Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

'I'm Just Not Interested in Eating': When Nutrition Becomes an Issue in Palliative Care

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

'I'm Just Not Interested in Eating': When Nutrition Becomes an Issue in Palliative Care

Article excerpt


Miriam is a 67 year old woman, recently retired from her secretarial position. Much to their children's surprise, she and her husband Gerry, had undertaken a lifestyle change, selling their family home and moving into a retirement village, by the sea. Gerry had also retired from his job as a builder, but appreciated the large garage that afforded him the space to continue his woodworking hobby, a space he happily occupied for most of the day.

Miriam had been living with chronic back pain for many years, mostly treated through chiropractic and complementary therapies. Since her move, however, her back had become increasingly painful, severely limiting her walking and other activities. The chiropractor suggested further investigation, which eventually revealed spinal metastases secondary to primary breast cancer. Miriam was informed that her disease was too advanced for surgery, but that chemotherapy followed by the option of radiotherapy would provide symptomatic relief. She became a day patient at her regional cancer centre and underwent her first dose of chemotherapy.

Miriam arrived home and slept for the rest of the day. Despite being provided with antiemetic medications, the next day she experienced severe vomiting and constant nausea; these symptoms persisted for almost a week. Gerry, while a pragmatic man in his own way, had always relied on Miriam to do the cooking, was now suddenly challenged to take on the role of carer and cook. He recalled all of Miriam's favourite dishes and frantically tried to recreate them, thinking this would encourage Miriam to eat, but she kept saying: 'I'm just not interested in eating'. He cooked large quantities, thinking that Miriam could eat what she wanted and then he would freeze the rest, meaning that he only had to cook every few days. Neighbours and the children also assisted in the provision of casseroles on a regular basis; but Gerry quickly tired of the same food. Gerry relied on Miriam to take her own anti-emetic medication; after all she had always been in charge. He also felt inadequate in the face of the limitations of such a previously strong and contained woman.

After a week or so, Miriam's symptoms receded and her appetite returned a little, but her disinterest in eating persisted. She now faced a lengthy period of six weekly doses of chemotherapy and needing to cope with these difficult side-effects of anorexia, nausea and vomiting. Gerry was quite panicked looking forward, and frequently described his inadequacy to Miriam and the family.

Gabrielle, the retirement village nurse visited one day when Gerry was desperate, as Miriam had not eaten for twenty-four hours. Sensing immediately, Gerry's discomfort in the kitchen, she quietly talked to him about the needs he perceived in the situation. She discussed the importance of not overloading Miriam with too much food, but offering a little food often; and the overriding importance of fluid maintenance, as well as calorie loading easily digested foods. She suggested Gerry seek outside support in providing meals; in the area, there was choice of a private service or the local Government meals on wheels. Gabrielle also requested that Gerry become more assertive with the family about what meals he really wanted from them. She enlisted another resident of the village to take Gerry shopping, to show him the variety of frozen single serve meals available. Another woman in the village offered to stay with Miriam on a regular basis, while her husband and Gerry had a game of golf and lunch afterwards. Gabrielle also contacted the local palliative care service, seeking their advice about what she was suggesting.

Miriam's treatment continued and she went up and down with each cycle. By the fourth cycle, the Oncologist informed Miriam that liver metastases had appeared, meaning that the treatment was not working and the disease was progressing. Miriam had sensed this for some time and was almost relieved that she could cease the difficult chemotherapy. …

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