Oesophageal Cancer Case study transcript
Burt’s story, health history – scene 1
Steve: Hello Burt.
Burt: Good Day
Steve: Nice to meet you. My name is Steve I’m one of the nurses on this unit. Would you mind if we spend some time talking about what’s been happening so I can give you the best care possible? Perhaps you can tell me what’s brought you here?
Burt: They say it’s cancer. I suppose I have been crook for a while. Couldn’t eat much more than soup and beer, and it hurt a bit going down. Suited me fine for a while, do like my beer … did.
Steve: You’ve lost a lot of weight over the last few months, your diet is one of the things we need to look at.
Burt: Well I’m not keen on most stuff they’re trying to force feed me in here.
Steve: Yeah the high energy foods take a bit of getting used to. You’re seeing the dietician regularly, do any of the extra menu items appeal?
Burt: Well I don't mind the soups, I don't like those milky drinks.
Steve: That’s good stuff, I’ll follow up on that and see if we can improve your diet
Treatment decisions –scene 2
Burt: Wow looks as if I’ve only got a year or two left in me. Seems like they’re not too keen to chop it out. Options are to give it all away or have chemo and radiation therapy. But they say even if I have the treatment may not give me more time. I suppose it’s just the way I want to go out. And what about getting home to Frank, I hope somebody is feeding him. My cat Frank, my mates back at the hostel, isn’t much left now. I’ve been wondering, perhaps I should contact the daughter, haven’t seen her for years. She didn’t like the drinking. I suppose she can say I told you so.
Treatment plan – scene 3
Burt; Well the doctor was pretty sure it can help and I just, when I heard that I just thought to myself well I couldn’t really go home like this. Not sure I could look after myself anyway. What was the point? Couldn’t enjoy my beer, swallowing was getting real hard. At first I was hungry, now I don't care if I eat. The doc says that the chemo should fix that up. All the extra phlegm too, I have trouble even swallowing that. The social worker has been in touch with my daughter Jenny, she said she’d been thinking of me because I’d just become a granddad again. I haven’t even seen the other two. She said she’d bring some photos.
During treatment – Scene 4
Jenny; How are you feeling?
Burt: Tired, not eating much, can’t complain.
Jenny: Dad they won’t tell me anything about your treatment or how things are going.
Burt: Don't worry yourself.
Jenny: But I am worried. Look I know we haven’t seen eye to eye for a while but perhaps we should let that rest.
Burt: Well there’s been a lot of water under the bridge. Can’t say I haven't been thinking about things. Turns out you and your mother were right, the drink will be the death of me.
Jenny: Dad don't say things like that. I know it’s not going to be easy, I’m here now though. Look put me down as a contact person and let the doctors talk to me. Please?
Burt: Let me think on it.
Jenny: They did say you might be going home this week.
Burt: I’ll see, I’ll be right
Jenny: Who’ll look after you?
Burt: I’ve got friends. My pension should take care of the Meals on Wheels. They say they can send mushy stuff. Anyway I’ve been looking after myself for a while now.
Social and Community Supports – Scene 5
Male nurse: During his treatment Burt rebounded back into hospital three times with complications related to poor nutrition, fatigue, nausea and vomiting. His management has been complicated by non-compliance with some aspects of his care related to his ongoing dependence on alcohol. On completion of his treatment regime Burt’s dysphasia has improved and scans indicate a partial response. He has put on two kilograms in this last admission and says he has some of his appetite back. We have support services, palliative care team and his GP co-ordinated for his discharge tomorrow. Our social worker continues to work closely with them. With support it is hoped he will be able to maintain some quality of life. His daughter has been more involved, actually when we put her in touch with the local Cancer Council they put her in touch with the Carer’s Connect telephone service. She says they’ve been her lifeline. I’ll be seeing him in three months or so when he comes in for another follow up.
Nutritional Issues – Scene 6
Burt: Yeah I haven’t been able to eat much this past week. I’ve got a bit of liquid in but not much.
Nurse: I can see you’ve lost weight Burt, you also look tired.
Burt: Well to tell you the truth I’m too scared to go to sleep, not sure if I’ll wake up in the morning. I can’t even clear the spit. You know sometimes I’ll cough and cough I feel like I’m going to choke.
Doctor: Now given that you haven’t been able to swallow are you often feeling hungry?
Burt: Well I am a bit hungry but not like I used to be. It just takes too much energy
Transition to Palliative Care – Scene 7
Nurse: Burt do you have any more questions or concerns before you go home?
Burt: Yeah nurse, I do. How much time do you reckon I’ve got you know until I kick the bucket?
Optimising Function in Palliative Care – Scene 8
Jenny: Well I just wanted to ask how he’s getting along. Is he managing his feeds, is he able to shower himself and take his medication? He doesn’t get much help at the hostel.
Nurse: I think you might be surprised how well he is managing. He is certainly showering and shaving himself and he showed me today that he’s able to manage to clean and dress his peg. The dietician is happy he can manage his feeds. His medications have been put into a weekly dispenser and the community nurse will fill those each week. He’s also shown me that he’s able to give himself the necessary pain medication for breakthrough pain through the peg tube. The community nurse will visit him two to three times a week, the community palliative care team will monitor his care alongside his GP. Domiciliary care are going to pay a visit this afternoon to take some extra equipment, a stand for his feed I think and do an assessment to see if there’s any more they can offer.
Jenny: That sounds great. I guess I just worry that if he has a fall over night or his pain gets really bad. What if he puts alcohol down the tube? You know he’s been a heavy drinker for a long time.
Nurse: Patients have been known in the past to put alcohol down their peg tubes. For many patients who have been drinking large amounts of alcohol it makes them feel better because it reduces the withdrawal symptoms they may be having. I’ll have a chat to him to outline how much alcohol will be safe and the community nurses will keep an eye on how things are going. You comfortable with that? Anything else?
Jenny: I know that dad has only perhaps months left to live. Sometimes I feel I’m not doing enough for him, I feel like, we’re just starting to get our relationship back on track. So what should I be doing now?
When Death is Imminent – Scene 9
Nurse: Morning Jenny. Did you get any rest over night?
Jenny: Oh I managed to get a couple of hours when his breathing was quieter. But it seems to have gotten noisier. Does that mean it’s getting closer?
Nurse: Yes it usually does. As the heart and lungs get weaker fluid collects in the lungs, that’s what you can hear now. Overnight the nurses tried some medication to dry up the secretions. Burt doesn’t seem too distressed this morning. He’s resting comfortably at the moment.
Jenny: How long do you think he’s got?
Nurse: Having seen him from yesterday to this morning things have changed. I think Jenny that he’ll die in the next few hours. You’ll notice that his hands and feet are looking a little mottled and dusky, that means his circulation is slowing down. You’ll also notice that his breathing is a little irregular.
Complicated Bereavement – Scene 10
Nurse: Is there anyone you’d like me to call to be with you or you think should visit dad now?
Jenny: No. No his mates at the hostel have said their goodbyes. It’s really just me. My husband will come and get me when I call him but he needs to be with our kids right now. It’s just me. Dad was a loner and I let things come between us because I didn’t like his drinking. I let him down.
EdCaN Case Based learning resource transcript – Oesophageal Cancer
© Cancer Australia 2014