Indexing Title: CLEYSONs Medical Anecdotal Report [05-06]
MAR Title:  Terminal Illness and Grief
Date of Medical Observation:  July 17, 2005 

Narration: 

It was one quiet evening when a 65-years-old, female was wheeled in screaming at the top of her lungs. At first we all thought that she was a victim of an accident but apparently she’s not. We noticed that her clothes were dirty, she was dirty and she smells like she hasn’t taken a bath for 200 years.  She told us that she has been experiencing the pain on her back for a year now. At first, it was tolerable and she self-medicate with various types of pain relievers. But it was different that night, the pain was unbearable and any slight movement brought pain that seems to be tearing her souls apart. She also informed us that she has been nursing a breast mass for more than a year and she suffered from a fractured humerus last February 2005, she consulted the Philippine Orthopedic Center but was lost to follow-up and it seems that she did not informed the doctors that she has a breast mass. This gave me an idea that she might be suffering from a metastatic disease.

 On examination, her right breast was totally fixed to the surrounding tissue. Skin involvement ranges from her right clavicular area to the right upper quadrant of the abdomen, from the right posterior axillary line to the left parasternal area. There was a non union of the fractured humerus; it seems that she has two elbow joints. She claims that she has been bedridden for three months, as evidenced by a decubitus ulcer grade 2 at her lumbosacral area. After giving an appropriate medication and the pain subsided, I got the opportunity to ask her if she consulted a doctor from the time she notices the mass growing. She said that she was afraid to see a doctor for her mass might turned out to be a cancer.  

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)  

Cancer is one of the dreaded diseases of the century. It is associated with the dawn of life, with death. People when faced with a terminal disease react in different ways. These patients experience grief—a reaction to a significant loss or to a terminal illness that expects death. Every human being experiences grief; it starts at the recognition of a loss and extends to the eventual acceptance of it. Responses will vary depending upon the circumstances associated with the death.

There are typically 5 stages of grief. These reactions do not occur in a specific order and may (at times) show simultaneously. Not all of these emotions are necessarily experienced:

           1.  DENIAL -- an ego defense mechanism that operates unconsciously to resolve emotional conflict, and to allay anxiety by refusing to perceive the more unpleasant aspects of external reality.   

           2.  ANGER—blaming others for having such a disease

           3.  BARGAINING—this is the stage wherein the person is asking for the total resolution from the disease in turn he will give-up something he loves.

           4.  DEPRESSION— which feelings of sadness, loss, anger, or frustration

           5.  ACCEPTANCE—coming to terms