A week later and I had to keep my promise, to prove that they were not just empty words.
I’m sorry that things are changing so quickly, that you are losing even more control.
The reason that you have been vomiting is that the cancer has caused a blockage in your guts, it’s really bad.
Is it going to get better?
We can try a medication which might dry up the vomiting, but I don’t think the blockage will clear. This is a dangerous situation, you probably won’t recover from this.
Could you decrease the pain relief? It’s making me too sleepy. I want to be awake for my son.
Okay, but if your pain gets bad, we might have to go up again.
The next day his vomiting had decreased but his pain was worsening. I was confident that I could improve his pain control, with a simple increase in medications but it would likely make him sleepier.
He could handle the physical pain even though at times it made him cry. Losing clarity, not being present as much as he could be for his son could not be tolerated.
I don’t want the doses in the pump changed, if there’s nothing else you can do for me, I’d rather spend my final time at home.
I understand, I’ll get out of your way.
It’s not like that man, I need to go home, to be with my family.
He went home and lived for another ten long and mostly uncomfortable days.
Some days were better with meaningful time spent with family, other days were spent screaming in agony, both physical and existential.
Right until he died he remained steadfast in sticking to the choices he had made, to be as present as possible, and choosing to tolerate pain.
I am not a religious person but I found myself praying each night to his God, for his death, in order for him to be released from suffering.
It was with some relief that I heard that he had died overnight.
Thus ended one of the toughest cases that I had ever dealt with in my 22 years of working as a doctor.
I found it really hard to support the choice he made, but he was clear-minded and able to make his own decisions for himself. I had promised that I would listen to him, and that I would support his choices.
He chose the hard road, despite my trying my best to convince him otherwise. I had to keep my promise to him, to let him control the end of his own life.
The night before he left our unit, I wished to myself that he would become delirious and unable to decide for himself anymore. Instead, he looked me clearly in the eyes and showed me that he was still there, was still competent and wanting to choose his own destiny. He had to do what was right for him.
True patient centricity can be really hard sometimes, it can be really hard to support patients’ choices. When what you offer from your strong desire to help is rejected.
It was so hard to bear witness to your suffering and to not do something about it.
But it is not about me, it’s about how I can help you.
Sometimes I may have to get out of your way to allow you to take control of your situation.
To allow you to do the right thing for yourself and your family.
I may not always agree with the choices you make, but I will fight as hard as I can for your right to make those choices.
Rest in peace Bro.
Been there, it’s agonizing, isn’t it. when you are very confident that you can control symptoms with medications but the patient does not want you to….
I take the same approach of respecting the patient’s wishes, of course, but it is painful.
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It can be really hard for the rest of the team to accept. To walk alongside suffering. Us clinicians are only involved in a patient and their family’s life only briefly and then we are gone. The patient and those who survive them have to be able to live with the consequences of their choices for much, much longer, and they have to do the right thing by themselves, if given the opportunity.
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