Tag Archives: deterioration

Palace of Care – Too Much

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Photo by John Fornander on Unsplash

Our patient who had been more comfortable after we had changed his medications was not as well today. I had heard he had fallen over the weekend. Falls are usually bad news for our patients. The risk of falls increases as people become weaker and more tired. The body is unable to maintain all kinds of balance, not only physical but emotional, spiritual and social. Everything can start to fall apart.

I couldn’t understand what he was saying today. It wasn’t a language issue. He was dozing off as I spoke to him. His replies were slow and they did not make sense. He had some twitching in his arm and leg muscles, suggestive of his analgesia being too high. At times his arms would jerk upwards without any warning. He looked otherwise comfortable.

I wanted to control his pain as quickly as possible thus we increased his doses aggressively. The aim was to control his symptoms earlier, so we could send him home quickly. I had to bring his medication doses down. I hoped this deterioration would be reversible.

I would have to see what happened over the next days..

Palace of Care – Nerves on Fire

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As if he didn’t have enough problems already two days ago his arm came out in an itchy rash. This made his already poor sleep worse. The itch was still present but was accompanied by severe burning pains. His skin had become too tender to touch. He didn’t dare rub creams onto the affected areas as even gentle touch resulted in worsened pain. He had taken extra pain relief at home but it hadn’t relieved his abdominal or arm pains.

He was admitted into our inpatient unit and medication changes were made. By the next morning, he felt his abdominal pain was slightly better, but his arm itch and pains still woke him up from sleep. A spot diagnosis of Shingles was made, and different medications were charted for pain control.

Our patient thanked us for all of our efforts in helping him and his family. Then he burst into tears. He was still holding out for a miracle but thought that his chances were not good. He wanted to stay alive as his children were still young. He wasn’t all that old himself but he looked at least 20 years older than his chronological age. He had lost more than half of his body weight because of cancer. He had no reserves left. He had a poor appetite and his lack of teeth made eating solid foods difficult. The masses in his abdomen continued to grow and caused him much pain.

The following day he was able to walk around the ward with the assistance of a walking frame. It was good to see him smile.

Palace of Care – Struggle

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Photo by Logan Fisher on Unsplash

“You’re really breathless.”

“Yeah. I’m. Trying. To. Calm. Down.”

“Hard to swallow too?”

Nod.

“You’re working hard to breathe. You’re having to shrug your shoulders up.”

“Yeah, Mum’s like that in the morning. She’s better in the afternoon.”

“I’m seeing quite a difference in Mum since I last saw you both a few days ago. I’m worried about her. I think we need to put a hold on the discharge plan. We need to calm things down first.”

“Okay.”

“Are you okay staying with us a bit longer?”

Nod. “I. Love. This. Place.”

“We’ll see how you go, one day at a time. If things become stable then we can talk about going home again. If things get worse, it might be better to stay here.”

Nod.

“No matter what happens we want to get you more comfortable, and let your daughter have a bit more rest.”

“Thanks. Mike.”

“You’re welcome.”

Palace of Care – Roller-Coaster Ride

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Photo by Itai Aarons on Unsplash

He had loved his last job and had done well until the stroke. A bolt of lightning had struck him down and rendered one side of his body paralysed. His mind was still intact and his will was strong which allowed him to recover well over the next months. He needed to walk with walking aids and had severe fatigue but he adjusted to his debilitated life. Speaking and writing were still effective forms of communication. Life was different but the strongest organ in his body still functioned well – his brain worked as well as ever.

He had lost the use of his legs earlier in the year. Nothing out of the ordinary had happened before they stopped working. It was thought to be due to a late side-effect of the life-saving radiotherapy he had received decades ago, which had helped to cure the cancer that almost killed him. He hadn’t been out of bed since then without great difficulty. He could not move his legs but the sensory nerves were intact. He was able to cope with the further disability until the pains started. It was a cruel combination, his legs were unable to move but were able to feel nerve-related pain. By the time I visited him at home the pain had been worsening over the past weeks. His medications which included nerve pain agents were not working. The strong opioids we had advised him to have were not controlling his pain but clouded his brain.

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I think therefore I am? – Homeostasis

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Humans are good at maintaining homeostasis and keeping things in balance. This includes the levels of various biochemicals in our bloodstream, blood pressure, body temperature, and sitting/standing/walking balance. The human body has many different organ systems with various functions and constant adjustments are made to keep us all in good running order.

When you are unwell the homeostasis may not work as well. You end up with fevers and may become dizzy and lose physical balance. Emotional balance can also be upset and uncomfortable feelings may be revealed. When things get really out of balance physical falls can occur. A high blood calcium level can be dangerous. Threatening both quantity of life, and quality of life.

The balancing act of life cannot be continued, the tight rope has become too steep to climb, the distance too far. Despite everyone’s best efforts, nothing can stop the fall. The situation’s gravity reminds us that what goes up must come down. How arrogant are we mere humans to think we could control Nature? State-of-the-art treatments may be offered but there aren’t many guarantees in this life. In the end, we all fall and cannot get up again. We can’t stop the fall, but maybe we can soften the impact of it with the care we provide. Let’s keep on trying.

Palace of Care – Family Reunion

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His sister and nieces pushed him in via wheelchair. His skin was a yellowish grey colour. According to his family it had been a huge change from when he had arrived in town last week. Then he had been well and was able to dance with his nieces. Now he couldn’t walk without assistance as he was too weak and fatigued.

He’d been diagnosed with end-stage cancer only months ago, and arrangements had been made for him to go into residential care. As he deteriorated, his elder sister and her daughters wanted to look after him. They picked him up from his residential care facility and moved him into his elder sister’s house in Auckland.

Over the course of his first week with his family he became more unwell. Nerve related pain from his cancer worsened and led to his hospice admission. His medications were adjusted to make him more comfortable. The family arranged for a reunion. His elder sister came down to see him.

All he wanted to do was sleep. He had no appetite.

He enjoyed the family reunion, it had been years since he and his siblings had been in the same room together.

On his final day he became comatose. His older brothers came to see him in the morning, after travelling two hours by car. They talked about when they had all been young. I explained that he was critically unwell and could die at anytime.

His sisters came back to see him, and within minutes he had taken his final breath.

Rest in peace family man.