Bedside Lessons – 18b. A troubled young man Part 2

Photo by krakenimages on Unsplash

His blood test results came back and were unusually good, the blast cells were reduced in numbers compared to on admission. Bloods were repeated weekly, and they continued to improve, to the point that there were no longer blast cells present at all. The Haematologist was contacted about this unexpected finding. She was surprised as his blood tests hinted at something that they had never been able to achieve before. Was this a remission?

A bone marrow biopsy was urgently organised, and revealed a pre-Christmas miracle – remission was confirmed. Somehow his disease had been controlled, by what we all did not know. Plans were hastily made for our patient to undergo a bone marrow transplant, with everyone’s hopes raised that it would lead to longer term control.

Our patient had mixed emotions, since he had become sick this was the first time that he had received good news, and he didn’t know how to handle it. He didn’t celebrate his remission as much as his family and clinicians did, as he couldn’t totally believe it. He was discharged home to his family’s rented home for Christmas together, with everyone hoping that a better year lay ahead.

In the New Year things had changed again. He had gone in for further testing and then had collapsed. The leukaemia which had settled down prior to Christmas had come back strong.
He developed a fever and had to be admitted into hospital and started on intravenous therapies, which did not work.

We were contacted and we re-admitted our patient for likely end of life care. On their return he and his family were glad to be back. He was really unwell, and it looked like he was about to die of his illness. He was barely able to respond to us, but appeared to recognise us and knew where he was.

The next day he looked a bit better, and the day after he had also improved. There was something about our hospice environment which allowed him to go from almost dying, to almost living again. Something in the water? Or just a less stressful place to be, himself.

Feeling better he was able to communicate to his family, his wish to go back with them back to the family home. He wanted to see his grandmother again, one more time. That would mean an eight-hour flight overseas.

Having had some experience with sending people home I called my network and we hastily made arrangements for him to travel, all of the time unsure if he would actually make it. It was his dying wish to be with his family, together in their home.

We said our goodbyes as I walked him out to the ambulance, wishing him well. Over the weeks we had known each other we had shared many laughs together, especially when his Uncle had also been around.

The trip home went well and he was reunited with his grandmother and other family members.
We received news about ten days later that he had suddenly deteriorated and had died in hospital.

Lesson learnt:

Clinical handovers are important sources of information and are necessary in order to provide continuity of care. They can also be sources of bias. Hearing about what had happened in the past and the troubles that he had been in, set up a negative impression of the man that we were about to meet. Prejudice developed even before we meet the person. The guy we actually met always treated us with respect, and I think he felt safe at our place.

There was something about the therapeutic environment of the hospice which had brought him back from the brink of death twice.

Although he had drifted apart from his loved ones, in his time of greatest need they had all been there for him. A strong desire to go home with his family was present, even though he had never been to that home before.

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