Carmen Gonzales is a 63 year-old who has been sent home to her rural community of about 1,500 residents from an urban hospital following surgery and chemotherapy for colon cancer. She has metastasis of the cancer to the liver and throughout the peritoneum. No further treatment is being considered. She has only one daughter, a single mom who lives with her three children in an urban community 75 miles away. She tries to visit Ms. Gonzales regularly but, with her job and family responsibilities, cannot come down to the community except on weekends. Ms. Gonzales has no other family. She lives in a small house with her 76 year-old husband, who has barely been able to care of himself in her absence. The community has a part-time clinic staffed 3 days a week by a traveling nurse practitioner. The county health department provides Well Child and Preventive Services at a monthly clinic only. There is a small general store, but no drug store or pharmacy. Ms. Gonzales and her husband retired to the community about twelve years back. They have kept to themselves and have not been active in church or social activities, and have not made many friends. Ms. Gonzales is currently able to take care of herself, cook light meals, bathe and dress, but she is getting progressively weaker. The pain is getting worse and she is requiring increased amounts of narcotic medication to control it.
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