Palace of Care – Palliative Plumbing

Photo by Paolo Chiabrando on Unsplash

Our patient was dying of end-stage cancer, it had spread throughout his body causing significant pain. He had been having trouble passing urine, over the last two days. This had worsened and our ultrasound bladder scan showed urinary retention with a collection of 1.5L. One of the more painful conditions that people can have. The bladder’s walls are elastic but are not meant to stretch that far. Many nerve endings were firing off pain signals, our patient writhed in his bed. His wife and daughter were distressed seeing their lovely man in such discomfort.

The doctor on call was called in at 1 am after the nurse had tried twice to catheterise our patient without success. The urinary catheter could not pass through a blockage despite the nurse trying all the usual tricks. The doctor attempted catheterisation three times before calling me in. I arrived just after 2 am and decided that I would have to perform a more invasive procedure. The patient was too distressed, he was too unwell to be transferred to the hospital. I would have to drain his bladder using a needle, something I had never done before in my 20 years of medical practice.

I gathered my equipment and then went in with the nurse to see the patient. Through his grimaces, he looked glad to see me. I calmly talked to him as I cleaned the skin over his bladder. I injected local anaesthetic and then inserted the needle into his bladder. “Thar she blows!” It wasn’t a white whale, I had struck liquid gold. There was instant relief of pressure – “Ahhhh,” said our patient as his face relaxed. The urine didn’t drain freely through the needle and we had to use a syringe to suck the urine out. Over the next hour, we removed 1.5L of urine. The patient was exhausted and fell asleep once his bladder had started to drain relieving his pain.

The patient’s wife and daughter had also fallen asleep. They stirred awake when we were tidying up after the procedure. They said they had fallen asleep listening to my voice. I told them I had almost fallen asleep listening to myself. It was after 3 am when I left the hospice. During my early morning drive home, I designed a sleep app that would feature the voice of our hospice’s hardest-working plumber.

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