In October, 1995 the author (NR) was completing a clinical rotation with a physician in a rural comunity as part of his Physician Assistant Training. His responsibilities included covering the Emergency Room in the hospital and helping the town physician at his three clinics, an Emergency Room call was shared with a medical student and the hospital and clinic rotation was for five weeks. A week into the training, a home health care agency nurse visited the clinic and asked if the a medical student or the author knew of a treatment that could help a "terminal" breast cancer patient with pain control, She said the patient had cancer for several years and the latest bone scan showed that the cancer had metastasized to "nearly every bone in her skeleton." She was particularly worried about pain from a merastatic lesion in the the patient's left upper arm. The patient was taking I.V. morphine for pain and needed sublingual morphine to cope with pain associated with getting up and going to the bathroom.