Cancer story. Nursing story about cancer fatality to a young expectant mother.

WARNING:

This story can be disturbing and emotionally traumatic. I recommend you stop reading it if you cannot handle painful truth that hurts, even if you do not know the patient. This case happened in an intensive care unit. I happened to take care side by side with the primary nurse who took care of this 20 years old expectant mother. Reader discretion advised.

SYNOPSIS

This young mother had a history of malignant lymphoma and underwent successful treatment. She was visiting cancer specialists often and all scans and blood test showed she had no cancer. She was in cancer remissions for over 3 years and never took anything for granted. Here is the story.

The shift started as usual and assignments allocated by intensive care unit charge nurse. We all took assignments and one nurse was assigned to this 20 years old expectant mother. The fact that she was expectant, young and medically needy made her to be of higher acuity. This warranted 100% attention from top qualified registered nurse.

The 20 years old had been in cancer remission for over three years. She underwent serious testing before she became pregnant. Gynecologists and cancer specialists closely monitored her pregnancy every month. Her scan 2 months before she was admitted in ICU was clear and she was cancer free.

Few weeks after her previous negative scan, she started to develop a cough, and something that she assumed was normal. After all, who doesn't develop a cough no and then, especially when pregnant? The cough persisted and this time, she started developing shortness of breath. She immediately called her gynecologist who advised her to go to emergency room immediately. The gynecologist followed up with her in the emergency room and a scan showed an egg size lymph node tumor in her chest area.

Radiological scans like x-rays are not recommended for pregnant mothers but when the mother life is on the line, it is better to take the risk than not at all. The severity of breathing difficulty was getting worse by the hour. She was taken for CT scan that revealed multiple lymph nodes swellings, including 2 more golf ball size around the neck region. These two had the potential to obstruct the airway, something that could make it a deadly medical emergency.

She was admitted to intensive care unit and after series of top qualified physicians and gynecologist, they decided to start her on radiation therapy the following day. These tumors were inoperable because her platelets level was critically low. She was admitted in ICU to receive intravenous platelets and stabilize her electrolytes levels in order to start radiation therapy and emergency surgery if needed.

All consent had been signed and it was just a matter of few hours before she could begin aggressive cancer treatment, this time, to save her life.

It is a common practice in intensive care unit to secure the airway by intubation to patient with poor oxygenation and those with a potential of losing their airway. Her case was one of those that required intubation. Several attempts to intubate her were unsuccessful because these cancer tumors were blocking the airway. However, she still could keep her oxygen saturation at 100% on 40% oxygen.

In ICU, the emergency anesthesia team was paged STAT to re-attempt the intubation as it was becoming harder by the minute for her to maintain oxygen saturation above 92%. This time, she was on 100% non-rebreather mask and still could not maintain good oxygen saturation. Her family was by bedside holding her hands as bags of platelets infused to bring up her platelet level. Without normal platelet levels, any attempt to operate could have made her to bleed to death.

When attempting to intubate, doctors discovered something even more serious. Those tumors had a pulse of their own, making them even harder to operate especially to a patient with low platelets level.

There was no way to save the 26 weeks baby in her uterus with platelet levels <2,000. Her urine was pink, indicating spontaneous bleeding from her bladder and urethra. Her eyes were bleeding despite how fast platelets were transfused. Her cancer was growing by the minute.

She started gasping for the air, only a few hours after being admitted in the ICU. Every hospital in the state she had ever gone had recommended she go to a level #1 cancer and trauma hospital. She was in the right place for this condition.

2200: Oxygen saturation was in high 80's, already lower than what is required to maintain acidity and alkalinity balance of the blood. An emergency meeting was held between the surgery, medical, oncology and gynecology teams. They came up with no answers.

2100: Breaking news: There is nothing medically possible that can be done at this time to save her life. The neck region tumors were swelling by the minute. That explained why it was becoming harder and harder for her to breathe by the minute.

2200: The fetal heart rate this time was becoming slower and slower. Again, there was nothing that could have been done that soon. The attempt to remove the baby would have been bleeding to death.

2300: bleeding was evident even from the vagina. Vaginal bleeding obviously indicated intrauterine bleeding. In a few minutes, we lost the fetal heart rate. Nothing could have been done. Everyone around could not avoid bursting in tears including us the nurses and doctors themselves.  The gynecologist pulled the family in a private room.

2400: Breaking news. We have lost the fetus! It was too late to do anything and the rate by which we were losing the ability to breathe was too fast to maintain fetal oxygenation. But the mother was still conscious and fighting for her dear life

0100: heart rate was in 150's and blood pressure was trending downwards. Oxygen saturation was getting worse by the minute. Attempts to breathe were becoming harder by each breath. She could be heard gasping for breath from a distance.

0200: breaking news: She became unresponsive but the monitors could show heartbeats and a low blood pressure. The heart rate this time is coming down slowly. The heart is about to give up without oxygenation. The tumors had also blocked the access for emergency tracheotomy.

0300: The family signed does not resuscitate order (DNR) despite their denial and painful impeding and irreversible/unstoppable loss.

0330: No chest movement of breathing could be detected by visualization or by the monitor. It was just a matter of minutes before the heart could stop.

0350. The heart stopped with her whole family holding her hands. She was dead. The curtains were drawn to give the family some privacy and time to digest the loss.

We all tried our best to save her life. The obvious was impossible due to speed at which these events were happening and underlying conditions. The 20-year-old American girl and a 26 weeks old fetus were dead. A life lost to cancer.

The most disturbing thing was, we helplessly watched her suffocate to death! Painful!

Update: I have had a lot of mixed reactions from the readers of this article and it is expected. It is a disturbing story. A lot of people are asking why the baby was not saved at a viable age of 26 weeks gestation. Others are stating that there is no way cancer can grow that first.

First about the baby. Medical procedures like those requires consents from the patient. Where the patient is not able to sign such consents, a legal next of kin can do it with witness. If Next of kin cannot be reached and the patient cannot sign the consents, two phycisians from different team can sign the concent, something you may hear being called "double doc".

1. The patient immediate family wanted the mother to be saved but there was no concent available for such procedures.
2. The hemodynamics for the mother were severely compromised and in such events, the fetal circulation from the mother shunts all resources to the vital organs to save the mother, hence, the reason why the baby died first.
3. On CT-scan, The baby was nodular (I forgot to mention that), a reason good enough not to attempt the surgery.
4. The risks of attempting a surgery were higher than not doing it!
5. ... and yes, some types of cancer can worsen in a few hours.