| 4 | 0 | 0 | 0 | A 65-year-old woman with metastatic squamous cell carcinoma of the nasopharynx admitted because of dysphagia. The patient received a percutaneous endoscopic gastrostomy tube for feeding. She experienced worsening episodic chest pain and dyspnea that worsened over the next 5 weeks that was treated with narcotics as needed and then continuous narcotics. The chart documents that the patient appeared in distress on numerous occasions, but because of a language barrier, it was difficult to know what symptoms she was experiencing. The patient died after a period of agitation and apparent distress that was treated with more narcotics. |
| 2 | 5 | 0 | 0 | An 84-year-old man with metastatic renal cell carcinoma was admitted with delirium secondary to hypercalcemia. He was given intravenous fluids. The patient began experiencing flank pain and dyspnea. Initially, every recorded episode was treated with narcotics, but the following assessment documents that the patient was still complaining of pain. The patient was getting frustrated with the poor pain control. The patient had increasing dyspnea that was treated with benzodiazepines. He died after 3 hours of increasing dyspnea. |
| 3 | 0 | 4 | 0 | A 62-year-old woman with metastatic esophageal cancer presented to hospital with diabetic ketoacidosis, acute kidney injury and malignant ascites. The ketoacidosis was treated, and the kidney injury resolved. The patient was waiting to go to hospice, but developed worsening abdominal pain and severe agitation that was treated with phenobarbital. The phenobarbital was titrated up until the patient was obtunded but calm. The patient passed away shortly after. |