A story of someone, and the people around him

Every time I walked past his room, I caught him at the corner of my eye. His face was like a human skull with living, brown skin growing on it.

20.Oct2008

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Tell me what you think.

We asked him if he still wanted active anti-retroviral treatment, and every time he would nod his head very weakly, almost drifting asleep in the process.

Clearly and dearly he was clinging onto his life – and why, you could almost ask. Certainly many of the nurses did. He had no friends that we knew of, and only one next-of-kin apparently – a cousin in a nearby town, but even she had disowned him one month ago… No longer wanted to be informed about him, no longer wanted anything to do with him.

“Why are we still treating him!? Can we put him on the LCP already?” some of the nurses would say, day by day. I have heard it so many times that I got a little annoyed.

And one day, when he became totally unrousable but his lungs still softly breathing and his heart still faintly beating, we finally decided to commence him on the LCP.

Then suddenly, as if from nowhere, more and more “family members” and “best friends” started appearing in his quiet room, sitting and standing by his bedside. Before this, we have always thought that he was lonely, with no friends or family.

I wondered, too, if he even knew that they visited him. He passed away shortly after. He is now fading in my memory.

He had late-stage AIDS, but that is not all. This is the story of someone during the last periods of his life, and the people around him. It is a sad story, I think.

Shouldn’t it be the other way round

Her beloved husband wasn’t faring that well. For the past many years, due to PSP, he hasn’t been able to comprehensibly articulate more than a few single-syllable words, but even so, she found no problem communicating with him everyday. Right now, he had a bad pneumoperitonium, in addition to an aspiration pneumonia that didn’t seem to get better. Her beloved husband wasn’t faring that well.

30.Jun2008

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Tell me what you think.

We discussed with her about resuscitation in the event of a cardiac or respiratory arrest. The chances of us being successful, in her husband’s case, would be small. Even if we were to succeed, the quality of life gained back would likely be much reduced too. So carefully we asked if she would still like for us to attempt a full resuscitation on her husband, if that were the case.

“Yes,” she replied with resolve, but her voice flickered a little afterwards. “We’ve discussed this before. I want full resuscitation for my husband. …We believe in God.”

What a difficult situation she must had been in.

Yet later, in the ward office, when we were thinking again about his resuscitation status, the elective student in our team echoed out my thoughts better than I could express myself – if they believed in God and His timing, “Shouldn’t it be the other way round?”

But perhaps many times we won’t know for sure. Tell me what you think.

I should have been kinder to her

She frowned with worry. Her elderly hands were lightly rubbing on her abdomen. “But this pain… can you do something, dear?” she pled.

7.Jun2008

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Tell me what you think.

How I wish the answer could be an easy and confident yes with a sparkling smile. Then and there I wasn’t even sure about the exact cause of her complaints. It could be something relatively simple, or it could be something fatal too, especially in view of her co-morbidities. Co-morbidities – oh she definitely had a number of those, not the least of which was end-stage renal failure on CAPD.

I had thirty minutes left to go before the end of my seemingly everlasting night shift when I was called to see her. I struggled by her bedside to decide whether her symptoms warranted immediate investigation and aggressive intervention.

“What should I do?” she asked me. Her hands grabbed onto mine, as if not wanting to let me leave. But I had to.

“I’m not sure what’s going on, but we’ll do a blood test to help us find out what’s going on. And I’ll get your nurse to give you some pain-relief now, okay?”

“But what should I do in the meantime?” she asked again.

“Well, it shouldn’t be too long, okay?”

She was talking fine – she wasn’t cringing and shouting. Her abdomen was soft – she wasn’t jumping when I touched her. Her vital observations were still within normal ranges. This wasn’t severe pain, I thought – maybe she was a little too anxious. Maybe. Peritonitis in CAPD is the important condition to exclude, but it didn’t seem to be too pressing at this stage.

I sent for some blood investigations to be done. I handed-over for the morning house surgeon to not delay in reviewing her. I expressed my concern that there there might be some sinister pathology going on – although none overt so far.

The morning house surgeon never got to see her alive, though. She died two hours later.

Could anyone have predicted? Did I do something wrong? About this I have thought for a long time. I remember being warned while in medical school about the inevitability of these questions. Of course I could have done better; I wish I had the experience to pick up the subtleties – oh I hate it when this happens. But if the deterioration was that fast – I wonder if the outcome could have been changed much.

Still, the worried, anxious face she gave me when I walked away haunts me greatly. I should have been kinder to her. There is no excuse. Really, I’m sorry.

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