Case 2: Mr. Ash

Provider

History

Mr. Ash is a 64–year–old black male with a history of lung cancer. He is currently on home O2. He presents with increasing Pain in his chest and bones. He is on Oxycontin for pain. He is also complaining of increased fatigue. He has no history of alcohol problems in the past.

Physical Exam and Work–up

He is cachetic, looking older than his stated age. He has had all the chemotherapy that he can have and is end stage at this time. There is nothing new on his x–ray or labs. His O2 saturation is stable at 93% on 2 liters of O2.

Alcohol Screen

He is drinking increasing amounts of whiskey, he is unclear how much. Probably, at least half pint each day.

Physician Advice

You believe that Mr. Ash is self medicating himself with alcohol. However it makes him fall asleep during the day, and then not sleep well at night. You wonder if he is able to take his Oxycontin on time, and perhaps that is why he wakes up in more pain. You really want him to try a period of abstinence at first, but if not willing you want him to cut back to 1 or two shots per occasion at the most.

Patient: Mr. Ash

History

You are a 64–year–old black man who has been suffering from metastatic lung cancer for several months. You are tired of it all, now the pain is increasing in your bones and lungs. You have been using home oxygen for several months now and you have these pills, Oxycontin that you are supposed to take regularly every 12 hours and you have some others you can take in between. You have been drinking more to dull the pain, and you life. You drink maybe a half pint or more of whiskey each day. You have never had any problems with alcohol before. There are days when you do not drink, because you have run out and you do not have any withdrawal problems.

Negotiation

You are not too ready to stop drinking at this time. After all what do you have left, you quit smoking already and this helps dull the pain. However, you are interested in what the doctor has to say about your pain. Perhaps falling asleep and missing your scheduled Oxycontin is causing more of a problem. You chose a 4 on the 1–10 scale because of that and will consider cutting back.

Patient Goal

You will agree to 2–maybe 3 drinks each day.