Patient with ovarian cancer seeks reassurance
It was a typical busy day at Weill Cornell Medical Center at New York Presbyterian Hospital in New York City, where I'm a nurse practitioner on short surgical stay. I took care of a 41-year-old female patient with a history of ovarian cancer that was married with two small children at home.
The patient was admitted to our unit after a simple ureteral stent exchange and was postoperatively stable from this procedure. The urology service cleared her for discharge the next day. Patient N.B. had been dealing with jaundice, gastrointestinal nausea, vomiting and obstruction for eight months from her primary diagnosis of ovarian cancer.
The patient was admitted with a peripherally inserted central catheter that had been put in two weeks prior, when she was admitted to an outside institution for peripheral parenteral nutrition (PPN). She had been receiving the PPN at home, but it had not been working. Although doctors from an outside hospital primarily followed N.B., she was receiving consultations from a gynecologic oncologist at New York Presbyterian who was not aware that the patient had been admitted for ureteral stent exchange.
The patient became very emotional, saying that no one cared about her. She complained that her oncologist had performed tests at her regular visit but that she had not received her results. She questioned why he had not seen her since she was first admitted. Although, the patient was cleared for discharge home, she was very emotionally distraught and scared regarding her condition and prognosis.
I was able to get her peripherally inserted central catheter working so she could resume her PPN at home. I spoke to the urology service that had performed the stent replacement and explained the situation. They were able to find out the results of patient's tests and explain them to her.
The patient was still not satisfied and still very emotional. I tried reaching out to the oncology doctor to let him know that the patient was on the unit, that she wished to see him and how emotionally distraught she was, but he was unavailable.
Although, he was not able to see the patient personally, the oncologist did send senior members of his team to help soothe the distraught patient and ease her concerns. The moral to this story is that although N.B. may have been admitted for one reason, we must treat all of patients' concerns from an emotional standpoint as well as medical.
Although this patient was medically cleared from her primary admission she still needed something else: emotional support. She needed to feel that she mattered to the medical team. With a primary condition of metastatic ovarian cancer, this patient wanted to know that no one was giving up on her, because she was still fighting. After the oncology resident visited with her, she agreed to go home.