Meet Sarah - a 63 year old white British female diagnosed with Stage 3 lymphoma

  • Lives with her husband, 65 who is retired and has manic depression
  • Own their own cottage in a small Gloucestershire village.
  • Sarah is a shepherdess with her own flock of sheep.
  • She has three sons and a grandson and granddaughter.
  • Sarah diagnosed with Stage 3 lymphoma initially for active treatment but after 3 cycles of chemotherapy there has been no improvement
  • Sarah had been caring for her mum (sleeping at her house overnight) up until her mum died and then Sarah was diagnosed. Sarah has had symptoms for a year
  • Sarah was an Independent and active country person who up until she fell ill was “bale bumping” and able to mange to care for her sheep and home
  • She was also worked part time as a freelance decorator.
  • Main carer for her husband whose mental health varied. 

Important to Sarah

  • To be able to stay in my own home with my husband.
  • To live in the Gloucestershire area, close to family and be in the country.
  • To know my husband will be cared for
  • To be able to be independent and be able to look after my own home.
  • My flock of sheep and my dog.
  • Being part of my grandchildren’s lives and teaching them about rural life.

Daily Living

  • Sarah has been struggling with her daily activities of living and is becoming increasing dependent on her family for support.
  • She has bouts of urinary incontinence and now has to use pads.
  • Since her last admission to Hospital her mobility has decreased so now he is only able to walk from the chair to the commode
  • She was discharged with minimal support, the family organised a recliner chair
  • Sarah is becoming increasingly physically frail but still able to climb the stairs to sleep in her own bed

Health Conditions, medication and provision

  • Up until her diagnosis nil of note.
  • Treatment consisted of chemotherapy.
  • Had two emergency admissions to the local oncology unit following acute infections which affected her mobility and independent living
  • District Nurse Support in place.
  • Sarah has been prescribed analgesia for bone pain (fentanyl patch) but is poorly managed and problems highlighted with application (duplication of administration of patches)
  • Sarah has been courses of steroids for her shortness of breath and is experiencing side effects (Cushing Syndrome) that is affecting her well-being and self-esteem

Resources and assets

  • Sarah has a small cottage that she lives in with her husband and her dog
  • Has supportive family who live fairly locally. The three sons (and daughter-in-law) visited daily to support
  • Sarah is quiet and reserved (stoical) but is a friendly, polite person with an amazing sense of humour.
  • Sarah was placed on the Gold Standards Framework register, following the oncologist discharge letter
  • The community/district nurse visit once a week

Concerns and questions

Sarah is able to communicate with her son-in-laws, mother-in-low who was a Nurse, how frightened she is of dying

Sarah’s concerns and questions

  1. What is my prognosis?
  2. How will my husband manage?
  3. Who will look after my flock of sheep and the dog?
  4. How can I leave my legacy behind?

Professionals concerns

  • Employment –  Sarah was able to be finically independent working as a decorator but now is reliant on her husband’s benefits to bring in an income to pay for her additional support
  • Social Network- Sarah had previously socialised within her work connections and spent time with her family only.
  • Family contact Sarah’s role within the family was that she was the “head” and her sons and husband relied her to keep their lives in order. She was a carer for her husband. Sarah is now independent on her family to support her and she is unable to talk to them about how she feels.
  • Daily living -Sarah is struggling to maintain her independence and trying to be strong for her family, she feels the roles have reversed
  • Sarah’s sons and husband are struggling to accept outside support although the community nurse has started to build up a relationship with the family, even although they are becoming increasingly tired caring for her. Personal care is being provided by her daughter-in-law
  • OOHs were being called to support incontinence needs as the husband was unable to manage at night