Posts Tagged ‘chemotherapy’

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Talking About Death: Not Nice, But Necessary

July 25, 2012

Photo by Eliza Peyton, via Flickr

By Amy M. Collins, editor

Our recent blog post on “death panels” triggered a memory of my own first real experience with the death of a loved one. It was a little over 10 years ago. I was living overseas when my mother called to tell me my grandfather had liver cancer and had been given maybe a year to live.

The physician had given my family three choices: the aggressive choice, chemo; a less aggressive treatment with an experimental drug that had moderate success; or to let him live out the rest of his numbered days. We chose the middle ground.

At the time I worked in medical publishing and thought I knew everything. Over the weeks that followed I would call home to get progress reports, usually putting my two cents in about what my family should be asking the physician. Finally, when things seemed to be getting worse, I flew home to help.

Nothing could have prepared me for the emaciated man I found sitting up in bed when I went to my grandparents’ house to visit. I hardly recognized my grandfather. It hadn’t been that long, but the cancer had already ravaged him. Despite this, he was cheerful and had high hopes. He didn’t seem to think dying was a possibility.

“When we go to the doctor, you can talk to him. Tell him I want to live,” he said. I remember him being positive as we discussed the plan of attack. He seemed glad that someone else would know what to say to his health care providers . . . but inside I felt like a fraud. I wasn’t a nurse or a physician. I was just a medical editor who knew there was little to be done.

Despite his energy that day, within my short visit home he worsened dramatically and was hospitalized. While there, he was mostly in and out of sleep, and I assume, in great pain. There were horrifying moments I won’t describe here. It was a few days before we even saw his physician. When we did, he was in a rush and barely stopped walking as I chased him down the hall, asking him what we could do next.

He paused for a moment. “Well, we can try chemo, but he’s very weak. It will probably kill him. Or you can let him die at home,” he said before leaving with no further instructions.

As he walked away, I felt myself start to lose it. What should we do? What would he have wanted? What did going home and ‘letting him die’ entail? How do you make a decision like that in three seconds, with a harried physician who’s clearly fitting you in and already spending too much time with you? Read the rest of this entry ?

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Those Who Wait: Recent Work in ‘Art of Nursing’

December 19, 2011

By Sylvia Foley, AJN senior editor

Beach Stone Found by mscaprikell, via Flickr

“I held that stone / in my hand for hours while they split your bones,” says the narrator of Janet Parkinson’s poem “Talisman,” which appears this month in Art of Nursing. The poem speaks to the tremendous strain of waiting for the outcome of a loved one’s emergency surgery. It’s about the  need for connection over great distances, for a “stone constant” in the face of grave uncertainty. The poet’s voice is unsentimental and steady, and the poem, just seven lines, itself feels almost talismanic. (Art of Nursing is always free online—just click through to the PDF file.)

In Roger Davies’s poem “Preparing to Pretend to Knit at the Chemotherapy Clinic,” featured in October’s Art of Nursing, a husband also waits, feeling helpless. “I’ll choose the long, elegant needles,” he says, imagining homespun wools dyed in autumn colors. Recalling his mother’s “nonchalant / competence” at the craft, he longs for the solace found in knowing what to do—even if it’s only how to hold the needles. In the poem’s last lines, the narrator says, “I could look out the window / to this fading autumn day.” But it’s clear that he’s not quite ready to see that view yet.

The Waiting Room: Norma, copyright 2010 Rebecca Thomas

Rebecca Thomas’s painting “The Waiting Room: Norma,” featured in November, depicts the artist’s grandmother, who gazes out at us, her expression both yearning and fierce. She seems to lean forward slightly into a blurred foreground, much as one might lean into an unknown future. About her grandmother, Thomas writes:  “She lived through lymphoma. Her husband didn’t. Now, the cancer and my grandfather are gone from everywhere but her face in this moment—her ‘waiting face,’ right before the smile.”

We invite you to pause with these works for a few minutes and listen for what resonates within you. And if you’re interested in submitting your own work to Art of Nursing—we consider visual art, “flash” fiction, and poetry—email me for guidelines: sylvia[dot]foley[at]wolterskluwer.com.

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Maybe Palliative Care SHOULD Go to the Dogs

September 13, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Sam in his hospice quilt

Last week, we took Sam, our ailing 14-year-old Labrador Retriever, on what became his last trip to the vet. Sam had been diagnosed with bone cancer in February after we noticed the right half of his head enlarging. Because of where the tumor was, it was inoperable. We felt that at his age chemotherapy wasn’t a realistic option, and we didn’t want the last few months of his life to be bad ones.

His veterinarian, who’d treated Sam since his puppy days, supported the decision, saying she would make the same choice for her dog. And so we spent the last few months adjusting doses of steroids and pain meds to enable him to live as normally as possible. For Sam, “normal” was being able to greet all comers to our door, to be the leader on his walks, to be smack in the middle of where his family was. (If people were in the basement and on the second floor, he would lie equidistant from where everyone in the house was. If we were in the same room, he sat, front legs crossed in his “elegant dog” pose, where he could see us all.)

So last month, when we saw that he would no longer get up to greet visitors or his family; was reluctant to go on walks (he did, but with a great sigh and lots of panting after even the shortest walk); and, finally, stayed in a corner of the back hallway, no longer making the effort to be part of the family, we realized Sam’s quality of life was diminishing. It became abundantly clear when he wouldn’t eat his normal food or even cookies, his favorite, that Sam was suffering.

When we took him to the vet, secretly my husband and I were hoping the vet would give us a different regimen that would restore Sam to the dog of a few months ago. But the vet pointed out that, at most, any measures we could take would only gain us another few weeks—and there was no guarantee of even that. She also asked us about our motives. Clearly, prolonging Sam’s life meant prolonging his discomfort. It became obvious that “keeping him going” would be only for our benefit and not for Sam’s. And so we decided it was time to say goodbye.

The technician brought out a quilt for Sam to lie on, and we fed him cookies and petted him and talked to him while the vet gave him a large dose, an overdose, of sedative. It was all very peaceful, and we were grateful for the support and guidance of the vet and her staff in helping us let Sam go.

I couldn’t help contrasting Sam’s death with Theresa Brown’s story of her oncology patient in her recent opinion piece, “A Dying Patient is Not a Battlefield.” Yes, I know Sam was a dog, and I’m not advocating euthanasia, but I am advocating that people deserve a good death and shouldn’t be cajoled into decisions for the benefit of others.

I worked as a chemotherapy nurse during graduate school, and I remember discussions with patients who made treatment decisions they really didn’t want to make but made anyway—because they didn’t “get” that things were not going to get much better, or they didn’t want to let their families down or, worse, felt they “owed it” to the physicians and staff who were working hard to keep them alive. What messages are we giving to patients and to families if they feel they owe us anything? What happened to what we learned from the work of Cicely Saunders or Florence Wald in creating hospice care? What happened to those of us who are charged to be advocates for our patients? Brown’s piece is a reminder to make sure our patients have the right information to make informed decisions, and then to listen and support their decisions.

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Taking A Stand Against Terminal Illness — Self-Delusion, or the ‘Good Fight’?

April 6, 2010

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

This week, The New York Times published an article about a young palliative care specialist who, when advised her cancer had progressed to the point where she should consider palliative care, rejected the notion and proceeded to pursue all available options. She was only 40 years old and said she was not ready to die. While the aggressive treatments (which she had plenty of money to pursue) gave her about another year, the article explains that her final days were spent heavily medicated for pain from the tumors throughout her body—even as she continued to request brutally painful procedures with little chance of prolonging her life.

That was her choice, and she knew what she was choosing. But that doesn’t always happen; too often, people really don’t know what it may cost them to take a stand against the inevitable. (For an engaging and comprehensive look at the issue and its implications for nurses, see Life Support Interventions at the End of Life: Unintended Consequences in the January issue of AJN.)

This month, AJN’s Reflections essay describes a scenario when full disclosure of the likely results of pursuing treatment wasn’t forthcoming from health providers. It tells of one nurse’s dilemma in balancing her role as family member and as a nurse during the last days of her mother-in-law’s terminal illness. At issue is how to explain to family members, who are “misinterpreting survival as recovery,” the likely outcome of aggressive treatments.

This piece struck home for me. As a chemotherapy nurse, all too often I witnessed patients with end-stage cancer wanting to undergo treatment that might promise, at most, a few additional months of life—but certainly not the life they’d had or wanted.  Read the rest of this entry ?

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