Palace of Care – Mixed vs. Clear Messages

Photo by Darius Bashar on Unsplash

I was worried he would die before the day was over. When I first met him he was hunched over in bed, his jaw clenched tight, his upper teeth were grinding into his lower teeth. His breaths short ragged grasps. In extremis, with tears dripping onto the tousled folds of the bedclothes. His family’s faces replaced by masks of terror. The tension in the room was thick, the silence as we all held our breath as the patient grunted in agony. His wet eyes begged me to help him.

“Your pain relief isn’t strong enough. I’ll make some changes to get you more comfortable. I’m very worried about you. You might get much worse. Let’s work on your pain first.”

I headed off to prescribe the higher doses and to ask the nurses to prepare them for our patient. He was another classic haematology patient. His discharge summary had recounted the breaking of bad news the day before. There were no further treatments available to stop the blood cancer. The team recommended no further transfusions as they would not be helpful. The next morning the standard blood tests had been repeated, and no surprise, all the blood counts were low, including a platelet count below 10. This meant the patient was at risk of spontaneous bleeds. The medical teams reaction, was to prescribe a platelet transfusion. The hospice doctors who read the notes were confused by this action. How did the patient and his family feel? The day before they had been told no further transfusions, and then less than 24 hours later, he was being transfused.

Over the weekend we managed to control his pain and he spent some time with his family. The highlight was a visit from his children before they went away for a long weekend trip. I was surprised that his weekend went well. He spent more time with his parents and siblings and other family. He asked our staff what was going on, as he was unsure what the treatment plan was.

I caught up with him after the weekend, and I brought up his wish to know what was going on.

“My team said you had some questions to ask?”

“Yeah, I’m not sure what’s going on, the Haematology team gave me really bad news just a few days ago. They said no more treatments, no more transfusions. Then the next day they gave me more platelets. Since coming to hospice I feel better. Am I going to get better?”

“You were really unwell when you arrived before the weekend. I was really worried about you. I thought you might not make it through the weekend, but you have. With the illness you have, you probably will get worse, not better. I don’t want you to have any surprises. I’m still worried about you, that your time is still short. I’m sorry man.”

Through crying sobs he said, “Okay Doc. Thanks for being honest.”

“I hope that I’ve got it all wrong. Your kids are due back this afternoon right?”

“Yeah, from their trip away, they’re going to stop by before heading back home.”

“When you see them later, give them lots of hugs. Okay?”

“I will.”

In the afternoon I spotted the children’s mother in the corridor and I took her aside for a quick chat.

“He’s really unwell, and I’m worried he might not have much time left. I don’t want their to be any surprises, but he might only have days left to live at the most, but his time might be much shorter. He’s just too unwell.”

“That’s what they had said at the hospital, a few days ago. I’d better join the kids in his room.”

He died two hours later in the presence of his children, his parents and his siblings.

1 thought on “Palace of Care – Mixed vs. Clear Messages

  1. How wonderful you were able to give his loved ones clear feedback. When his time came he was able to be surrounded by all his loved ones. That’s not just being a good Dr but a kind compassionate human being🙏


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