Aimee,
Wow, you have already done great work. You built enough trust that he agreed to return. This is an incredibly complicated situation, so I would break it into small steps. By the end of this post I think you will know why his brain is flight out of the survival responses of fight, flight, or freeze.
Stabilize his body first.
Ask for a formal addiction medicine consult along with palliative care or a cancer-pain specialist. Fentanyl withdrawal, opioid tolerance, cancer pain, fear, and other medical factors are all overlapping. He needs specialists who can treat the addiction, cancer, and cancer pain all together, not as separate problems.
Give back as much control as possible.
In my nursing experience, anger was often the visible layer covering fear and loss of control. Offer small, genuine choices whenever possible. Even small choices can help someone feel like a person again.
“Would you rather talk now or after you rest?”
“Would you like me to stay while the doctor explains this?”
“Would you like to focus on today’s plan or tomorrow’s plan?”
Speak to the here and now.
When someone is in severe pain, withdrawal, fear, or survival mode, warnings about what might happen months from now mean very little. His brain may only be thinking, “How do I get through this moment?”
Try:
“Let’s concentrate on getting you through today.”
“What is making this feel unbearable right now?”
“What would make the next two hours more manageable?”
Do not turn leaving into a power struggle. It is his right to choose.
If he wakes up wanting to leave and has the ability to make that decision, be honest without judging or shaming him:
“I really want you to stay because I am concerned about you. I also hear that you want to leave. Before you go, can we make a plan so you do not have to start from the beginning when you are ready to come back?”
Give choices:
“Would you like me to schedule the next appointment, or would you rather we have someone call you?”
“If you leave today, may I call you tomorrow?”
Most importantly, let him know the door remains open.
Build one coordinated plan.
If possible, have an oncology navigator, addiction specialist, pain specialist, cancer specialist, case manager, social worker, and recovery specialist, and yourself as the person to coordinate the pieces.
He may feel as though he has failed at life, failed because of the addiction, and now his body has failed him too. Addiction is a medical condition, not a moral failure. His response to this overwhelming cancer situation may be dangerous, but it is also understandable.
The immediate goal may not be getting him to commit to months of treatment. It may be helping him feel safe and in control enough to take the next step.
When I was an oncology nurse, I cared for patients in similar situations. It can be a long roller-coaster process with plenty of ups, downs, side-to-sides, and even a few pirouettes. This is a tough situation for your patient and for you.
Please reach out if you want to talk through any part of it. I am happy to help.
Sue
Hello, I have experience with diabetes and dementia and I work with people virtually. I do free 30 minute Discovery calls. I am not located near Chicago however meeting over Zoom works well for a lot of people. Please reach out if I can help. Thank you, Sue Adair.
I’d be happy to help with this. FMLA can feel like a big and confusing process, and I can help break it down into clear, manageable steps. I can educate the client about the process, help them prepare questions and possible wording for conversations with their employer and healthcare provider, and support them in feeling more confident as they navigate it.
I'm a nurse of 28 years and my specialty is working with healthcare professionals over 50, and I’m also comfortable helping clients outside that specialty. Please feel free to reach out, I’d be glad to talk with you. 😊
Wow, you have already done great work. You built enough trust that he agreed to return. This is an incredibly complicated situation, so I would break it into small steps. By the end of this post I think you will know why his brain is flight out of the survival responses of fight, flight, or freeze.
Stabilize his body first.
Ask for a formal addiction medicine consult along with palliative care or a cancer-pain specialist. Fentanyl withdrawal, opioid tolerance, cancer pain, fear, and other medical factors are all overlapping. He needs specialists who can treat the addiction, cancer, and cancer pain all together, not as separate problems.
Give back as much control as possible.
In my nursing experience, anger was often the visible layer covering fear and loss of control. Offer small, genuine choices whenever possible. Even small choices can help someone feel like a person again.
“Would you rather talk now or after you rest?”
“Would you like me to stay while the doctor explains this?”
“Would you like to focus on today’s plan or tomorrow’s plan?”
Speak to the here and now.
When someone is in severe pain, withdrawal, fear, or survival mode, warnings about what might happen months from now mean very little. His brain may only be thinking, “How do I get through this moment?”
Try:
“Let’s concentrate on getting you through today.”
“What is making this feel unbearable right now?”
“What would make the next two hours more manageable?”
Do not turn leaving into a power struggle. It is his right to choose.
If he wakes up wanting to leave and has the ability to make that decision, be honest without judging or shaming him:
“I really want you to stay because I am concerned about you. I also hear that you want to leave. Before you go, can we make a plan so you do not have to start from the beginning when you are ready to come back?”
Give choices:
“Would you like me to schedule the next appointment, or would you rather we have someone call you?”
“If you leave today, may I call you tomorrow?”
Most importantly, let him know the door remains open.
Build one coordinated plan.
If possible, have an oncology navigator, addiction specialist, pain specialist, cancer specialist, case manager, social worker, and recovery specialist, and yourself as the person to coordinate the pieces.
He may feel as though he has failed at life, failed because of the addiction, and now his body has failed him too. Addiction is a medical condition, not a moral failure. His response to this overwhelming cancer situation may be dangerous, but it is also understandable.
The immediate goal may not be getting him to commit to months of treatment. It may be helping him feel safe and in control enough to take the next step.
When I was an oncology nurse, I cared for patients in similar situations. It can be a long roller-coaster process with plenty of ups, downs, side-to-sides, and even a few pirouettes. This is a tough situation for your patient and for you.
Please reach out if you want to talk through any part of it. I am happy to help.
Sue
I'm a nurse of 28 years and my specialty is working with healthcare professionals over 50, and I’m also comfortable helping clients outside that specialty. Please feel free to reach out, I’d be glad to talk with you. 😊