What a disaster I thought, as I listened to the referral. A 44 year old man had become unwell in the Pacific Islands and had been urgently transferred to New Zealand for assessment and treatment. He had an abdominal mass lesion which was extremely painful after having had massive weight loss over the previous two months. He had been a great orator and had been destined to be a future leader of his church. He was married without children.

He and his wife had come over two months ago and things had not been good at all.
He had been diagnosed with a large abdominal mass found to be cancer with spinal cord compression and lung metastases. The impression was that there was nothing that could be done medically for him, and that he should try to return back to the Islands as soon as possible as his condition would likely deteriorate quickly.

Travel arrangements were made for him and his wife to return back home in the following week, but he became acutely unwell before he could finish arranging his journey. A difficult situation, thousands of miles from home, with little in the way of family members or support locally. Displaced, stuck, and also critically unwell.

He was admitted to hospital where they treated him for severe infected intra-abdominal abscess resistant to the strongest antibiotic available. It had ruptured through his skin and was spontaneously draining. Again urgent travel plans were made, for the couple to head home, but again he took a turn for the worse.

He stayed in hospital for a further fortnight, but he deteriorated further. He was then transferred to our hospice for likely end of life care.

We admitted him and got to know him over the next weeks. Right from the start he said that he wanted to go home, that his strong faith would make it happen. I had my doubts and was unsure if he would survive a week with us, let alone be well enough to travel thousands of miles. For whatever reason I chose pain relief options that he would be able to use back home on the Islands.

His condition fluctuated wildly and by the end of the week I was sure that he would not make it through the weekend. But he actually did, and so it continued, heading closer and closer to death, but somehow coming back off the edge of the cliff again, and again.

He again expressed his strong desire to return home, and said that he and the local Pasifika community had been making plans, had been raising funds…

He stabilised and the idea of going home appeared to bring him peace. I was still unsure if he would make it home or not, but was willing to try to help him do so. Tickets were purchased, and I spoke to the airline about his specific needs. They said that they would need either a doctor or nurse escort in order for him to travel. That would be expensive. He would need to book six seats as he could not sit in a chair and a standard stretcher would need to be supported on the equivalent of six standard airplane seats.

All up this would cost $10720, not including the nurse or doctor escort. Unaffordable to most people but the local community fund-raised and the main fundraiser promised that the $3320 that was still needed would be available the day before the trip.

A search was made for an appropriate health practitioner to support our patient on the flight, the best discounted fee for a doctor I found would cost $3800. No nurses were available. Eventually I found someone else with the right level of skill, someone who knew the man and his wife well, and someone with appropriate experience in complex end of life situations. He kindly agreed to waive the usual doctor fee which would enable the trip to happen.

I had volunteered to take him back. I knew his case better than anyone, and I felt that I would be able to look after him well on the trip back home. We planned to fly on Saturday morning and made all of the preparations, including obtaining a month’s supply of his medications that he would take with him as access to medications on the Islands was uncertain.

Many communications were made in order to make the journey as smooth as possible, including to contacts that I had on the Islands.

At 3pm on Friday afternoon, 18 hours before our departure time, I received bad news. The promised community raised funds had not come through. Was the trip to be cancelled because of $3320?

Island-Man: No Way Home?

To be continued…