Sunday, July 23, 2006

Unintended closure

Emotionally she was worn down. Just weeks earlier, and very unexpectedly, her father, who lived continents away had died. She made the trek to mourn, but being so far away missed the official funeral ceremonies.  She returned to the states to continue her duties as a resident in my residency program. It was evident she was hurting, feeling guilt for not being by her father's bedside in death.  As a Hindu, her faith gave her no hope for closure.  And yet, how mysteriously God works...

She was working in the ICU after her return.  A tough month regardless, but compounded by her emotional instability.  Mr. J was an elderly lung cancer patient in her care. All knew he was close to his end. On this particular night, all signs pointed to this being the time. All day he had been inquiring about the arrival of his only son. He made it clear he wanted to tell him goodbye.  Sunitha, my friend, knew all to well how important it was for both of them.  His son arrived mid afternoon, and was by his bedside constantly.

Around 8 o'clock Sunitha came again to check on her patient, Mr. J's son decided to head to the vending machines to grab a snack and something to drink. He walked from the room and Sunitha inquired about those medical things like pain and anxiety.  Suddenly as the two talked, Mr. J looked at Sunitha and said, "The time is now, I'm dying." Sunitha in a panic looked for the son, wanting to escape and get him back in the room.  Mr J, however, looked Suintha in the eyes and quietly asked, "Please don't leave. Will you just hold my hand and say a prayer for me".

In that moment, Sunitha the Hindu, took this dying man's hand and though not clear on what kind of prayer this man wanted, she opened her heart to God on his behalf. She tells me that it became her father's hand that she held. She wept and told her father goodbye.  Such a profound peace and closure came over her as Mr J slipped away.

The timing of his death, though seeming to be at the worst time - in those minutes his son had stepped away, was perhaps perfect in a grander sense.


Saturday, July 22, 2006

Abuse

I don't mean for all of my tales to be sad, but it's the extremes that have stuck out these first few weeks. Here's another psychosocial dilemma.  What do you do if you're dying at home on hospice and your spouse is abusive? It's hard to "leave" as we encourage in other situations, when you are trapped in your bed dying of cancer.  This was the predicament of a woman I admitted yesterday.  In her case, coming to the "house" was a safety issue.  So now, he's not allowed to come and visit, and she hopes to end her days not being threatened or abused.  

Tuesday, July 18, 2006

Things to do

I had a bit of a shock yesterday with one of my patients.  He is a 41 year old who had a very swollen left leg.  His upper thigh was tight, red and very painful.  Without my prompting he said he had noticed it was hard to breath the last few days.  The combination of these complaints will send off warning flags in any medical provider. His leg and breathing shouted blood clot.  Worse than that, he could have a piece of the clot sitting in his lungs.

I calmly told him my suspicions, and the plan to admit  him to the hospital to do the tests we needed to see if this was indeed a clot. I was shocked then, when his blank stare ended and he shook his head and said "nah" like he was turning down a request for an extra slice of cake.

"I don't think you understand what I'm saying" I explained. "If you walk out of this clinic, that clot could dislodge and go to your lungs and instantly you'd be unable to breath, and could die"  I say this trying not to sound condemning.  He again just shook his head and said "we all have to die sometime".

There's not much else to do in these situations. I tried exploring the reason WHY he didn't want to come in- but no real reason was apparent besides "I've got things to do at home" He did add, "I guess I could come in some other day" Sure, I thought, when it's convenient for you to save your life, we'll talk.

I ended up having him sign something called an AMA paper.  It's a document protecting me in case he dose drop dead once he gets home. He signed this document that says he knew he was leaving against my advice.

What keeps playing in my mind is the eerie similarity of this encounter to one I had when I worked a month in Papua New Guinea 3 years ago. A man about his age had come to our hospital in the highlands of new guinea with what seemed to be clearly a blood clot.  I recall having a similar conversation with this man about coming into our meager hospital for treatment and having him refuse.  He had things to do at his village.  Death was a real possibility, and just like my patient, he made some comment about the time to die coming for everyone.  At the time I attributed his insolence to the ignorance of the new guinea people.  I was shocked at the carelessness of his attitude.  Now I know, it's not something immune to a developing country.

I know we do all have to die sometime, but it seems irresponsible to play rush and roulette with that life!