it or don't request it until great pain and discomfort have been endured too long and death is only days away. These people need education and support, and you sound like the perfect person for the job. Good luck!