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Mr Adami’s story
Eighty-six year old Mr Adami lived alone after his wife died, until he became ill with bile duct cancer. Over time he found it more and more difficult to manage at home so he moved into a nursing home. He was settling in well, enjoying the care and company, but soon became quite sick. He developed jaundice (yellowing of the skin and eyes), as well as severe abdominal pain, and his GP arranged for him to go to hospital.
Mr Adami’s surgeon put in a tube (stent) to clear the blockage that was making bile go into his bloodstream. The tube allowed the bile to flow into his bowel again and the yellowing of his skin and eyes faded. The surgeon also asked the hospital’s palliative care team to visit Mr Adami to help relieve his pain and to talk with him about his hopes for the future.
The team met with Mr Adami and, as Mr Adami did not speak fluent English, an Italian interpreter helped them to communicate. The palliative care team talked with Mr Adami about regular morphine tablets for his pain and laxatives to relieve his constipation. Mr Adami told them that he knew he was dying and that he would like to return to his nursing home where he felt safe. He would like to die there.
The palliative care team spoke with the nursing home staff, who said they would be glad to have Mr Adami back for end of life so long as they had assistance and coaching from community palliative care.
The hospital palliative care team referred Mr Adami and his nursing home care team to community palliative care services. They arranged for a nurse to meet with Mr Adami, nursing home staff and an interpreter the day after he was discharged from hospital.
The community palliative care nurse helped nursing home staff plan how they would look after Mr Adami. They also arranged for a palliative care nurse to call the nursing home each week to make sure they were happy that he was comfortable and content, and to give advice where needed.
The nursing home called community palliative care when Mr Adami’s health deteriorated and he was no longer able to swallow his morphine tablets. After consulting with the GP, the palliative care nurse visited to start a syringe driver (battery-operated pump) to administer morphine. He coached nursing home staff in how to manage both the pump and extra morphine if they thought Mr Adami needed it.
The nursing home staff felt confident to give extra pain relief on two occasions, and they were pleased they were able to make Mr Adami comfortable again. He died peacefully three days later.
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