Mr. M is a 54 year old man admitted to your service with abdominal pain, nausea, anorexia and a 15 pound loss over 3 months since diagnosis of a locally extensive and unresectable pancreatic cancer. He was treated with radiation therapy and 5-Flourouracil over ensuing 6 weeks after diagnosis. He was also begun on MS Contin 60 mg twice daily and MSIR (immediate release morphine) 30 mg orally every 4 hours as needed. He is now re-admitted to the hospital with increasing abdominal pain and nausea. He has had scant amounts of loose to watery stools during the past week. As you enter his hospital room to evaluate him, he appears agitated and red-eyed.
Mr. M: “I have been through all you people’s recommended treatments, and I am still in pain and not getting better. I can’t live like this. What is wrong with you people? Can’t you get it right? I take this pill it makes me feel like crap, I take that pill and I am out of it and can’t function - I can’t even watch T.V. for crying out loud! Nothing helps my pain, and it keeps getting worse. I am nauseous all the time, I can’t eat, sleep, I can’t do anything! And now here I am - what are you going to do to me now!”