Peeling back the layers

While I'm not the one who waits to admit patients to the Hotel anymore, I have assessments to do for folks who end up in the SU, so I still visit. I knew this particular patient would be trouble from the start.

Mr. I. had a history from faraway. He was a complex character. I had fun trying to find his records but when I did, they told me two big things: mental illness and intractable pain. Many nurses, when they see this think of two words: drug seeker. Mr. I. had a life of ill repute, so certainly he must be addicted to those painkillers, one staff member told me matter of factly one day. He was also mentally ill.

I did my required assessment and found him pleasant and with his sister when I came to call. Mr. I was fine doing his assessment with the sister there. "Sure, she can be here. I tell her everything." I did my work and was on my way, thanking both of them. Mr. I had been estranged from his family for a long time due to the distance and his illness.

The course of his stay was usual. Patient caused trouble, psych was called, meds were changed, and the Caffeine free Diet Mountain Dew cans were thrown at staff. Empty, Mr. I told the security staff, when they called a surliness code one day. "I know a full can might hurt someone, so I'd never do that, but she (Nurse Suzy) made me mad." Nurse Suzy made him mad when his pain meds were late and he was in pain. Mr. I told everyone that he was in pain all the time and nothing worked. Mr. I also said he had pain for years. "I probably have terminal cancer." he told another nurse. "I've been reading about it on the internet."

Day after day, Mr. I still complained about this and that, and was finally consulted to the pain management doc, and he/she said to leave his pain meds alone. He/she didn't see any changes coming anytime soon, so it was best to leave them alone.

Well, change came soon enough. Mr. I complained, complained, and complained some more. The docs decided to give him big workup. We found out his one chronic problem wasn't the only thing causing his pain.

The workup found that Mr. I has cancer. Metastatic cancer, partly related to his chronic condition, but the rest they aren't sure of. The oncologist gently told him that they can't give him a realistic prognosis without one more test (that wouldn't be terribly invasive, but would answer his questions.) Mr. I said he wanted to know, so do the test.

It was a sad day recently when his sister showed up. I asked if she needed anything and she just looked up sadly and said, "I need to get I's things. He's going to hospice, instead of that assisted living place the social worker found." The nurses guided her to the room and one offered to help her. "I'm fine," she said. "I always knew something like this could happen. I just never thought it was true. Now I know."

I waited to see if there would be an emotional response, but she stoically packed his belongings and took the computer and clothes out of the room."I promised to be there for him this time, and now I've got my chance. I never thought it would happen because he was gone for so long."

She turned and with a look of calm said, "I'll take whatever time he's got to help. It's all I can do. I'm his sister after all."