Here in Florida, many of our patients are from elsewhere. And when they get sick and dying, they want to go "home". Home to my 93 year old patient this morning was Ohio. Dying of a cancer of unknown primary with metastasis to the liver, she was adamant that she was going to get on a plane and get to Cleveland. So we did what we could to expedite the trip.
Her son was her companion and caregiver. He was as invested in getting her to Cleveland as she was. Our social worker called the hospice agency there and faxed information so she could continue services. He took care of the flight arrangements. We made sure her medications were ordered and delivered in time before she left. She was getting Lasix, so I had the nursing staff place a Foley catheter early this morning and attach a leg bag. The nurses wrote out a list of her medications and the times she was to take each one. She had long acting medication for pain, as well as some for breakthrough, with explicit instructions for what to take when. Her son was a willing student and seemed to understand everything.
My main concern for her has to do with air travel. Most people don't realize that airplane cabins are pressurized to about 7500 feet. If you think that Denver, Colorado, is at 5000 feet, 7500 feet is really high altitude. People with heart and lung disease have no margin for error, and can have symptoms of CHF and pulmonary edema within a very short time. This woman is 93, frail, has a history of CAD, CHF, COPD, and has lymphedema of her lower extremities from tumor burden in her abdomen. She had also started to leak from her abdominal incision this morning. The effect of altitude could be most unpleasant. However, all of this was explained to her, and she was adamant. She was going.
And go she did. I hope she did ok. I hope she is there safe and sound. She and her son were going to be busy the rest of the afternoon and evening getting settled in, so we didn't expect or get a phone call. Whatever happened, it was the way she wanted it. "These bones don't belong in Florida", she said to me.