Palace of Care – Saying No – Part 1

Photo by Debby Urken on Unsplash

In his professional life he was used to taking charge, of taking control and at times this bled into his personal life as well. His wife’s mother was unwell with widely spread cancer, she had been admitted into the hospice for symptom control of pain, breathlessness, and nausea. He had always been close to her right from their first meeting, he was probably closer to her than he was to his own parents, and even called her Mum. She had always been there for her children and their partners, and he really wanted to be there for her. He wanted to make sure that she was treated right, and he had a small inkling that his manner might come across as intimidating, but that was useful in police work. He just wanted to make sure that Mum was being well looked after, it was what she deserved.

She was a Pasifika lady in her early 60s, with end-stage cancer to her liver, lungs, and many bones. She was the frailest patient in our inpatient unit and I was worried that she might be dying. She was well cared for by her family who were always with her. Her husband of similar age, two daughters and a son-in-law, who I found out was a police officer. He had already caused a bit of a disturbance in the unit as he had spoken in an aggressive manner to some of our nurses, and was impatient. The family were all tired, worried about our patient, and stress levels were high. The family members all seemed to defer to the policeman who had taken on the role of family spokesman. The patient was fatigued but had not slept much in the past days because of uncontrolled pain. The first time I saw her I thought to myself that I wouldn’t be surprised if she crashes quickly.

The next day things had changed, Mum became sleepy, and was breathless. The policeman had to do something, he was used to dealing with crises, and his response was usually to take action. To make something happen. He needed to save her, he needed to make sure that she could get the treatment that would keep her alive. He might’ve been a bit short with one of the nurses, but time was running out, he had to get her to the treatment that would save her. Yeah he took control, but Mum’s life was on the line, he needed to save her. He called the intravenous Vitamin C clinic and told them of Mum’s situation. They said to bring her over as soon as possible. Okay, he had a plan, and no-one would stop him from making it happen. What next? He was going to order an ambulance, as there was no way he could get Mum into his car. At that time the doctor walked in.

I was seeing another patient when the nurse knocked on the door and asked me to speak with her. She told me that the son-in-law was arranging to take his mother-in-law across town for alternative IV therapy. I rushed into the room and assessed her. Her hands and feet were cool to touch, her pulse was racing and thready. She did not respond to my voice, she was breathing rapidly, short, shallow breaths. I recognised that she was actively dying. The policeman looked angry, and was trying to tell everyone what to do. He was intent on taking his mother-in-law for her alternative treatment. I could not let this happen and had to tell him so. I explained what I thought was going on, that our patient was dying. “I have to look after my patient’s best interests, and I cannot let you take her out of here. I think that she is dying and she might only have hours left to live. I am worried that she will die in the ambulance on the way to the clinic. I cannot let her leave this bed. We need to keep her comfortable in whatever time remains.” The family looked at each other and the policeman was about to say something, when our patient’s husband nodded to me, and asked, “You’ll look after her here?” I nodded back to him.

What the hell? He is saying that she is dying, and he’s not going to do anything about it? No, we have to do something to save her. The clinic will be able to save her, how can he stop me from saving Mum? He’s saying No, that he won’t let me take her out of here. I’ll teach him a lesson…I’m going to give him a piece of my mind, who the hell does he think he is? It’s my Mum that he’s talking about, he doesn’t even know her. He’s only seen her for a few minutes yesterday, and only for a few seconds today. What the hell? I really need to save Mum, the others don’t understand how important it is. I don’t want to lose her. Wait, my father-in-law has spoken, he usually let’s me do all the talking when it comes to Mum’s health stuff. What, he wants her to stay. No way man, we’re not in the Islands any more. The clinic can save her.

I made some adjustments to her medications to try to ease my patient’s distress. The changes wouldn’t have kicked in by the time that she died, three hours later. I went back to see her to confirm and certify her death. I couldn’t find any pulses, there was no heartbeat or breath sounds over one minute of listening with my stethoscope. I checked her eyes for response to light, and there was none. “I’m very sorry for your loss,” I said to her husband, daughters and son-in-law, before leaving the room. The policeman came out and asked to speak to me. We went around the corner to the hallway.

He said, “Hey man, thanks for what you did before, keeping her here and looking after her. She would’ve died in the ambulance on the way to the clinic, and it would’ve been my fault.”

“It’s okay man, I understand, you were trying to do your best for her. I had to look after my patient, and I had to do my best for her too.”

“Thanks man.”

“You’re welcome, you take care, and look after your family.”

“Will do.”

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