I had been on call for the hospital when the little old Chinese man had first presented to hospital. They had discussed his situation, a large stomach cancer which kept on bleeding, and that his Hb level was only 41. My opinion was that he was dying from recurrent bleeding that could not be stopped. My advice was that the hospital team have a discussion with the patient and family about the fact that his bleeding would be a life-ending event, that further transfusions would not be able to keep up with the amount of bleeding that was happening.
Some of my advice was taken, but not everything. It was as if the hospital doctors had spoken to me in a second language, one that didn’t lead to mutual understanding. They did end up having a conversation with the patient and his daughter about no further transfusions, but this was after transfusing one more unit of blood. The hospital doctor could speak Mandarin with the patient and family. He told them that the last unit of blood was an, “especially strong unit of blood, and would give him an extra boost.” Following this final transfusion the patient was sent across to the hospice.
In the first days of admission the patient was stable, he didn’t have pain, he didn’t have bleeding. His appetite returned and he ate small amounts of food that his family brought in. He remained stable over the course of a week and we started to consider discharge plans. His wife would come to visit him towing a small suitcase with small wheels behind her. They had been together for over sixty years, and had been university classmates.
We were preparing to discharge him home and then his nausea returned, followed by vomiting, and then he vomited blood. He continued to deny pain but looked sore, especially as the vomits continued. We changed his medications to control his nausea and lessen his vomiting. He became more sleepy, less clear in his thinking, he was dying. We made him comfortable and looked after his family including his elderly wife.
His look-alike son was a doctor and worked in Australia, he was trying to make his way back to New Zealand but at the time both countries were in the middle of Omicron coronavirus surges. His doctor son ended up catching Covid himself and thus was not able to travel back to see his father. His only grandson who was studying further abroad also was unable to see him. They both made video phone calls and said there goodbyes from many thousands of miles away.
The little old Chinese man died peacefully in his sleep, in the presence of his wife and daughter. They would miss him dearly but were glad that he did not have to suffer any more.