Pain management is a lot like creating a recipe which you know in advance has to change regularly. Today, for instance, the recipe includes a ratio-Fentanyl transdermal patch which administers the drug continuously at a rate of 100 mcg/h. In addition to that, there is an optional "breakthrough" morphine, delivered in bolus infusions at a rate of 30 mg/ml (15 mg) per 60 minute maximum by means of a PDA pump administered directly by the patient "on-demand".
Every day, I meet with a member of my pain management team so that we can review side-effects of the "recipe", the "butterfly" sub-cutaneous injection point, the PDA pump being used, the amount of "breakthrough" morphine being used in the previous 24-hour period, and so on. In addition, we review my sleep patterns, bowel functioning, appetite, urinary functioning and anything else that has arisen as an "issue" during the past 24 hours.
For example, we continue to monitor late afternoon and evening spikes in body temperature. Currently, my wife and I are able to deal with these spikes using cool cloths, removing clothing and bedding, sipping ice water and popsicles, drinking lots of water and cool fluids, and then finally relenting to the use of Tylenol when all else fails. In all cases thus far, the temperature will decline to a reasonable measure by bedtime.
What all this illustrates is that the recipe changes regularly, sometimes as frequently as every 24 hours (if you include the optional bolus infusions of morphine, then every hour).
But when the recipe is in good order, and the side effects are minimal, the work of the team declines to a quick daily monitoring which can often be conducted over the phone via a quick conversation with the nurse. At that point, other recipes take centre stage.
One of the nurses who works at our regional cancer centre's oncology unit in the hospital is a friend who we have known for many years. She is the master of what she calls the "hot soup and hugs" treatment plan. A couple days ago, she came to our house to deliver the treatment - home-made hot soup, bread, and hugs for all. From years of experience, she is convinced that the hot soup and hugs treatment plan is effective. I have to agree.
Another very good friend dropped by with a turkey pie from the Stone Crock in St. Jacob's and some muffins for our sons. Again, his recipe is a simple one - a little food and an excuse to share war stories about our various ailments. In a way, his recipe is about guy hugs.
What all these recipe stories illustrate is just how much the cancer patient needs both the professional and the personal, the medicines and the hugs, the prescriptions and the conversations. We need both and I wouldn't want to be the one who had to decide between the two.