In June 2017 Mrs. C, a 70 year old lady was diagnosed with Stage - 1 Pancreatic Cancer. A Whipples procedure was performed at a tertiary Sydney hospital with a protracted and complicated post-operative period. In October 2017 Mrs. C commenced chemotherapy at a regional hospital 2 1/2 hours from her home.
After 6-months of chemotherapy, including multiple hospital admissions for complications; 3-monthly serial CT showed nil evidence of secondary tumours. In September 2018 pancreatic cancer markers were slightly elevated, December CT was NAD, March 2019 cancer markers were significantly elevated and CT identified tumours in the liver, lungs and omentum.
Mrs. C wanted to live a full-life with her disease. Mrs. C lived at home, returned to reduced hours at the local hospital where she worked and lived her life her way.
Conversations about what Mrs. C wanted commenced at diagnosis. This included an Advanced Care Directive, appointment of Enduring Guardians and Enduring Power of Attorneys, creating a Will and registering her plan with NSW Ambulance.
Mrs. C wished to die at home, in her own bed, with her beloved dogs beside her.
In September 2019 Mrs. C was hospitalized. Previous second round chemotherapy had been ceased as per her wishes knowing full well the implications of the decision. This was difficult for the family to understand and accept. Mrs. C requested to go home and as planned one of her daughters came to care for her.
IMPLICATIONS FOR PRACTICE
The daughters experience was profound. The level of anxiety felt by Carers was accepted but not fully realized, the difficulty in accepting someone’s decision; that is opposite to your own, the intensity of the grief and sadness. In her own practice now there is a heightened sense of knowing and compassion as she is works to try to minimize this impact this emotional shock. And, finally the importance and value of self-care.
Three weeks after leaving hospital with her daughter Mrs. C died at home, in her own bed, her daughter lying beside her and her beloved dogs nearby. Mrs. C was my mother.