Friday, July 16, 2010

Today I went to work. I clocked in, I got my assignment of rooms 1-5, I got report from the night shift nurse, and I started my day.

My patient in room 1 is a mid 50 year old woman who has AML a type of Leukemia and is in remission. She began running fevers and came to the hospital because she was neutropenic (meaning her white blood cell count was dangerously low and she was at high risk of infection). She had a good day today.

My patients in rooms 2 and 3 are both AML patients who are in for chemo treatments, they are also in remission, doing well and coming in for 'maintenence' chemo to keep the cancer at bay. I discharged my patient from room 4, who survived the first round of chemo and successfully put his cancer into remission for now- and then got a new patient late in the afternoon.

My patient in room five however was not so fortunate today to find out his cancer was in remission. He does not have leukemia. He is 39 years old, married to a wife of 11 years with two children ages 8 and 5. He was diagnosed with a glioblastoma, a brain tumor in his frontal lobe. A couple years ago one formed, they did a craniotomy and were able to successfully get the tumor out with minimal side effects and a great recovery. His main side effect was personality changes and mood swings- but overall was able to live a great life. Until this March- when he found out that a new tumor had grown and the glioblastoma was back.
He has spent the past week at Baptist Hospital waiting for doctors to decide how they will save his life. Waiting for his miracle. He stays 24 hrs a day in a pitch dark room because he is so sensitive to light and sound it is painful due to his tumor. How do you explain mood swings, anger, personality changes, and the fact that dad can't come out to play to an 8 and 5 year old? At 1830 this evening, the neurosurgeon came in to see him and his wife and discuss the options they had of tackling the tumor.
Option 1. is to do the surgery again. which will be very difficult, will not be successful in relieving any of the symptoms of photosensitivity and sound sensitivity that he is experiencing, will require a very extensive recover of up to 8 weeks, and will not give him back his life he had before. It will not cure him. The risks far outweigh the benefits. And in the end they will be back to the original issueThe neurosurgeon is completely against the surgery. He does not want to do it but says he will do it if it is truly what they want and believe is best for their family.

Option 2 is Gamma Knife. Which is very focused radiation on the tumor itself that will shrink the tumor, alleviate some of the pressure and pain but also, will not cure or fix any of his symptoms. It is less invasive and has a much easier recovery.

The doctor explains all of this to the patient and his family, to which the wife promptly responds 'We disagree with you, we believe that the surgery is the option, it will get the tumor completely out and he WILL be back to normal without any suffering from the symptoms.'

This debate continued for a good thirty minutes. I was asked to be there with the family by the wife of the patient. And I walked out emotionally spent. How do you tell a woman that there is no best option- there is no cure, her husband will never be the same again and will never live the way he did 3 years ago. I'm not even sure I can convey the emotion that was in that room.

As much as the neurosurgeon tried to tell the family that the surgery would not give them their miracle- it would make his life much more difficult, assuming he survived the surgery, they would not listen. They needed to believe in their miracle. They needed to believe that dad could be the same again. The wife herself said "The man I married died 3 years ago and this person is totally different, if you do the surgery there will be a new person." What guts it takes to say something like that infront of your sick husband. She also said that due to the mood swings and personality changes from the brain tumor, her kids were afraid of their father, they did not understand what was going on or why he was so hateful towards them. What a sad situation.

As I sat there and listened, part of me was frustrated. The nurse/science mind that I have wanted to scream "LISTEN TO THE SURGEON!! HE'S RIGHT! There is no cure, there is no possible way the surgery will 'fix' your husband, it will just get worse from here" The other part of me, my heart I guess, was amazed at the belief and faith that the surgery would give them their miracle. How does someone have that much conviction that they will not back down from their belief? Is it denial of the actual situation? Or is it truly a belief that she has?

At any rate, I came home exhausted emotionally and sitting there saying 'how in the heck did I get put in that situation.' It amazes me what I encounter on a daily basis....and I am so thankful I am just the nurse, not the patient or family. SO thankful.

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