BS (Bahamas) Phalloplasty

The assessment and management of an acute pain crisis in the setting of advanced illness is challenging. Using the case of Mr X, a 33-year-old man with advanced metastatic mucinous adenocarcinoma of the appendix and "15 out of 10" pain, we explore the issues of acute pain and its management. We define a pain crisis as an event in which the patient reports pain that is severe, uncontrolled, and causing distress for the patient, family members, or both. Our management strategy focuses on making a pain diagnosis, differentiating reversible from intractable causes of pain, and making decisions about further workup; selecting the opioid and monitoring and treating opioid adverse effects; titrating and rotating opioid and coanalgesics; consulting experts to treat a pain crisis as quickly as possible to prevent unnecessary suffering; and co-opting the available institutional resources. The timely intervention of a palliative care team and its expertise can provide the staff, patients, and their families the benefit of an interdisciplinary approach and help the patients address goals of care; understand the benefits and risks of treatment decisions; and meet the psychological, social, and existential needs of the patient and the family commonly seen in this setting.

The populace is predictably friendly and more religious than one might expect: the Bahamas have one of the highest ratios of churches per capita in the world, with Baptists being the largest single group. Local newspapers will reveal religious references by elected officials in a manner that exceeds what would be found in the United States. This devotion does nothing to prohibit the activities of visitors nor is it intended to. There is a very "libertarian" attitude about personal morals.