Nutritional in the palliative care
I had a chance to take care an Ethiopian man who had cancer of the Ampulla of Vater for several months.
The first visit of me and him was not a good time. He had several cycles of chemotherapy already, so he wished that the tumor will be collapsed. The point was that he seems to be unlucky, because the tumor grew and he developed pleural effusion. It made his wife cried a lot. The attending oncologist thought that it was a time, so she consulted oncology nurse specialist, and me as a clinical dietitian.
The next day, I visited him and conduct nutrition assessment. He had severe malnutrition but able to eat some food though, so I decided not to plan giving tube feeding. I adviced high protein diet and high protein oral nutrition supplement while encouraging power to fight with cancer. Both patient and his wife had several misinformation about nutrition and cancer, so I adviced these too. He looked a lot more comfortable. After several cycles of chemotherapy, he flew back home.
Next several visits, he came to the outpatient cancer department with stability of weight and muscle mass. The oncologist was happy, so do the familes. He though developed taste alteration and couldn’t tolerate the usual oral nutrition supplement, so the oncologist sent him to visit me, and I changed the formula to the new one. He could tolerate it so I ordered it for him to bring back home.
Before routine visit, he suddenly developed new pleural effusion and dyspnea, so his wife brought him back to Thailand. After the examination, the oncologist consulted palliative care nurse specialist. Consulting her means that the next station is the terminal station for sure.
Few days ago, I visited him again. He was more tired and unable to lay down sleeping so the wife let him sit and sleep. He could eat foods (and oral supplement) a lot less than usual. One reason was that foods in Thailand wasn’t same as foods in Ethiopia. I adviced that near the hospital there is some Ethiopian restaurants she can buy for the patient. I also told her some principles of food safety since his immunity dropped, and calculated meal plan for her to create the menus for her husband, wishing him to be able to eat as I recommended.
The wife seemed to be mentally better. She said that her daughter will come to Thailand bringing some traditional Ethiopian foods. He might eat more with the handmade food.
Before exiting the patient room, the wife handed me 200 Baht, saying that this is for me. I said that I couldn’t receive this money. She quickly said that you must keep it because I’m so thankful with your help. I decided to keep the cash and walked to the hospital charity for helping children with congenital heart disease. In my religion, donating money is a type of making merits, and we could wish for others while making merits too.
The next day, I visited the patient again. He seemed to be more tired and denied eating, told by the wife. I said never mind, just let him eat the foods he likes when he want, that’s OK. Don’t force him to eat, and you can give him traditional food. That’s the best. I walked out because she would cry if she talked to me a little longer. Now it’s no point to force patients to get 100% of the caloric and protein requirement. The most important thing to focus is the comfort of the patient, by serving him the comfort food, and well hydration.
After visiting patient, I had a little chat with palliative care nurse specialist. She said that the doctor planned to let the patient and family sign the living will because extending life to suffer more from the disease may not be a good idea. The nurse just hoped that the family will be OK, because the wife cried every time she see her, opposing with the patient that is more calm and understand current situation of his body.
What will be going tomorrow? Will the patient reach his terminal station? No one could answer this question. It belongs to the mother of nature.
For me, this is another palliative care nutrition experience that I will not forget. It’s so emotional, and you will never ever be able to learn this from the classroom.
Best wishes everyone, from Thailand.