I Want To Go Home

In the course of seeing patients who need palliative care, we often encounter requests to help patients go home. Home can mean different things. It can mean being at one's house or with loved ones or doing an activity that makes the patient feel at home. Alternatively, home can mean “home land,” especially today when we see patients who emigrate from many countries and who have different backgrounds, cultures, dreams, and histories. Why go home? Because once home, we can be more in control, at ease, and safe. We can decide how to live and conduct our lives. Our home is our castle. But sometimes, we as health care professionals can't get our patients home, even though we desperately want to. Or so we thought.

Mrs. V. is a 66-year-old Filipino with no medical history. Her home is located in a province that is a 4 hours' drive from Manila. She lives with her husband and has 10 children and 13 grandchildren. One of her daughters, Ginny, lives in the United States. Early in 2004, Mrs. V. came to the United States to help Ginny with her 3 children and to work part time to make extra money. Soon after her arrival, she experienced increasing abdominal girth and pain, nausea, and weight loss. She went to the local hospital, where a computed tomography scan revealed several intraabdominal masses. The presumptive diagnosis was ovarian cancer, and Mrs. V. was sent to a tertiary care hospital for diagnostic and surgical evaluation. A biopsy attempt was unsuccessful, and results of laboratory studies were consistent with a diagnosis of pancreatic cancer. Two months later, Mrs. V. was frail, hardly able to walk, laden with ascites, and malnourished (as a result of poor appetite and vomiting). She also was dyspneic (because of pleural effusions) and …