Assignment: Pick one of the case studies that follow and read the story and then answer the questions that are listed below the story.
Mr. B.: Family Conflicts
Mr. B. is a 21-year-old African-American male who has been treated over the last year at your hospital for widely metastatic Burkitt’s lymphoma. Mr. B. had lived at home with his mother, but a few months ago against his mother’s wishes, he married his long time 17-year-old girlfriend who is the mother of his 2-year-old son. His mother does not get along with the patient’s wife. The couple have a small apartment and his wife has been trying to keep working nights as a nurses’ aide to support them. He’s applied for disability, but they currently have no consistent source of financial support except her part-time job.
Unfortunately, after his first course of chemotherapy, he became septic and nearly died in the ICU. His disease has continued to progress through second and third line treatment, and he has been hospitalized almost continuously for the last two months for dehydration and fevers, among other problems.
He has been evaluated for bone marrow transplant, but has steadfastly refused it because “I don’t want my family to lose everything because it’s probably not going to work at this point.” He has told you that he was pressured by his mother to have the evaluation: “It’s really hard to say ‘No’ to her. Mom told me she’d take the hospital to court, if they don’t do a full court press. She’s already contacted a lawyer. My wife can’t stand up to her, so I guess I’ll end up doing it even though I don’t want to.”
As a nurse working in an inner city medical center hospital, you take care of many underserved patients. On rounds with the gynecology oncology team, you meet Ms. D., a 33-year-old white unmarried woman with Stage IIIC ovarian cancer. Ms. D. has refused all offers of chemotherapy treatment for ovarian cancer that has now spread throughout her abdomen and inguinal nodes. She has malignant ascites and a bowel obstruction. Her condition has worsened to the point that she has to have daily paracenteses and the team has told her that they may have to operate to partially alleviate the obstruction.
She tells you she has schizophrenia and she hasn’t taken her psychotropic medications in a while because “they’re poison.” She tells you, “I may be crazy, but I’m not stupid. That treatment is going to kill me. I don’t want it.” The treatment team tells her that treatment is her only chance of curing her cancer, and they will contact her family against her wishes to make sure she gets appropriate treatment.
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