I have only ever played the computerised version of Dungeons and Dragons, the fantasy role-playing game, and the version I played was more of a battle simulator. You went on quests with your band of characters, exploring different places, constantly running into trouble. Fights would involve cold hard steel, and mysterious magical spells. Some spells had obvious intended effects, e.g. Stinking Cloud (now that’s magic that I have understood since I discovered baked beans as a kid,) Hold person. A favourite spell of mine was Charm Person, casting this spell on an enemy could instantly change them into a team-mate.

As I started practising medicine as a junior doctor I often fancifully wished that some of the Dungeons and Dragons spells would work in real life. Over the past 22 years I have searched for Heal Person, Cure wounds, Revivify and have been caught short. If only life was that easy. I often wish that I had a magic wand that could change my patients condition for the better, I really do. Or magic pills or potions that would lead to a cure. Sometimes the best magic I can offer is to soothe suffering, provide comfort, offer support. On occasions I have had to use Charm Person, and sometimes even Charm Monster.

Illness can bring out the worst in people, but some people might not have been all that easy to get along with even when they were physically well. There are no difficult people or patients but at times communicating with humans can prove to be a difficult endeavour.

I once met a lady who had developed the habit of firing all of the clinical teams that had been involved in her care. She had dismissed, sometimes rudely, the teams that had been trying to look after her. She hadn’t always been like this, she had only become sick in recent months and had hated every second of it. She was diagnosed with metastatic cancer, and it caused her to have severe nausea and vomiting. The clinical teams had offered her various medications which they thought would help her symptoms, but she had declined everything. Arrangements were made for her to be transferred to hospice.

She arrived and it was handed over that looking after her had not been easy, and that she had rejected all the care offered. She was being consistent with how she had been for her whole life, wanting to live as naturally as possible. She had avoided going to see her family doctor for many years. She preferred taking natural products and did not want to take Western medications at all. What would we do for her? We need our patients to work with us, otherwise it is really hard to provide good care for them. We were confident that we could help her if she would only let us. The first afternoon, we talked about possibilities and asked her to consider some treatment options. She politely declined.

As she grew acquainted with our team over the next two days, she felt that we had listened to her, and she allowed us to talk her into trying medications. They actually worked, her nausea was controlled, her vomiting resolved. She was able to eat and drink again. Her condition had improved rapidly until she was comfortable and stabilised to the point of us talking to her about going home. She did not like the idea at all, and told us that she would like to stay in hospice for the rest of her life. She became demanding, and one night demanded to be admitted to hospital for drainage of collection of abdominal fluid. Her husband who usually would do whatever she said, stood up to her, as he did not think it was in her best interests.

I prepared my best Charm Person spell that morning and went in to see her. I mentally prepared for a challenging battle of wills. How would it go?

Initially she refused to make eye contact. She was unhappy that her husband had stopped her from going into hospital. I explained that given the small amount of fluid present, that they would not have been able to offer much in the way of treatment. That it would’ve led to a stressful and sleepless night for no benefit at all. That her husband had done the right thing in not allowing her to go in to hospital. The frosty start to the conversation did not help, and the ice-breaking moment came when I said to her, If it was my mother, I would not want her to go into hospital, wait-a-minute you’re not old enough to be my mother, you’re more like my sister. That brought out a golden-toothed smile and allowed me to find out who she was.

She told me proudly of having worked in retail for 25 years, of being one of the top salespeople. That she had enjoyed her job a lot, and that she had always enjoyed working with people. Interacting with them in a fun fashion had led to loyal customers, who would always come back for more of her friendly service.

Her husband confirmed that she had always been a decisive lady. She had firmly made up her mind that she wanted to live out her days in hospice. She was displeased that we thought she was better and wanted her to consider going home, as we thought she was not imminently dying. She started being rude to staff, and questioning everything they did. She refused medications that were offered to her, including the ones that had worked. She then purposefully took three times the recommended amount of liquid meal supplements. This made her nauseated and restarted her vomiting. This was hard for staff to deal with as we knew that our medications had helped her, but she was refusing our help.

I went to talk to her as we had developed a friendly banter with each other the other day. I was upfront with her and she would not make eye contact, but did listen. I said, *I know what you are doing, and you don’t need to do it. I know that you are feeling unwell, but you don’t need to make yourself sick to prove it, I know you are unwell. So please only eat and drink if you feel like it, don’t make yourself vomit. No-one is going to send you home without warning you first, and before making sure that everything is ready. You are going nowhere in the weekend, and you are staying right here. We are going to review your situation after the weekend. Let’s see what happens, one day at a time. Is that okay with you?

Yes.

She calmed down, and was more pleasant to the staff. She stopped purposefully making herself vomit.

I left her over the weekend, expecting to review her on Monday.

I was as surprised as everyone else when she died suddenly on Sunday. I guess she had known something that the rest of us didn’t know.

Through sheer bloody-mindedness she had gotten her way, to stay in the hospice for end of life care.

A strong-willed lady had exerted her will and had made her choice, no matter what anyone said. No ifs ands or buts. My way or the highway. The lady has spoken. Drop the Mic’.

More power to her, I thought to myself when I received the news.

Good on you, I thought as I smiled at the memory of her golden smile.

Who was the person actually charmed?