A young man had been discharged home to an uncertain fate. His home was a converted garage, he had no family to support him, they were all located an eight hour flight away. He was reported to be in severe pain, due to his end-stage leukaemia. As he was 26 years old they had tried every treatment available but nothing worked. He refused to be admitted into the local hospital as he had been banned from there after previously assaulting a security guard during an admission. The referral said that he was under the ongoing care of a psychologist as he had “many issues” to deal with, including borderline personality traits, anxiety and anger control issues. We admitted him for symptom control, and possible end of life care.

From what we read we expected trouble, what arrived was a sick young man who looked as if he was about to die. Doubled over in pain from a grossly swollen spleen, he could barely speak to us, but was polite when he did so. We increased his pain medications generously and started high dose steroids to try to decrease his spleen swelling.

He managed to have some sleep overnight, and the pain had improved slightly. We adjusted his medications further, thinking that we would need to do further increases the next day. We were surprised that he was comfortable the next morning, something we had done had worked.

His family arrived from overseas, his father, mother, sister and younger brother had rushed over as they were worried about him.

He was so used to having regular blood tests that he still wanted to have them, and we negotiated that we would do them on a weekly basis. We weren’t sure if these would be of much use. He also wanted to continue his targeted therapy, despite it not having worked up to this point. “Okay as long as it is not causing any harm, you can continue.”

His favourite Uncle had face his greatest fear, of flying, and had made the long trip to support our patient and the rest of the family. The two of them together were truly funny, with gentle and not so gentle ribbing of each other, all day long.

The first blood test showed deranged levels of white blood cells. The next test, showed a slight improvement which surprised everyone especially our patient. What did it all mean?

To be continued.