100 years ago, when I was still a trainee registrar, I asked myself, “what were we going to do?” I was about to admit the kind of patient that hospital doctors would be eager to transfer to the local hospice. I’d done exactly that in my previous hospital role, but I was then working in the local hospice and would have to deal with the situation myself.
She’d been nauseated for two weeks in hospital. They had tried everything and nothing had worked. The last weeks had been rough for her, and even in that short amount of time she had lost weight. Her appetite was suppressed to nothingness, as she felt too sick to eat anything. The mere sight of food put her off completely.
After I finished the admission I felt miserable myself, some of her misery had rubbed off on me. Was this transference, or counter-transference? Something about the situation that she was in made me feel similar to what she was going through herself. What to do? One option was to stop all treatments and start all over again. That’s what I did.
The next day I found myself leaving the miserable lady until the end of the ward round. I did not want to catch her misery again in the fear that I would spread it throughout our inpatient unit. I was trying to avoid her as yesterday’s experience had made me feel worse for wear. She had made my heart sink and so I put her off for as long as I could. Things hadn’t really changed much, and I had another dose of misery before lunch time.
By day three I felt bad for being unsupportive of the patient and I promised to myself that I would try harder to connect with her and decided to see her earlier in the ward round. It wasn’t her fault that she was so miserable, it was the illness making her so, and we hadn’t been able to control her symptoms. Walking into her room I braced myself for the tidal wave of negativity. I held onto the door jamb as I entered her room, expecting to be sucked into the black hole of her misery.
I walked in and did a double take as I thought I had walked into the wrong room, because in the bed that my patient had occupied previously, was someone who I had mistaken for someone else. She was smiling, friendly and talkative. I recognised the shape of her eyes, but not the expression in them. She was happily eating breakfast, the furrowed brow had relaxed, all tension in her face had resolved.
She talked about the two loves of her life. Her husband the father of her children had died 20 years ago. Her second husband had always made her laugh. He had died two years ago, and she still missed him. With a cheeky grin she told me that she had killed both of them with kindness.
Now that she was comfortable, it was like meeting a completely different person, she had been transformed. Gone were the frowns and worry lines of the older looking woman who had been miserable with nausea. Lifting the clouds of her uncontrolled symptoms had allowed her real personality to emerge.
Her nausea remained controlled and she was able to spend quality time with her children and their children. Her favourite grandson came to spend time with her as he was just about to leave for the United Kingdom in order to further his university education. She had always been proud of him, and he would always have a special place in her heart.
She had a good week before her condition deteriorated once again. During that week she had good times with her family and friends. Her condition deteriorated and she became less active, and less able to be herself again. Five days later she died, but at least she had some quality time with her loved ones prior to her death
In my immaturity I had been too fast in judging her book by its illness-induced cover. Good symptom control allowed the light of the real person to shine through the shadowy murk of uncontrolled symptoms.