By Diane Scheb RN, MSN
Spend less. Live better. Except, she didn’t have that long to live. Maybe 10 days. . . probably not.
Thirty-three years old, an illegal Mexican migrant worker, she was diagnosed in an emergency room with an aggressive stomach cancer two years ago and she had been fighting for her life ever since. Multiple rounds of chemo administered through our Community Medical Clinic had not worked.
And now, here she was in my ICU, valiantly clutching to life after yet another horrifying gastrointestinal bleed. Horrifying to her four children ages 3 to 14, who witnessed the event. According to the 14 year old, it was “like her stomach was being coughed up with bright red blood”. It was these four kids that this mother was trying to live for. It was because of these kids that she was insisting that “everything be done” thereby rejecting Hospice care.
My eyes took in the living corpse who seemed translucent, lying in the sterile ICU bed. Surrounded by machines, monitors, and blood bags infusing into her body, she appeared ghost-like, emaciated, almost surreal. Her eyes, deep brown and large, said it all, as I held her hand. “Help me. My tummy really hurts”. As crazy as this sounds, my first thought, in this very intense environment, was that I was amazed at her English. My next thought was, “Thank God she’s here with us. I can do what I need to do to get her pain under control”.
I have the best job of my professional RN career. Along with the Pharmacy Director, I direct the clinical activities of the Acute Pain Service. Under the auspices of a Pain Management Physician, we use medical staff approved protocols to relieve the pain of hospitalized patients.
I quickly titrated her Dilaudid via the pain pump and she was comfortable five minutes later. Her hollowed out, deep hazel eyes spoke volumes. They spoke of fear, suffering and despair and looked markedly out of place in her emaciated sunken face.
I was deeply thankful that she was comfortable but, to be honest, I was far more worried about where we were headed. No insurance, no Medicaid, no Medicare. I heard her family lived in a two room, one bathroom efficiency in Northport. Read that as having zero money. Indeed, I hear the nurses were ordering guest meals for the family. One meal easily fed the three kids who were thrilled with the hot meals. We stabilized her and transferred her out of the ICU. She was fragile, wanting more chemo and maybe some pain medications for home. Again she refused Hospice which was unfortunate as they would have paid for her medications. The challenge was before us. Find a cheap, easy to swallow pain pill that would keep her comfortable in her last days on earth.
For obvious reasons, we quickly eliminated Methadone and Fentanyl patches from the potential medications. Our research yielded the following information. We knew that Dilaudid 8 mg. every four hours would keep her comfortable.
Pain Pill Retail Cost at Walgreens/CVS
Dilaudid 4 mg. pills (100) $ 99.90
Oxycodone 10 mg (100) $144.90
Oxycontin 10 mg (100) $249.90
Let’s just say that none of these prices were in the ballpark. Spend less. Live better. Remember that catchy slogan? Across the nation in these dire economic times, people have been trying to do just that by shopping at Walmart. As it turns out:
Pain Pill Retail Cost at Walmart
Dilaudid 4 mg. pills (100) $30.00
Shazzam! Everyone on the Oncology unit chipped in $2.00 and she had enough medication to last at least ten days. She only needed enough for five days. We all heaved a sigh of relief when we heard the news. Her final days were relatively pain free thanks to the cost awareness of the staff who cared for her and the giving spirit of her caregivers. The lesson learned is to be aware of cost savings available to every patient. We can therefore ALL. . . Spend less. Live better.
Diane Scheb RN, MSN is Acute Pain Program Co-coordinator for Sarasota Memorial Hospital and was a contestant in the 2012 Costs of Care Essay Contest.