Caroline works in the Home Telehealth program. She recently had a patient who for 6-8 weeks called her complaining of severe pain. Caroline took the appropriate steps to notify the patient’s PCP. The PCP prescribed pain medications. The patient continued to call Caroline regarding his severe pain. Caroline told the patient to go to the ED. The patient did so, and again was prescribed pain medications. Once again, the same routine persued; the patient called Caroline again about his severe pain. At that time, Caroline spoke with a family member and encouraged them to be an advocate for the patient and go to the ED and insist on admission. The patient and his family did just that. The ED MD admitted the patient. While in the hospital, teses were run to determine the cause of the patient’s pain. It was not until a resident noticed that the patient had an elevated alkaline phosphatase and ordered a stat bone scan which showed bone metastasis. After the patient was admitted into the hospital and administered the appropriate medications for his disease process, Caroline went over to the hospital (she works offsite) to see the patient. The patient was vision impared and the medications made him very drowsy. Caroline went to his bedside, held his hand and said “Mr.____, it’s Caroline, your nurse from Telehealth” and he replied, “Caroline, I am not in any pain now”. She stayed there for an hour and continued to hold his hand.
After this, the patient quickly deteriorated and subsequently passed away the next day in the care of hospice. Because of Caroline’s determination to identify the cause of her patient’s pain, he died pain free and his family members were relieved knowing that his death was peaceful.