Bedside Lessons – 20 – Crossing the Line – Part 1

Photo by Max Böhme on Unsplash

I was working on the liaison psychiatry team in my final year of medical school. I went to meet a patient that had self-referred, which was unusual. Psych liaison provides psychiatric input for patients who also have medical issues that have brought them into hospital. I went with the nurse specialist to see the patient, an Englishman in his mid-thirties.

Work had brought him and his Latin American wife across the world. He was a nature documentary maker and had been based in the lower South Island filming the local wildlife. Just before Christmas he became unwell with a severe nosebleed, which required hospital intervention. Simple blood tests revealed grossly abnormal results. Acute Myelocytic Leukaemia (AM bloody helL) was the shocking diagnosis which destroyed their plans for Christmas and life in general. An urgent admission was arranged to our hospital’s Haematology department, which served the entire region. Harsh chemotherapy needed to be started otherwise our patient would’ve only had days left to live.

A distressing situation that plunged our patient into a period of darkness. He did not feel like his usual self any more, but was still charming and maintained his sense of humour. His overwhelming concern was for his wife. They had been married for four years and he described her as ‘very fond of me.’ He bravely faced his uncertain situation including the possibility that his treatments would not go well, that the AML would lead to his death. He was worried about how his wife would cope with this possible loss. We quickly determined that he had no acute psychiatric need, and that he was having a normal grief reaction. We would follow him up over the next week or so, but thought that we would be able to discharge him from our care soon.

This proved to be the case and the psych liaison team did not need to formally follow him up. I was assigned to informally follow him up and would visit him over the rest of my six week rotation. Short visits were held as he was recovering from his chemotherapy cycles. Everything went well, he tolerated the chemotherapy and it was successfully suppressing his blood cancer. I finished my liaison psychiatry rotation and started my next hospital-based rotation. I would visit when I had the chance to. The visits were no longer on a professional basis, as a boundary line was crossed and we had become friends. I was added to his email list and would receive his almost daily updates. This was back in 1999 when the Internet was relatively young, and blogging was not yet a thing. His emails relayed to his friends and family all over the planet what he was going through on a daily basis. The trials and tribulations of life with cancer, and its treatments.

These email posts provided a fascinating insight into the daily life of a young man trying his best to stay alive. All the physical and emotional ups and downs. The isolation of neutropenia (when his immune system was at its lowest ebb) when he had to stay behind closed doors, with everyone masked up and wearing PPE (Patient Protection Equipment) to protect him from the outside world. The loneliness could not even be broken by food, as special neutropaenic meals were delivered, and nothing from outside could be brought in to broaden the palate.

He was well ahead of his time and his posts were well-written, brutally honest, and entertaining. In modern times he would surely have gone viral, and probably would’ve done well with a You Tube channel. Over the next four months he responded well to treatments and had successfully gone into remission. He would require a bone marrow transplant and the plan was that he would go home to the UK for this next important step.

Prior to his return home he hosted a going away party in which he invited all his local friends that had supported him and his wife during their stay. I was invited and attended this get-together. My friend was in high spirits and eagerly anticipated his flight home, which would be via first class. He excitedly talked about what he would be eating on the plane. “Would you like a massage sir? Yes why not, I’ll have one after my shower, and prior to my seven course dinner.” He was going to make the most of his long journey home. It was nice to see him well, and we all had a lovely time before we wished him all the best for his trip home and the treatments ahead.

The emails continued to flow and he provided regular updates for his group of international supporters. He was so relieved to have made it home and was able to catch up with many of the people that he had been emailing in person. His bone marrow transplant was arranged and the gruelling cycles of chemotherapy began again in preparation. He continued to send us emails, during this period, as he approached the big day of the transplant. He was exhausted, could hardly eat anything because of nausea, but overall was in a positive state of mind. He warned us that he might not be able to post any updates over the next days as he really needed to rest up.

There were no updates over the next two weeks. I checked my inbox and found a new email had arrived and I eagerly opened it. It was written in a different style and it took me a few seconds before I realised that author was his wife.

“I have sad news to share. The bone marrow transplant had initially gone well, but following this he developed a severe infection, despite aggressive treatments he was not able to recover and died last week. Thank you for all the support that you have provided us.”

I had to read the email three times before it sank in. I hoped that his wife would be supported by his family in the UK, and sent my deepest condolences in my reply. For the first time in my life a friend had died.

The risk of entering into relationships with people is that at some stage you might have to say goodbye to them. When you cross the line of professional boundaries there is a risk of getting hurt. Was it worth it?


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