Palace of Care – Opportunity Cost

Photo by James Bold on Unsplash

In my misspent youth I studied Economics during high school and into my first year of university. Opportunity Cost is the cost that you incur when you make a choice. Because you have chosen A, you miss out on B, or vice versa.

The New Zealand school ball is an important event in a young lady’s life it is a coming of age event. The proud parents will see their daughter off for her first school ball. This can be a big deal especially for the father. The ball was scheduled to take place in a week’s time. Our patient had his blood tests done as he was looking pale, was fatigued, and slightly short of breath. Symptoms and signs of anaemia, low red blood cells in his body. His counts were dangerously low, and if we didn’t do something about it, he was at risk of dying before the day of the school ball. He really wanted to be there for his daughter, it was his only chance at providing the whole family with this milestone memory. He agreed to our plan of transfusion, a top up to give him the best chance of being there for his daughter.

In the days after the transfusion he was able to walk further without losing his breath, his thinking had sharpened, almost as good as normal. Looking in the mirror his skin tone no longer reminded him of the vampires from the Twilight series that his daughter and her friends all loved. He would make it to the ball, and the whole family was excited about it again. They could proceed with the pre-ball party at home, he would go home for a few hours of leave. A nice dose of normal family life to break up his cancer story if only for a brief respite.

After the weekend the pre-ball photos were shared with us, and they were lovely. The only clue to his illness was that Dad was thin, and looked tired in the photos, otherwise a beautiful New Zealand family celebrating a special night together at home. A snapshot frozen in time, if only the image would stay like that, no changes occurring, no one deteriorating, no brightness fading from their eyes. But that is still life, real life is about the changes that occur with each passing minute, hour, day, week.

The nausea started five days after the ball, it came on just after dinner, they thought it might be the dessert that the hospice had served that night. He didn’t usually eat so much whipped cream, but he enjoyed the sweet dessert, and the cream offset the sugary taste. Anti-nausea medication was taken, with good effect. The next morning he had nausea after breakfast as well. The doctor was informed and prescribed regular anti-emetics which worked for the next three days, before the vomiting started.

This would happen with or without nausea, but always an hour after eating or drinking. He would feel a buildup of pressure, like he needed to burp loudly. It would furrow his brow and his mouth grimaced while he gritted his teeth together. He had thought he was burping and he was surprised that it was a vomit instead, all over his bedsheets. He had always hated vomiting, that’s why he had not been a heavy drinker. He had been the sober walker at University, walking his too drunk friends home. They would decorate parts of the landscape that they traversed on their way home. The contents of the junk food dinner mixed in with bar snacks that they had eaten on the night. As a child following an episode of severe food poisoning, he had vomited so much that he vomited up blood.

The doctors tried various combinations of medications, but none of them worked particularly well. The vomiting would wake him from sleep, whatever he ate or drank would come back up again. They said it was the cancer, that it had caused a bowel obstruction, a blockage. Anything he swallowed would probably come back up again. They had talked about a nasogastric tube, and he was keen on trying it but he could not tolerate them trying to pass it through his nose and down into the throat. He tried to swallow it but it triggered gagging and vomiting. No, please stop he had to beg them to stop.

The vomiting would not stop. Even when he stopped eating and drinking it continued. He thought he had nothing left to vomit up, but then his body would surprise him. First it was food contents. Then it was green-stained liquid. Then brown stained liquid, and eventually he was vomiting up shit. This went on for two exhausting weeks. The taste he could wash out, but the smell was of rot, reminded him of his compost heap at home. His garden had been a place of solace for him, the garden that he knew he would never see again. Sheer and utter misery, he told the doctors that if he had known that he would end up like this, that he would have refused the blood transfusion. That it hadn’t been worth the torture of the past weeks of vomiting.

He believed that the opportunity cost had been too great for him to handle, and if he had his time over he would have chosen to die of anaemia. If only he had known.

If only we had been able to predict the future we would’ve warned him, but that was beyond our abilities and remains so even to this current day.

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