Exceptional Care: A Case Study, Part 1, The Initial Visit

By | May 4, 2011

The pancreas in an organ deep in the middle of the upper abdomen. Tumors of the pancreas often cause a squeezing band-like sensation of pain in the area that travels to the back. By the time Jane came to see us she could not even lie down comfortably and was reduced to sleeping in a chair. Despite all of this, the idea of having a pain pump implanted in her body frightened her. I knew that I could help her, but I was afraid that she would just run away like a frightened deer in the headlights.


I spoke last time about the collaborative nature of healthcare today, but without a concrete example, this may sound like just a bunch of words. I hope that the details of a recent case, of which I am particularly proud, will make this clear.

I received a phone call late last Monday afternoon, 9 days ago from a prominent oncologist and an old friend, Raul Mena. Jane Smith, an important civic leader, (obviously not her real name) was sitting in his office suffering with upper abdominal pain from a pancreatic tumor. The pain, which had previously been manageable, was now out of control. Could I help? I said the only thing I could think of and the only thing Raul wanted to hear, “Send her over.”

Jane made the journey of 4 blocks in about 45 minutes. It’s hard to move quickly when you are in that much pain. My staff and I spent about 90 minutes with her. I told her that the only thing I could do that would really help her was an Intrathecal Drug Delivery System (in other words a spinal pain pump). I knew that she was not happy about this. None of the patients ever really are. The idea of an implanted pump always seems extreme and conjures up unwarranted feelings of sickness, treatment failure and impending death.

We explained the procedure for trialing the pump and for the final implantation if the trial were to be successful. We gave her some literature, a DVD and the URL for several helpful websites including ours and sensing that Jane was now in a state of informational and emotional overload, we told Jane to go home. We told her to talk to her family and then call us. We suggested she come back in a day or two with any interested friends or family so that we could answer any questions. And then we prayed that Jane would not just run away like the frightened deer in the headlights that she appeared to be.

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