Case Study: Palliative care team

Martha is a 65-year-old woman who has battled with depression for most of her adult life. For many years she has been reluctantly accepting medication which has ameliorated many of her symptoms, but she hates having it. Martha has had many community mental health nurses who have attempted to engage with her and have negotiated a path to her lounge whilst trying to avoid being snapped at by her very protective Jack Russell dog, ‘Pip’, who she adores and who helps her to feel safe. You have noticed that Martha hasn’t been looking well, she has lost a great deal of weight, isn’t eating properly and seems to be in pain. She is also becoming forgetful and disorientated. Eventually, you persuade Martha that she needs to see a doctor, and her family doctor, Dr Green meets you at her house.

Dr Green is similarly concerned and together you persuade Martha to have some blood tests and an abdominal scan. In time, the results suggest that Martha is very unwell indeed and she is seen at the hospital as an urgent appointment with a surgeon. At the appointment Martha is very subdued. In the bright hospital light, you can see that Martha is quite jaundiced. She looks sad, and sat beside you, you realise how frail and confused she has become. She says that she has been frightened every day of her life and now she is frightened that she is dying. Sadly, the surgeon’s opinion confirms this and she is referred to the palliative care team.

1. How can you work with the palliative care team (PCT) to ensure that Martha’s needs are met?
2. What information do the PCT need to enable them relate to Martha well?
3. How can you support Martha to express herself?
4. What support do you need?
5. Martha is very worried about what will happen to ‘Pip’.