Osteosarcoma Cancer Case Study Transcript
Justin’s Story
Diagnosis – Scene 1
Justin:Hi I’m Justin. I’m 16, I live with my dad Steve, his girlfriend Sue and my half-brother Cameron who is 10. I see mum alternate weekends but you know wish I didn’t have to. I don't like her new boyfriend. My best mates are Liam and Brett, we hang out together with my girlfriend Sophie. Me Liam and Brett play footy for Sydney’s West.
I’m normally pretty healthy but I’ve had a sore left arm for the past couple of weeks. Can’t remember taking a hit on the arm or anything but must have had it somehow.
Doc said it was probably a torn muscle or something. Rest it for a while, no way we’re in the finals.
Sophie noticed the lump and said it didn’t look right. Coughing a bit, maybe getting a cold or something. I think I’d better see the doc.
Waited heaps to see the doc, told him about the cough, seems like everyone has got it this winter. A lot of it going around he said, got some medicine for the cough told to come back if not better in a week.
Dad saw the lump and made a doctor’s appointment. Doc took one look and said something to dad about seeing a specialist, I’m not sure. Best to get it checked out. Doctor at the hospital asked heaps of questions about how long I’d had it and stuff. He did some tests, blood tests, X-rays and he reckons it might be osteosarcoma. Bone cancer. No way.
Dealing with Diagnosis – Scene 2
Justin:I knew something was wrong but I didn’t want to believe it. This isn’t really happening, a week ago I was playing footy, being with Soph. And you know normal sort of stuff. Now everything has gone ape shit. Mum is crying, dad is upset and some doctors said I’ve got cancer. That’s crap I mean guys my age don't get cancer do they? This is not cool, this isn’t really happening to me. Liam and Brett have started pre-season training and they’re going on camp next term. Guess I’m not going now. What am I going to tell them, should I tell them? And what about Soph? Is she still going to want to be seen with me when my hair falls out?
It seems like mum or dad are here all the time. Even when Soph, Brett or Liam come in. They don't get it, I need some me time to get my head around things. You know so much is happening so quickly.
Most of the nurses are pretty good in dealing with them though. One did a tag team the other day, got mum out of the room and started talking to her about chemo side effects and how I had to keep it clean or I’d get sick. Yeah. And then they were talking to me about Soph and that and if we were having sex yet, as there’s stuff I need to know. Whoa. I’ve been wanting to ask someone about that but never seemed to be the chance with mum or dad here. And it was good to be able to talk without having mum interrupting all the time and not letting me get anything out.
Disease Progression – Scene 3
Justin:I knew it, I just knew it would come back, here we go again. What am I going to do, how am I going to tell Soph, mum and dad? And the doc said more chemo. I’m not sure I can go through all that again.
Chemotherapy – Scene 4
Justin:So much for the chemo. What’s the point? I feel like crap the whole time and it’s not going to stop me from dying. Mum and dad were in at the same time today. First time in ages they both agree on something. They want me to continue the chemo. Mum just freaked out when I said I’d had enough. And dad just won’t let me use the D word. Why can’t they just get over it? I am dying and nothing they say or do and nothing the doctors do is going to make any difference now. I just want to go home to my own room you know have Soph with me, have the guys over whenever I want. Soph gets it. She cries a lot but at least she’s not bloody delusional.
End of Life Preferences – Scene 5
Justin:The palliative care nurse has been visiting me, reckons that some community nurses can come in and help me at home with my pain, drugs and anything else. So what’s the problem? It’s just not fair, I’ll be 18 later this year if I don't die first, why can’t I make my own decisions, what right do they have to rule my life? I die here or I die at home. I want to be at home
Impact on Family and Carers – Scene 6
Anne:Hi I’m Anne and I’m on the early shift this morning. I’ve had to readmit Justin to the ward. He’s been at home for about 3 weeks now, his family have been caring for him. But unfortunately overnight his pain has increased, he’s no longer responding and his breathing has become really laboured and noisy and the family are finding this very distressing. His girlfriend Sophie is here and she’s distraught. I’ve suggested to Justin’s dad it might be an idea now to call her parents so that they can come up and support her while Justin dies.
The waiting room and his room are full of all his family and friends. I know his best mates Brett and Liam are here as well and his grandparents have just arrived. And his little brother Cameron is just bereft and he just doesn’t know what to do. I know mum and dad were talking to the social worker earlier and at their request we’ve got the hospital chaplain coming up for support.
Gosh, I have to admit today is a really tough day. I’ve got a son, Jonathan and it’s got to be the hardest thing about being a nurse here and a mum. I just want to go in there and hold little Cameron and he just looks so bereft and dad has barely left the room and can’t keep his eyes off Justin
End of Life – Scene 7
Anne:So at 10:15 Justin required some breakthrough medication and about 15 minutes later he settled. I’ve just explained to Justin’s family that he’s imminently dying. His respirations have become quite shallow and irregular and consistent with cheyne stokes respirations. And his extremities are all mottled and his pulse is quite weak and irregular. Mum even asked me if it was due to the medication, the changes that have occurred but I explained to her that this is the natural course for Justin dying.
Justin’s pupils were not constricted as they would be if he was opioid toxic, so although I’ve given him extra medication it was just in response to his symptoms.
Justin died at 1:30 today. So although it’s sad it was good to actually have his family and friends here so they could say their last goodbyes.
EdCaN Case Based learning resource transcript - Osteosarcoma
© Cancer Australia 2014