July 18, 2011
Today at work I had only one patient, though a quite interesting and tragic one. I cared for a 34 year old African American woman who has neurofibromytosis Type 1. Really that’s the name of it.
Here’s a definition: Neurofibromatosis type 1 is a condition characterized by changes in skin coloring (pigmentation) and the growth of tumors along nerves in the skin, brain, and other parts of the body. Though the tumors in and of themselves are not malignant, they lead to a condition called spindle call carcinoma which is deadly.
My patient has tumors all over her body - some exterior, others subcutaneous (under the skin). She has a tumor in her pelvis larger than a basketball by two. Her pain is excruciating. The gigantic tumor has encroached on her aorta, the main blood vessel from the heart. Because of that, her lower body is so grossly swollen that she is unable to move her lower limbs, and her kidneys are compressed. She has tubes coming out of each kidney to drain her urine from her body.
Eventually, her aorta will be completely blocked by the tumor, and she will lose all circulation to her lower body. It will squeeze her heart and the vessels that serve the upper body and brain, and she will die. Her tumor is growing so fast that her end will be, I pray, swift.
She is mildly mentally deficient, but she is alert and appropriate, can express her needs and wishes. I have never treated a more kind and gentle person.
Morphine drips into her vein at 2.5 mg per hour. She gets Ativan for anxiety every four hours. When I arrived at work this morning, I found her in pain and gave her what is called a bolus dose of morphine. I pushed a button on the top of her pump and delivered a burst of morphine. 20 minutes later, she was still in pain and very anxious, so I gave her 1 mg of Ativan to treat her anxiety and potentiate the effect of the Morphine. She went to sleep.
(Sigh)
She slept quietly until a few minutes after 1:00 PM. Before we bathed her and changed her dressings, I gave her another bolus and increased the hourly rate of her drip. She didn’t complain a single time while we turned and treated and bathed her, but the expression on her face is forever etched in my mind. Deformed and in terrible pain, she is the very picture of dignity.
After her bath, she needed more medicine, so I once more gave her some Ativan and she drifted into the arms of Morpheous. With God’s grace, she will remain there until her heart stops beating. It is our challenge to make that happen. And we will.
Please pray for all of us.
© cj Schlottman
Tuesday, July 19, 2011
12 comments:
Praying! Thank you for helping her to die with as much dignity as this awful disease will allow!
Oh wow. Man. I was just sitting here whining about something stupid in my life and this made me shut up. My thoughts are with you and your patient. You are a strong woman and so is you patient.
I am glad this woman has such a kind and compassionate caretaker. And yes, I will say a prayer for both of you.
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Your stories of dying patients are written with such respect and love. I have yet to read one that doesn't make me tear up. I am in awe of what you do and the compassion you so obviously feel for your patients.
My thoughts and prayers are with both of you. I am in awe of the courage, care and detailed attention you have given this woman. God Bless you.
What a heartbreaking story, CJ. I had an artist friend who died of this disease several years ago.
I'll be out of town for two weeks, but I do have a new post out, if you feel like reading.
Take care, sweet friend.
CJ, you are indeed a very special person. Thank goodness there are some people like you in this world, who care for the very sick and dying. I agree with Hipstercrite....I'll try to remember this story, any time I feel like complaining about someing insignificant in my life.
CJ, thoughts and prayers with you and your patients.
Oh, cj. So chilling. I hope that by now, this dignified young woman has moved on to a kinder sphere.
I hope her passing will be swift and peaceful and as painless as I know you will make it.
Thank you Cj for what you do.
Yes Thank you! I don't believe anyone in this day and age should have to suffer pain with all the pain medications available. This is a horrible way to die. I can only pray that this woman will pass peacefully! Bless you CJ for what you do.~Ames
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