“I’d prayed for this to be TB, but my PPD was negative and the CXR shows something abnormal…oh sorry, you wanted to talk to me?” This was my introduction to Mrs. G, a 54-year-old married woman admitted with hemoptysis r/o lung mass. The patient quickly described to me her purpose and role in life. Married to a man who was a provider, alcoholic and never a husband or a father to her four children — all with substance issues, one son died, two sons are alcoholics and one daughter with two children in a drug/etoh treatment program. The patient described herself as “the rock” who does the right thing for everyone and had officially adopted her daughter’s two children.
When she adopted the children, she immediately “took charge of her health.” She had gastric bypass, lost 200 lbs., but could not stop smoking. She was heroic in her efforts to provide for the grandkids — secured medical care for both children, who were diabetic, found resources for summer camp and additional educational programs. “I’m terrified of what life has in store for them if I am sick.” A barrage of tests, dx of stage III lung cancer; and described as stoic when the team leveled the verdict three months to two years.
Stat page. “Get me a priest will ya - make me a discharge plan.” The patient was realistic, declined treatment, and knew the disease would take control quickly as she had cared for her four brothers who died of lung cancer. A plan of action was complete in one day, and the patient decided on home hospice.
Referral to Joslin Clinic for the kids, oncology social worker to work with grandchildren around loss, caseworker at daughter’s treatment center established a transition plan to get daughter back to patient’s home — in two weeks daughter was at home, cooking appropriately, administering insulin, and meeting with her counselor daily. My concern was that daughter was overloaded and could fail. Family meeting resulted in pt’s one brother who had recently lost his partner to AIDS would take on the role of “the rock.”
Ten weeks from dx, adrenal hemorrhage mets to liver — two months. “Get me outta here, I have 2 weeks!” Stat page from patient at home, “I need my nails and toes done in light blue. Got a dress last night and want it to match. Can’t go out again.” A local beautician agreed to come to the home. “I love the dress, looks great, come and see me.”
I visited, we reviewed the plan painstakingly, had her brother “take the reins” for a few days to see how he held up, and brought him into the room to confirm with me that he was sure he could manage; after he left to get us coffee, she whispered to me, “Always good to have a witness when he says I swear to God.” Hang the dress up so I can see it — it’s so beautiful — just like a dream. The patient passed peacefully two hours later with her family at her side.
