Mrs. Thomas is a 56-year-old female with a history of breast cancer. Three of Mrs. Thomas’s five
female relatives died before the age of 50 from the same illness. After identification of a malignant
mass in her right breast one year ago, Mrs. Thomas underwent a right mastectomy with the
removal of five axillary lymph nodes, followed by chemotherapy and radiation therapy. She
subsequently suffered moderate lymphedema and pain in her dominant right arm. At that time, the
BRAC (Be Ready Against Cancer) analysis was positive, revealing a higher than average chance of
the disease recurring.
Six months ago, Mrs. Thomas felt a pea-sized, hardened lump in her left breast. A biopsy was
positive for malignancy. She underwent a second mastectomy with chemotherapy and radiation.
After treatment, the cancer was found to have metastasized to her lungs, and further surgery was
not determined to be a viable option. She has been given a poor prognosis for recovery, and
palliative care is now recommended.
After the last chemotherapy, Mrs. Thomas experienced a moderate degree of pain on most days.
Even though she had been prescribed Vicodin (hydrocodone/paracetamol), Mrs. Thomas endured
the discomfort without pills most of the time because she says she did not want to become
"addicted to drugs." Lately, however, her pain level has been increasing and she spends
much of the day crying in bed. She can no longer hold the clerical job that helped to supplement
her husband’s income, and they find it difficult to make ends meet, even though she is receiving a
small disability check each month. Mrs. Thomas has medical insurance but no long-term healthcare
insurance. Since all of her close female relatives have died, she has few people to help her. She
does not want to call on friends or coworkers for support.
Mrs. Thomas lives with her husband of 31 years in a private home in the suburbs of a large city. Mr.
Thomas has suffered from chronic depression that has been managed with medication. He is a
police officer who is extremely supportive of his wife and is attempting to provide for her care at
home. However, Mr. Thomas is now showing increased signs of depression because of difficulties at
work and because of the stress of his wife’s condition. He often forgets to take his medication
due to the stress. Mrs. Thomas has become concerned because she fears he is suicidal. This, in
turn, is causing Mrs. Thomas even more distress, as she feels her husband is suffering because of
her illness. Because of Mrs. Thomas’s condition, the couple does not go out and does not have
friends over to visit.
Mrs. Thomas has two sons, aged 28 and 30. Both live out of state with their wives and children and
are very upset about their mother’s condition. Even though they phone regularly, they find it too
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