We’d been trying to admit her for weeks, but she had not been keen. We had her on the admission list for a whole week but she said that she had to sort out something for her children and couldn’t come in. I thought that it might be an excuse, as a lot of people are still scared of hospice. Most people have not had anything to do with hospice but they may have some pre-conceived idea of what hospice might be. Often this is inaccurate, and can generate a lot of fear.
It took some convincing by the hospital palliative care team before she would finally agree to coming in to hospice. She was still nervous but her favourite cousin had promised that she would go in with her. They had grown up together and they were best friends, but this had been taken to a completely different level once the cancer diagnosis had been made five months ago. Something was wrong as she had lost a lot of weight, without trying to. Life had been busy for many years with her five children, and her partner could not always be counted upon. It was her cousin who had attended all the Oncology appointments with her. Her cousin had been there for all the chemotherapy sessions. Having her cousin accompany her to hospice was comforting and if there was anything scary, she would be there for her.
She was surprised at how friendly the staff were, the room was nice. Not noisy, and you could open the windows and the doors. There was a garden outside and you could see it from the room’s balcony. She didn’t have much appetite but the food they brought her looked and smelled really good, so she ate as much as she could. The next day she said to the doctor that she was glad that she had come, sure she had actually been putting off coming in for ages, but now that she was here, she felt safe. They seemed to know what they were doing in hospice, and her pain responded to the change in medications. They were worried about her leg not working as well and had restarted her steroids to see if it would help. The walker that they provided helped her to walk around, as she had almost fallen over a couple of times at home.
The other doctors came to see her and they were nice. They actually sat down and listened while she talked to them. They didn’t seem to be in as much of a hurry as the doctors in the hospital had been, and she had met many different doctors over the past five months. Most of their names she couldn’t remember as they had barely introduced themselves to her or the family. They did lots of talking and didn’t have much time to listen.
The hospice team wanted to know what was going on and what was important to her. There was only one thing on her mind, as usual, her children. She had already sorted out four of them, but it was the eldest boy that she had to concentrate her efforts on. The government had taken him away and sent him to another city four hours drive away. She wanted her mother to become his legal guardian.
She knew that her cancer was bad, the other doctors hadn’t told her in a gentle fashion. It was like they had thrown the information at her, and while she was picking up the pieces off the floor, they had run off, before she could even look up. They had told her the worst news possible but did not wait around to see if she had understood it. It had taken a while for it to sink in. They were telling her that her cancer was all over her body, and that she only had a short time left to live. This made it even more important for her to make sure that her boy would be looked after.
The hospice people understood this and offered to help, the whole team, the nurses, the social worker, even the doctors all wanted to help. They knew that she needed to travel South in order to have an important meeting with the government care providers. It was important that she go down there, and she wanted to be at her best. Medications were changed and they told her to take the pain relief when the pain was 3/10, and not to wait until 7/10 as it would take more doses to control her pain, and she might have more side effects. She was worried about the trip and had arranged for accommodation close to the hospital, just in case she became really sick. The day before the planned trip her left arm started to go numb and felt weak. The doctors said that they would double the steroid dose to see if it would help.
There was some mix-up with the flights and with the motel she had booked, but apart from that the trip had gone well. It had been so good to see her boy again. If all went according to plan she would see her son again in the following week, when the next meeting would occur. Where they would finalise things for her boy. She was so glad to come back to the hospice, and had made it back without needing to go to hospital. The next morning she had trouble swallowing pills, and the doctor said that he thought that her voice sounded different. By the afternoon she was having trouble breathing and needed to be put on oxygen.
The doctors checked in with her and told her that they were worried that if she continued to deteriorate at this pace that she might only have days to short weeks left to live. She was determined to hold on until the end o f the week, when her boy would be coming up for the meeting, to see if he could be looked after by her mother, his grandmother. She would hold on for her boy, after he was sorted she would be okay to go, she had sorted out everything else.
Looking in the mirror she thought she looked thirty years older than her actual age. She thought that her mother looked younger than she did herself. She felt so tired, but she had to go through with it. Just another two days…the pains were getting worse in her leg, the breathing was harder, but she would hold on for her son.
“Hi son, this is the doctor I’ve been telling you about. James we’re going to the family meeting.”
My prognostication had been spot on with this case. I had predicted that she would crash after coming back from her trip South. Then I had thought she would let go once she had sorted things our for her son on the Friday meeting. She died two days after sorting out the guardianship of her son.