Throughout the day James’s pain increased and by early evening he described it as 9 on a scale of 0-10. I called the oncologist’s office and received a callback from the doctor on call. She consulted with palliative care (pain management even though it sounds like hospice). They said it was safe to increase his hydromorphone pills. Those are supposed to be “as needed” since he has a fentanyl patch, but he needs them on a regular schedule. He is now taking twice the dosage daily that he was getting in the previous weeks. The pain nurse we usually work with said he would need to go to the emergency room if the pain couldn’t be controlled.