Discussion 4: Non-Hodgkin’s lymphoma

Mrs. Thomas is a 54, year old African American widow, mother and grandmother, who lives with her daughter and four grandchildren (ages 12, 10, 7 and 5) in a 4 story walk up apartment. She is an active member of her church community and friends, comments that she had so much energy that she exhausted all of them just being around her. At age 51, she was diagnosed with non-Hodgkin’s lymphoma. Busy with raising her grandchildren, a little more than 3 years went by before she sought attention for her symptoms and was diagnosed. Despite aggressive treatments with chemotherapy and radiation, her diseased progressed and she was considering undergoing a bone marrow transplant. Climbing the stairs to the apartment one afternoon she became very short of breath and collapsed. Her twelve, year old granddaughter called 911. At the hospital she was minimally responsive and in severe respiratory distress. She was intubated and transferred to the ICU. A family meeting with the oncology and ICU team was called to discuss Mrs. Thomas’s advanced condition, the fact that she would probably not survive further treatment for the lymphoma and to develop a plan of care. Fifteen family members arrived, including her daughter, pre-teen granddaughters and grandson, three nieces, four nephews, several friends from her church and the minister. On being asked that only the immediate family participate in the meeting, the family and friends became angry and insisted that all of them be involved in this discussion.

1. The students should focus their thoughts on the dynamics of this family meeting. If you were the nurse in this situation, how would you address meeting? Here are some questions that may help your thinking. What is your impression regarding this scenario? What are some concerns you have with this case? What do you anticipate would happen? How would you handle all the family members and friends wanting to be included in the discussion? There is not right or wrong answer. But remember you need a professional journal to support the discussion.

2. Now think about you being the patient. How would the situation be handle within your family? Have you thought about what kind of care you would want? Does someone know what you would want if you had a catastrophic event? Would family members support the decision maker’s decision for for you?

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